Prunuske -- Stroke

Question 1

stroke definition

Answer 1

Sudden onset of a focal CNS deficit due to vascular causes

Question 2

transient ischemic attack (TIA)

vs.

transient symptoms with infarction (TSI)

Answer 2

TIA is a transient neurologic deficit of cerebrovascular origin without infarct

TSI is clinically indistinguishable from transient symptoms with infarction (TSI); however, TSI is associated with irreversible ischemic brain injury on neuroimaging

Question 3

A majority of strokes are caused by what disease?

Answer 3

atherosclerotic disease

Atherosclerosis can cause large-vessel stroke by direct thrombosis of cerebral vessels or embolism from other sources such as cervical arteries, the aorta or the heart.

Question 4

What are the two types of stroke?

Answer 4

ischemic stroke

and

hemorrhagic stroke

Question 5

Ischemic stroke categories…

Answer 5

Large vessel

   Anterior circulation

• Common carotid > MCA and ACA

   Posterior circulation

• Vertebral artery > basilar artery

Small vessel

• Penetrating arteries (lacunar stroke)

Question 6

Intracerebral hemorrhage has many clinical presentations. Can you name some?

Answer 6

• Putamen – contralateral hemiparesis, gaze paresis and aphasia or hemineglect
• Thalamus – contralateral hemianesthesia
• Cerebellum – vomiting, ataxia, nystagmus, facial paralysis, ipsi gaze palsies and  LOC
• Pons – coma, quadriplegia, pinpoint pupils, autonomic instability

Question 7

Intracerebral hemorrhage definition…

Answer 7

Bleeding into the brain tissue

Question 8

Intracranial Hemorrhage - how do you manage treatment?

Answer 8

No medications for hemorrhagic stroke!! Try to prevent it!

Stop or reverse anticoagulants

Question 9

subarachnoid hemorrhage

Answer 9

Intracranial vessels are located between the arachnoid and pia mater in the subarachnoid space. The subarachnoid space in normally filled with CSF. A subarachnoid hemorrhage results when vessels bleed the CSF-filled space between the arachnoid and pia mater. Subarachnoid hemorrhages are most commonly caused by trauma and shear forces tearing the perforating vessels feeding the underlying cortex.

Question 10

What is the most common non-traumatic cause of subarachnoid hemorrage?

Answer 10

rupture of intracranial aneurysms

Question 11

subarachnoid hemorrage clinical presentation

Answer 11

• “Thunderclap” headach 74%
• Nausea or vomiting 77%
• Focal neurologic deficits 64%
• Sentinel headaches 15 – 37%

Question 12

When a clinician is concerned for subarachnoid hemorrhage, the most appropriate initial action is?

Answer 12

non-contrast head CT

(positive usually shows blood around the ventricles)

Question 13

TPA pharmacodynamics in treatment in stroke

Answer 13

Enhances the conversion of plasminogen to plasmin by binding to fibrin, and initiates fibrinolysis. In short, it helps restore patency to thrombosed vessels.

Question 14

Use aspirin for stroke treatment? How? Why?

Answer 14

Aspirin 160 – 325 mg daily should be started within 24 to 48 hours in patients with an ischemic stroke or transient ischemic attack (TIA).

Clopidogrel can be used for people who are allergic to aspirin.