Management of Stroke in the ED Flashcards
1
Q
characterized by the sudden onset of focal neurological deficits due to a vascular cause
- unable to distinguish between a hemorrhagic and ischemic stroke until imaging is obtained
- Pts suspected should be triaged with the same priority as a leveled trauma or STEMI
A
Stroke
2
Q
- thrombotic due to atherosclerosis
- embolic- most frequently due to cardiac source
- lucunar (small vessels) - typically cause pure motor or pure sensory symptoms because the vessels affected are so small
A
ischemic stroke
3
Q
- sudden onset of neurological or retinal symptoms (e.g, hemiparesis, hemi-sensory loss, aphasia, neglect, amaurosis fugax, hemianopsia, or ataxia
- lasts < 24hours before resolving completely (often < 15min)
- not associated with any acute infarction on neuroimaging
A
TIA
4
Q
Risk factors for stroke?
A
- older age
- HTN
- hyperlipidemia
- smoking
- DM
- hypercoagulability
- cardiac arrhythmias
5
Q
presenting symptoms in patients with acute ischemic stroke
A
- weakness
- numbness
- aphasia
- dysarthria
- gaze deviation
- facial droop
- ataxia, gait instability, vertigo, vision changes, nausea and vomitng
6
Q
- aphasia (assumes dominant left hemisphere)
- left gaze deviation
- right-sided arm > leg weakness
- right facial droop
- right sided sensory loss
- right visual field deficit
A
Left MCA
7
Q
- Left hemi-neglect
- speech typically intact (rarely aphasia in left handed patients)
- right gaze deviation
- left sided arm > leg weakness
- left facial droop
- left sided sensory loss
- left visual field deficit
A
Right MCA
8
Q
- crossed signs of CN deficits (gaze palsies, facial droop) mixed with contralateral weakness
- alternating hemiparesis or posturing
- locked-in syndrome
- acutely obtunded or comatose-particularly with pinpoint pupils
- myoclonic jerks stimulating status epilepticus
* CTA is a gold standard diagnosis
A
Basilar/ Vertebral
9
Q
- contralateral leg weakness and sensory loss
- variable loss of executive function
A
ACA
10
Q
- contralateral visual field deficit (complete or partial)
- occasional sensory deficits
- occasional contralateral leg > arm weakness
- occasional memory loss
A
PCA
11
Q
BP management in stroke patient
A
- if no tPA, permissive hypertension up to 220/120
- prior to tPA administration–> BP < 185/110
- post tPA–> BP < 180/ 105
12
Q
unilateral droop of entire face
- no forehead raise
- bell’s palsy
- facial nerve injury
- ramsay hunt syndrome
A
Peripheral lesion
13
Q
unilateral droop w/intact forehead raise
- stroke
- tumor
- hemorrhage
A
central lesion
14
Q
absolute contraindications to TPA
A
- Significant head trauma, ischemic stroke, intracranial or instraspinal surgery prior to 3 months
- prior history of ICH or intracranial neoplasm
- GI malignancy or bleeding within 21 days
- currently taking DOACs or warfarin
15
Q
relative contraindications to tPA
A
- pregnancy
- MI in previous 3 months
- major trauma in previous 14 days
- unruptured or unsecured intracranial aneurysm, AVM,
- arterial puncture or LP in previous 7 days
16
Q
what is required before IV tpa administration?
A
check fingerstick glucose
BG< 50 or > 400
17
Q
Post IV tPA management
A
- no antiplatelet agents, anticoagulation, or DVT chemoprophylaxis for 24 hours after TPA bolus
- check BP and neuro exam together on the following schedule ( Q 15 min x1 hour; Q 30ming x 6 hours; then hourly for first 24 hours)
- BP goals (SBP < 180 and DBP < 105)
- if acute neurologic change, severe headache or vomiting, IV tpa should be stopped and stat ct started
- minimize invasive procedures
18
Q
- one limb in a nerve distrubution
- face only
A
mononeuropathy
19
Q
one limb restricted to a dermatome and myotome
A
radiculopathy
20
Q
one limb but more extensive (brachial plexus)
A
plexopathy
