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Neurology > OME - Stroke > Flashcards

OME - Stroke Flashcards

1
Q

3 types of stroke?

A
  1. Thrombotic:Ischemic
  2. Embolic: Ischemic
  3. Hemorrhagic stroke
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2
Q

What type of hemorrhage is a hemorrhagic stroke?

A

Intracerebral

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3
Q

Risk factors thrombotic stroke?

A

Same as MI:

  1. Smoking
  2. Obesity
  3. FH
  4. TIIDM, Htn, Hld
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4
Q

Sources embolic stroke?

A
  1. Carotid artery stenosis
  2. A fib
  3. Bad valve in heart
  4. Septic from IE
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5
Q

Presentation stroke?

A
  1. Focal neurologic deficit
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6
Q

What do the anterior cerebral arteries feed?

A
  1. Feet

2. Legs

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7
Q

What does MCA feed?

A
  1. Hands
  2. Arms
  3. Face
  4. Speech
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8
Q

What to PCA feed?

A
  1. Visual Cortex
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9
Q

What does the basilar artery arrive from?

A

2 vertebral arteries

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10
Q

What can cause locked in syndrome?

A

Occlusion basilar artery

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11
Q

Presentation occlusion vertebral basilar System?

A

Syncope

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12
Q

What controls coordination?

A

Cerebellum - finger to nose, ambulation (ataxia)

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13
Q

What side of body does right brain stroke impact?

A

Left body, and vice versa

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14
Q

Is bilateral body nuero loss ever stroke?

A

Never a SINGLE stroke

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15
Q

Presentation stroke patient?

A
  1. Vasculopath
  2. Afib/flutter, valve no on coag
  3. Young woman c/o neck pain post trauma
    - Could be a carotid dissection
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16
Q

What is Cushing syndrome?

A

Sign of intracerebral hemorrhage.

  1. Altered breathing
  2. Bradycardia
  3. Hypertension
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17
Q

First step someone comes in w/ possible stroke?

A

Non contrast CT head

  • The purpose is to rule out bleed
  • Blood is white w/o contrast
  • Also much rapider as don’t have to wait for contrast to distribute
18
Q

Next step in hemorrhagic stroke after diagnosis?

A
  1. Drop BP with drip
  2. Call neuro: coil? clip? craniotomy?
  3. FFP if INR elevated
19
Q

How does clip work? Coil?

A

Clip: need to open brain to close off vessel
Coil: Need to go through vessel

20
Q

Next step after diagnosing nonhemorrhagic stroke?

A

Decide if we give TPA

21
Q

Work up ischemic stroke if survive?

A
  1. 2d Echo (TTE) - vegetation?
  2. Carotid US -
  3. EGK monitoring - Afib or flutter?
22
Q

Next step if stroke and afib or flutter?

A 
Anticoagulation:
1. Warfarin
or
2. NOAC
***Heparin bridge NOT needed
23
Q

Next step in stroke if thrombus on TTE?

A 
Anticoagulation:
1. Warfarin
or
2. NOAC
***Heparin bridge IS needed
24
Q

Next step in stroke if Carotid artery stenosis?

A
  1. Less than 70% no symptoms:
    - Medical mgmt
  2. Greater 70% symptomatic:
    - Surgical mgmt
  3. Greater 80% no symptoms:
    - Surgical MGMT
25
Q

What is the penumbra?

A

Area around stroked out area that is at risk

  • Used to wait on enterectomy to preserve
  • Now we no longer wait
26
Q

What is CPP?

A

“Cerebral perfusion pressure”

- MAP minus ICP

27
Q

Who gets TPA?

A
  1. Over 18
  2. Focal neurologic stroke
  3. Less than three hours
    - 4.5 non diabetics
  4. BP under 180/105
28
Q

Contraindication tPA?

A
  1. History Brain bleed
  2. Recent surgery
  3. Risk of bleeding - GI bleed?
29
Q

Acute management stroke no tPA?

A
  1. No heparin
  2. No anticoag
  3. Antiplatelet - Aspirin 325g
  4. Control sugars - mildly
    - HYPOglycemia risk for low perfusion
  5. Permissive htn first 24 hours
    - 220 / 120
30
Q

Why do we allow permissive htn in first 24 hours?

A

Body is upregulating BP to increase blood flow to save penumbra tissue

31
Q

Chronic management stroke no tPA?

A
  1. LMWH if paralyzed or immobile
  2. Anticoag - valve, fib / flutter
  3. Aspirin +/- clopidogrel
  4. Atorva 40 or 80
    - Rosuvastatin 20 or 40
  5. A1C under 8
  6. Control BP
32
Q

Why not give CT contrast in stroke?

A

Contrast looks same as blood

33
Q

What are we looking for in CT perfusion?

A

Penumbra - area around infarcted tissue we can hopefully save

34
Q

At what NIH class are we thinking large occlusion?

A

Over 6

35
Q

When does TPA need to be given?

A

Within 4.5 hours

36
Q

TPA contraindications?

A
  1. NOAC
  2. Coumadin over 1.7
  3. History head bleed
  4. Platelet under 100
  5. BP over 185/110
  6. MI within 3 months
  7. Hypoglycemia
37
Q

Dosing TPA?

A
  1. 9 mg / kg with max dose 90
    - 10% in first minute
    - Remainder over an hour
38
Q

How to manage BP after TPA?

A

180/100

39
Q

CPP equation?

A

CPP = MAP - ICP

40
Q

Timeframe thrombectomy?

A

24 hours

Neurology (37 decks)

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