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pom-stroke 1 Flashcards

1
Q

stroke definition

A

sudden focal neurologicl deficit, attributed to a vascular cause

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2
Q

two subtypes of strokes

A

ischemic attack- 80%

hemorrhagic: <20% including both intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH)

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3
Q

tia definition

A

transient focal neurological deficit due to ischemia

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4
Q

traditional defnition of tia

A

less than 24 hours

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5
Q

newer definition of tia

A

no evidence of infarction on brain imaging

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6
Q

should we be worried about a tia?

A

yes- more likely to have stroke!

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7
Q

vascular risks - how to score?

A

abcd

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8
Q

a

A

age >= 60

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9
Q

b

A

bp >= 140/90

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10
Q

c

A

clinical features: unilateral weakness, 2 pts, speach disturbance w/o weakness 1 pt

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11
Q

d

A

duration >= 60 minutes, 2 pts

10-60 mins 1 pt

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12
Q

d

A

hx of diabetes

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13
Q

stroke symptoms

A

weakness, aphasia (impaired language), vision loss, numbness, gait disturbance

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14
Q

other symptoms

A

vertigo, double vision, loss hearing, face weak, difficulty swallowing, headache, confusion, neglect, seizure, coma

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15
Q

post ictal paralysis

A

one side of body completely paralyszed

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16
Q

stroke mimics

A

seizure w post ictal paralysis, systemic infection, brain tumors, toxic/metabolic derangement, other (migraine, sdh, tga, ms, bpv)

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17
Q

what sort of imaging to do if you think there’s a stroke happening?

A

Ct scan

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18
Q

mri image quirk? same w ct?

A

right is actually left

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19
Q

what is ct good for looking for?

A

blood

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20
Q

on ct, most opaque to least opaque?

A

metal, bone, blood, soft tissue, fluid, air

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21
Q

intracerebral hemmhorage number 1 cause

A

htn

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22
Q

3 other causes of ich

A

cerebral amyloid angiopathy, coagulaopathic hemorage, surgical options?

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23
Q

subharracnoid hemorage nickname

A

Crab of death

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24
Q

gold standard to rule out sah?

A

angiography

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25
Q

sah- what pt says?

A

worst headache of life

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26
Q

ct scan detects what percent of sah?

A

90

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27
Q

how can we definitively diag sah?

A

angiography or lumbar punctiure will have yellow tinge

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28
Q

what’s ct look like when brain is damaged?

A

darker (damage to brain appears dark- stroke edema inflamm)

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29
Q

early signs of stroke on ct?

A

loss of grey white jxn, obscuration of deep grey structures, suical effacement, hyperdense bv

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30
Q

malignant ischemic stroke

A

pt is going to die

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31
Q

frontal lobe

A

motor

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32
Q

parietal lobe

A

sensory

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33
Q 
right hemispere is
motor: R or L?
sensory : r or l?
visual field? r or l?
and..?
A

motor- left body
sensory from L body
L visual field
spatial fxn

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34
Q

l hemispher?

A

motor to right, sensory from right, right viusal field, language

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35
Q

r hemi has spatial fxn so if damaged get –?

A

neglect

36
Q

wernicke’s area-?

A

speech comprehension

37
Q

broca’s area?

A

speech production

38
Q

precentral gyrus

A

primary motor cortex

39
Q

postcentral gyrus

A

primary sensory cortex

40
Q

occiptial pole

A

primary viusal cortex

41
Q

sensory and motor homunculous shows?

A

area we have greater control over has more space in brain- fingers than toes etc

42
Q

branches off ica?

A

opthalmic, ant choroidal, ant cerebral (aca), middle cerebral (mca)

43
Q

aca supplies?

A

medial parietal, temporal and frontal lobes, contralateral leg> face, arm,

44
Q

bilateral aca strokes are assoc with ?

A

akinetic mutism

45
Q

akinetic mutism?

A

dont say anything , no motivation, catatnoic

46
Q

mca supplies?

