pom-stroke 1

Question 1

stroke definition

Answer 1

sudden focal neurologicl deficit, attributed to a vascular cause

Question 2

two subtypes of strokes

Answer 2

ischemic attack- 80%

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

Question 3

tia definition

Answer 3

transient focal neurological deficit due to ischemia

Question 4

traditional defnition of tia

Answer 4

less than 24 hours

Question 5

newer definition of tia

Answer 5

no evidence of infarction on brain imaging

Question 6

should we be worried about a tia?

Answer 6

yes- more likely to have stroke!

Question 7

vascular risks - how to score?

Answer 7

abcd

Question 8

a

Answer 8

age >= 60

Question 9

b

Answer 9

bp >= 140/90

Question 10

c

Answer 10

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

Question 11

d

Answer 11

duration >= 60 minutes, 2 pts

10-60 mins 1 pt

Question 12

d

Answer 12

hx of diabetes

Question 13

stroke symptoms

Answer 13

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

Question 14

other symptoms

Answer 14

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

Question 15

post ictal paralysis

Answer 15

one side of body completely paralyszed

Question 16

stroke mimics

Answer 16

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

Question 17

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

Answer 17

Ct scan

Question 18

mri image quirk? same w ct?

Answer 18

right is actually left

Question 19

what is ct good for looking for?

Answer 19

blood

Question 20

on ct, most opaque to least opaque?

Answer 20

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

Question 21

intracerebral hemmhorage number 1 cause

Answer 21

htn

Question 22

3 other causes of ich

Answer 22

cerebral amyloid angiopathy, coagulaopathic hemorage, surgical options?

Question 23

subharracnoid hemorage nickname

Answer 23

Crab of death

Question 24

gold standard to rule out sah?

Answer 24

angiography

Question 25

sah- what pt says?

Answer 25

worst headache of life

Question 26

ct scan detects what percent of sah?

Answer 26

90

Question 27

how can we definitively diag sah?

Answer 27

angiography or lumbar punctiure will have yellow tinge

Question 28

what's ct look like when brain is damaged?

Answer 28

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

Question 29

early signs of stroke on ct?

Answer 29

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

Question 30

malignant ischemic stroke

Answer 30

pt is going to die

Question 31

frontal lobe

Answer 31

motor

Question 32

parietal lobe

Answer 32

sensory

Question 33

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

Answer 33

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

Question 34

l hemispher?

Answer 34

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

Question 35

r hemi has spatial fxn so if damaged get --?

Answer 35

neglect

Question 36

wernicke's area-?

Answer 36

speech comprehension

Question 37

broca's area?

Answer 37

speech production

Question 38

precentral gyrus

Answer 38

primary motor cortex

Question 39

postcentral gyrus

Answer 39

primary sensory cortex

Question 40

occiptial pole

Answer 40

primary viusal cortex

Question 41

sensory and motor homunculous shows?

Answer 41

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

Question 42

branches off ica?

Answer 42

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

Question 43

aca supplies?

Answer 43

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

Question 44

bilateral aca strokes are assoc with ?

Answer 44

akinetic mutism

Question 45

akinetic mutism?

Answer 45

dont say anything , no motivation, catatnoic

Question 46

mca supplies?

Answer 46

lat surfaces of parietal, temporal, and frontal lobes

Question 47

mca strokes cause?

Answer 47

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

Question 48

vertebral arteries arise from?

Answer 48

subclavian

Question 49

vertebral arteries enter skull through

Answer 49

foramen magnum

Question 50

vertebral arteries join to form

Answer 50

basilar artery

Question 51

basilar supplies

Answer 51

brainstem

Question 52

brainstem strokes cause

Answer 52

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

Question 53

pca strokes cause

Answer 53

VISUAL FIELD DEFECTS

Question 54

basilar artery splits into ?

Answer 54

posterior cerebral arteries (pca)

Question 55

vision deficit in pca?

Answer 55

1/2 vision gone in both eyes- binocular

Question 56

what percent of people have complete circle of wills?

Answer 56

25

Question 57

major clinical findings- aca block?

Answer 57

contralateral leg weakness

Question 58

major clinical findings- mca block?

Answer 58

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

Question 59

pca block findings?

Answer 59

contralateral visual field cut

Question 60

basialr block findings?

Answer 60

oculomotor defect, ataxia, diminished conciousness

Question 61

verteral block findins?

Answer 61

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

Question 62

causes of stroke- 4

Answer 62

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

Question 63

cardioembolic risk factors:

Answer 63

atrial fibrillation, lists many others

Question 64

vessels for large vessel atherosclerosis- 4

Answer 64

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

Question 65

what is lacunar stroke?

Answer 65

small vessels

Question 66

what does lacunar mean sizewise?

Answer 66

smaller than 15 mm

Question 67

describe corical neglect

Answer 67

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

Question 68

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

Answer 68

young adult

Question 69

symptoms of carotid dissection?

Answer 69

horners, - one sided stuff, miosis, etc

Question 70

what happens in carotid dissection-?

Answer 70

seperation of arterial wall layers

Question 71

what are likely caues of stroke?

Answer 71

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

Question 72

what to do if suspect stroke?

Answer 72

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

Question 73

gold standard tx for acute strke?

Answer 73

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

Question 74

penumbra-

Answer 74

tissue at risk , trying to save

Question 75

core

Answer 75

dead tissue

Question 76

downside of tpa?

Answer 76

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

Question 77

other tx ?

Answer 77

neuroprotection (minimize damage) antithrombotic therapy, supportive care

Question 78

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

Answer 78

increase

Question 79

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

Answer 79

decrease

Question 80

what to do to temp after stroke?

Answer 80

decrease

Question 81

why would we give heparin to pt after stroke?

Answer 81

decrease risk of addn clots

Question 82

antiplatelet agents that can prevent stroke?

Answer 82

apsrin, clopidogrel, asa/dipyramidole, warfarin, dibigatran

Question 83

warfarin mech

Answer 83

oral vitamin k antagonist

Question 84

dabigatran mech

Answer 84

oral direct thrombin inhibiotr- NO ANTIDOTE

Question 85

surgical prevention options

Answer 85

carotid endarteretomy, carotid stenting, cardiac surgery for valvue replacment

Question 86

indications for carotid stenting

Answer 86

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