Module 3: CVA

Question 0

Number 1 Risk factors for CVA? Others?

Answer 0

Hypertension

#Diabetes
#Smoking
#Hyperlipidemia

Question 1

TIA – how to evaluate for admission?

Answer 1

ABCD 2
Age
Blood pressure
Clinical features
Diabetes
Duration

Score over 3 should be admitted

Question 2

Atrial fibrillation accounts for what percentage of strokes?

Answer 2

20-30%

Question 3

Basic etiologies of stroke?

Answer 3

Vessels (large vessels, medium vessels, small vessel)

versus

cardioembolic

Question 4

Large vessels? Etiologies of large vessel CVA?

Answer 4

Carotid, ICA

#Arteriosclerosis – atheroembolic stroke
#Dissection

Question 5

Medium vessels? Etiologies of medium vessel CVA?

Answer 5

In situ thrombosis

MCA, ACA, PCA, basilar

Question 6

Small vessels? Etiologies of small vessel CVA?

Answer 6

Lenticulostriate, thalamostriate

Lipohyalinosis and Lacunar strokes

Question 7

Causes of cardioembolic stroke?

Answer 7

#Atrial fibrillation
#Ventricular clots (cardiomyopathy)
#atrial myxoma
#PFO
#Endocarditis

Question 8

How common is a PFO? Benefit of PFO closure?

Answer 8

25% of patients

No benefits unless hypercoagulable state

Question 9

Hematological etiologies of stroke?

Answer 9

#Hyperviscosity (polycythemia vera, essential thrombocytopenia, essential leukocytosis)
#APLS
#Waldenström's
#Sickle cell
#Malaria

Question 10

Patient presents with stroke symptoms – work up?

Answer 10

Cardiovascular
#MRI/MRA + carotid
#TTE
#EKG and 24-hour telemetry

Labs
#Lipids
#Fingerstick
#Coags if in liver failure
#Homocystine
#ESR

Question 11

CT scans show stroke when?

Answer 11

6+ hours after onset

Question 12

ACA stroke – mainly affects?

Answer 12

Contralateral leg

Question 13

R superior MCA stroke versus L superior MCA stroke?

Answer 13

Left hemiparesis versus

right hemiparesis and Broca’s aphasia

Question 14

R inferior MCA stroke versus L inferior MCA stroke?

Answer 14

Left hemineglect versus

Wernicke’s aphasia

Question 15

L PCA stroke versus R PCA stroke?

Answer 15

Right Homonymous hemianopia versus left Homonymous hemianopia

Question 16

Patient with suspected stroke – do not give these medications? Exception?

Answer 16

Blood-pressure medications (unless blood pressure is over 185 and the patient is going to receive TPA)

Question 17

When to give TPA? (And route?) if over a lot of time?

TPA is shown to have a beneficial effect when?

Answer 17

#if under 4.5 hours – IV
#If 4.5-6 hours in the medium vessels – intra-arterial TPA
#If over six hours consider IR

After 90 days

No effect until 90 days later

Question 18

Post stroke drugs?

Answer 18

#Antiplatelet agents (aspirin or Plavix or aspirin + dihyrdropyramidamole)
#statin
#If diabetic, good glycemic control
#If hypertensive ACE-I inhibitor and diuretics
#If indicated, carotid stent/endarterectomy

Question 19

In hypertensive patients post stroke, do not use? Drug that is neuroprotective?

Answer 19

Beta blockers

ACE-Is

Question 20

Symptoms of Wallenburg syndrome?

Answer 20

Dorsolateral medulla lesion

#Vertigo (vestibular nuclei)
#Dysarthria and paralyzed palate (nucleus ambiguous)
#Ptosis and meiosis (Horner's from descending sympathetics)
#Facial numbness (spinal trigeminal tract)
#Contralateral body numbness (spinothalamic tract)
#Dysmetria – ICP

Question 21

Contraindications to TPA?

Answer 21

#Minor symptoms or signs of hemorrhage
#Seizure with stroke
#Stroke within three months, surgery within two weeks
#Any prior history of intracranial hemorrhage
#Elevated coagulation panel all platelet count under 100,000
#glucose under 50 or over 400
#Systolic over 185 or diastolic over 110

Question 22

Charcot-Bouchard aneurysms? Seen when?

Answer 22

Lipohyalinosis that becomes small aneurysms which rupture can cause intracranial hemorrhage