left side weakness Flashcards
when pt is weak on one side
define: numbness, tingling, unable to hold/lift things
-where is the weakness; i.e. fingertips-whole arm
“christmas lights” CNS or peripheral, impinging nerve by sleeping with neck “kinked”- nerve palsy
5 most common causes of left-sided weakness
CVA-stroke TIA Intracranial bleed Intracranial mass Migraines (hemiplegic-presents like a stroke, N/V)
other causes
radiculopathy i.e. pressure on brachial plexus while drunk
dissection (subclavian, another–>hematoma)
C-spine arthritis/herniation (compresses nerve–>injury) -trauma
AVM (AV malformation)-“jumbled BVs”
Todd’s paralysis (hemiplegia after seizure)-usually self-resolving
MS
Psychiatric (anxiety/panic attack)
drugs-vasospasm of BVs
Life threatening conditions with left sided weakness
Acute CVA Intracranial bleed Aneurysm Meningitis-intracranial abscess Intracranial mass
(stroke, blood, vessel bulge, infection, tumor)
stroke mnemonic
timing
prevelance
FAST
face, arm, speech, time
clock starts at onset of symptoms
1/6 ppl ww will have stroke
CVA: thrombotic stroke
thrombus in BV-occlusion to part of brain
-destroy clot
CVA: embolic stroke
dislodged embolus from a fib–>to small BV in brain
*from somewhere else
“fix” heart
ventral septal defect–>to brain
CVA: hemorrhagic stroke
bleeding is cause
subarachnoid or intraparenchymal bleed
risk factors for CVA
DM HTN smoking afib hyperlipidemia obesity fam risk factors CAD previous strokes OCPs *similar to MI risk factors*
TIA
- resolved symptoms
- high risk for CVA development-may have thrombus/emobolus present–>admit
- need to find risk factors and tx
- opportunity to prevent CVA
CVA imaging: CT scan
initial (inflammation-deviation)
6 mos: goes back, swelling goes down
helps determine: is there a mass or bleed?
-can be done v. quickly, 10 min
CVA imaging: MRI
MRA
can see more detail of injury
Magnetic resonance angiography, see BVs-can see occlusions-thrombus, where no perfusion
*both take longer than CT and $$
not all pts require
intracranial mass
see inflammation, pushes opposite ventricle-deviation
intracranial bleed
INR 3.6 (high, on blood thinner) HTN–>aneurysm–>may have spontaneous bleed
hemiplegic migraine
unilat. musc. wkness, and/or paralysis
familial hemiplegic migraine- mult. fam members
vs. sporadic: gene mutations
*stroke (esp. ischemic) pts don’t typ. present with ha unless “popped” BV-aneurysm
IC mass may have ha
MS
demyelination of brain/SC
may present as stroke symptoms-photophobia, optic neuritis, painful EOM, weakness, pain on one side, other neural exam abnormalities
usually in younger pts-may have no risk factors
dx: MRI- shows plaques, brain atrophy-enlarged ventricles, spots
tx: high dose steroids (i.e. 1000 mg)
AVM
jumbled up BVs compress brain tissue–>symptoms
radiculopathy
C-spine arthritis, disc herniation
observe dermatome pattern
MRI
PT, steroids, surgery
carpal tunnel syndrome
transverse carpal ligament
numbness, tingling in arm, moves proximally
what dermatome pattern?
peripheral prob if specific fingers, NOT stroke
dx: NIH stroke scale
LOC
best gaze visual fields facial palsy motor limb ataxia sensation best language dysarthria extinction and inattention *see scale *tPA advised?
dx modalities
Imaging
CT scan
MRI/MRA
Labs
EEG-seizure, may have stroke-like symptoms
Invasive techniques
when change in mental status,
call stroke alert
complications of stroke
chronic pain, disability, death
left side weakness questions
stroke?
ischemic(meds) or hemorrhagic (OR)?
onset of symps?
candidate for tPA? (3 hr)- TOU-time onset unknown, can’t use tPA
CIs for tPA? inc. bleeding risk
need consent? pt w. in time frame (3 hr)?
what are possible legal risks? -lawsuits, more lawsuits for NOT giving tPA
stroke centers
acute stroke ready center: rural, basic, may use tele medicine–>neurologist
primary stroke center: standard, stroke unit, tPA
comprehensive stroke center: academic
stroke certification is a big deal for hospitals
high volume, insured, high risk pts–>$$$ for hospitals
tPA
3-4.5 hrs
*may extend from 3 hrs
Hussain stops at 3, may be sued if given after 3 hrs
more invasive clot tx: intra-arterial
take catheter to thrombus and give small dose tPA
- dec. risk factor for bleeding
- up to 6 hr time window
more invasive tx: if see clot on MRA
clot retraction- take out in situ with suction
-v. specialized centers
CIs to tPA
bleeding anywhere trauma, chest compressions anemia blood thinners HTN platelets low recent sx hx of IC hemorrhage
tx
Depends on the etiology Antiplatelet agents Thrombolytics Invasive techniques Pain control Treating the underlying medical conditions
ischemic stroke
ASA/plavix (anti-platelet)
tPA
invasive: clot retraction
supportive: BP, glucose control
