pom-stroke 1 Flashcards
stroke definition
sudden focal neurologicl deficit, attributed to a vascular cause
two subtypes of strokes
ischemic attack- 80%
hemorrhagic: <20% including both intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)
tia definition
transient focal neurological deficit due to ischemia
traditional defnition of tia
less than 24 hours
newer definition of tia
no evidence of infarction on brain imaging
should we be worried about a tia?
yes- more likely to have stroke!
vascular risks - how to score?
abcd
a
age >= 60
b
bp >= 140/90
c
clinical features: unilateral weakness, 2 pts, speach disturbance w/o weakness 1 pt
d
duration >= 60 minutes, 2 pts
10-60 mins 1 pt
d
hx of diabetes
stroke symptoms
weakness, aphasia (impaired language), vision loss, numbness, gait disturbance
other symptoms
vertigo, double vision, loss hearing, face weak, difficulty swallowing, headache, confusion, neglect, seizure, coma
post ictal paralysis
one side of body completely paralyszed
stroke mimics
seizure w post ictal paralysis, systemic infection, brain tumors, toxic/metabolic derangement, other (migraine, sdh, tga, ms, bpv)
what sort of imaging to do if you think there’s a stroke happening?
Ct scan
mri image quirk? same w ct?
right is actually left
what is ct good for looking for?
blood
on ct, most opaque to least opaque?
metal, bone, blood, soft tissue, fluid, air
intracerebral hemmhorage number 1 cause
htn
3 other causes of ich
cerebral amyloid angiopathy, coagulaopathic hemorage, surgical options?
subharracnoid hemorage nickname
Crab of death
gold standard to rule out sah?
angiography
sah- what pt says?
worst headache of life
ct scan detects what percent of sah?
90
how can we definitively diag sah?
angiography or lumbar punctiure will have yellow tinge
what’s ct look like when brain is damaged?
darker (damage to brain appears dark- stroke edema inflamm)
early signs of stroke on ct?
loss of grey white jxn, obscuration of deep grey structures, suical effacement, hyperdense bv
malignant ischemic stroke
pt is going to die
frontal lobe
motor
parietal lobe
sensory
right hemispere is motor: R or L? sensory : r or l? visual field? r or l? and..?
motor- left body
sensory from L body
L visual field
spatial fxn
l hemispher?
motor to right, sensory from right, right viusal field, language
r hemi has spatial fxn so if damaged get –?
neglect
wernicke’s area-?
speech comprehension
broca’s area?
speech production
precentral gyrus
primary motor cortex
postcentral gyrus
primary sensory cortex
occiptial pole
primary viusal cortex
sensory and motor homunculous shows?
area we have greater control over has more space in brain- fingers than toes etc
branches off ica?
opthalmic, ant choroidal, ant cerebral (aca), middle cerebral (mca)
aca supplies?
medial parietal, temporal and frontal lobes, contralateral leg> face, arm,
bilateral aca strokes are assoc with ?
akinetic mutism
akinetic mutism?
dont say anything , no motivation, catatnoic
mca supplies?
lat surfaces of parietal, temporal, and frontal lobes
mca strokes cause?
face and arm> leg weakness, sensory loss, visual field defects, aphasia in dominant hemi, or neglect if non dominant hemi
vertebral arteries arise from?
subclavian
vertebral arteries enter skull through
foramen magnum
vertebral arteries join to form
basilar artery
basilar supplies
brainstem
brainstem strokes cause
cranial nerve dysfxn, cerebeller dysfxn (ataxia, vertigo, clumsiness), rarely, impairment in LOC?
pca strokes cause
VISUAL FIELD DEFECTS
basilar artery splits into ?
posterior cerebral arteries (pca)
vision deficit in pca?
1/2 vision gone in both eyes- binocular
what percent of people have complete circle of wills?
25
major clinical findings- aca block?
contralateral leg weakness
major clinical findings- mca block?
contralateral face/arms>leg weakness, sensory loss, field cut, aphasia or neglect
pca block findings?
contralateral visual field cut
basialr block findings?
oculomotor defect, ataxia, diminished conciousness
verteral block findins?
lower cranial nerve deficits and or ataxia, w crossed sensory deficits
causes of stroke- 4
cardioembolism, large vessel atherothromboembolism, small vessel dz, rare cause of stroke (hypercoagulable state, dissection, vasculitis ) cryptogenic/ideopathic
cardioembolic risk factors:
atrial fibrillation, lists many others
vessels for large vessel atherosclerosis- 4
aortic arch, carotid artery (extracranial)-most common!, vertebral (extracranial) (less common), intracranial arteries
what is lacunar stroke?
small vessels
what does lacunar mean sizewise?
smaller than 15 mm
describe corical neglect
touch foot, pt feel, but cant tell u which foot
rare causes of stroke- carotid dissection- who it occurs in?
young adult
symptoms of carotid dissection?
horners, - one sided stuff, miosis, etc
what happens in carotid dissection-?
seperation of arterial wall layers
what are likely caues of stroke?
paroxysmal atrial fibrillation, hypercoagulable state, subclinical large vessel disease, pfo, inflammatory or infections disease
what to do if suspect stroke?
take time of onset, physical exam, nihss, head ct, labs
gold standard tx for acute strke?
tpa- thrombolytic drug, proven to work , reopens bv by lysing clot
penumbra-
tissue at risk , trying to save
core
dead tissue
downside of tpa?
can die- inc risk of intra-cranial hemorrhage, , or can have neuro defect
other tx ?
neuroprotection (minimize damage)
antithrombotic therapy,
supportive care
after stroke, what do we want to do to bp?
increase
what do we want to do to blood sugar after a stroke?
decrease
what to do to temp after stroke?
decrease
why would we give heparin to pt after stroke?
decrease risk of addn clots
antiplatelet agents that can prevent stroke?
apsrin, clopidogrel, asa/dipyramidole, warfarin, dibigatran
warfarin mech
oral vitamin k antagonist
dabigatran mech
oral direct thrombin inhibiotr- NO ANTIDOTE
surgical prevention options
carotid endarteretomy, carotid stenting, cardiac surgery for valvue replacment
indications for carotid stenting
recurrent stenosis, surgically inaccessible disase, post radiation stenosis, poor operative candidate