A

lat surfaces of parietal, temporal, and frontal lobes

47
Q

mca strokes cause?

A

face and arm> leg weakness, sensory loss, visual field defects, aphasia in dominant hemi, or neglect if non dominant hemi

48
Q

vertebral arteries arise from?

A

subclavian

49
Q

vertebral arteries enter skull through

A

foramen magnum

50
Q

vertebral arteries join to form

A

basilar artery

51
Q

basilar supplies

A

brainstem

52
Q

brainstem strokes cause

A

cranial nerve dysfxn, cerebeller dysfxn (ataxia, vertigo, clumsiness), rarely, impairment in LOC?

53
Q

pca strokes cause

A

VISUAL FIELD DEFECTS

54
Q

basilar artery splits into ?

A

posterior cerebral arteries (pca)

55
Q

vision deficit in pca?

A

1/2 vision gone in both eyes- binocular

56
Q

what percent of people have complete circle of wills?

A

25

57
Q

major clinical findings- aca block?

A

contralateral leg weakness

58
Q

major clinical findings- mca block?

A

contralateral face/arms>leg weakness, sensory loss, field cut, aphasia or neglect

59
Q

pca block findings?

A

contralateral visual field cut

60
Q

basialr block findings?

A

oculomotor defect, ataxia, diminished conciousness

61
Q

verteral block findins?

A

lower cranial nerve deficits and or ataxia, w crossed sensory deficits

62
Q

causes of stroke- 4

A

cardioembolism, large vessel atherothromboembolism, small vessel dz, rare cause of stroke (hypercoagulable state, dissection, vasculitis ) cryptogenic/ideopathic

63
Q

cardioembolic risk factors:

A

atrial fibrillation, lists many others

64
Q

vessels for large vessel atherosclerosis- 4

A

aortic arch, carotid artery (extracranial)-most common!, vertebral (extracranial) (less common), intracranial arteries

65
Q

what is lacunar stroke?

A

small vessels

66
Q

what does lacunar mean sizewise?

A

smaller than 15 mm

67
Q

describe corical neglect

A

touch foot, pt feel, but cant tell u which foot

68
Q

rare causes of stroke- carotid dissection- who it occurs in?

A

young adult

69
Q

symptoms of carotid dissection?

A

horners, - one sided stuff, miosis, etc

70
Q

what happens in carotid dissection-?

A

seperation of arterial wall layers

71
Q

what are likely caues of stroke?

A

paroxysmal atrial fibrillation, hypercoagulable state, subclinical large vessel disease, pfo, inflammatory or infections disease

72
Q

what to do if suspect stroke?

A

take time of onset, physical exam, nihss, head ct, labs

73
Q

gold standard tx for acute strke?

A

tpa- thrombolytic drug, proven to work , reopens bv by lysing clot

74
Q

penumbra-

A

tissue at risk , trying to save

75
Q

core

A

dead tissue

76
Q

downside of tpa?

A

can die- inc risk of intra-cranial hemorrhage, , or can have neuro defect

77
Q

other tx ?

A

neuroprotection (minimize damage)
antithrombotic therapy,
supportive care

78
Q

after stroke, what do we want to do to bp?

A

increase

79
Q

what do we want to do to blood sugar after a stroke?

A

decrease

80
Q

what to do to temp after stroke?

A

decrease

81
Q

why would we give heparin to pt after stroke?

A

decrease risk of addn clots

82
Q

antiplatelet agents that can prevent stroke?

A

apsrin, clopidogrel, asa/dipyramidole, warfarin, dibigatran

83
Q

warfarin mech

A

oral vitamin k antagonist

84
Q

dabigatran mech

A

oral direct thrombin inhibiotr- NO ANTIDOTE

85
Q

surgical prevention options

A

carotid endarteretomy, carotid stenting, cardiac surgery for valvue replacment

86
Q

indications for carotid stenting

A

recurrent stenosis, surgically inaccessible disase, post radiation stenosis, poor operative candidate

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