Rothrock-Clinical aspects of stroke

Question 1

What are the 2 most common neurological disorders?

Answer 1

• stroke

- headache

Question 2

What is a cerebrovascular accident (CVA) or cerebral apoplexy?

Answer 2

a stroke

Question 3

If you have determined you have had a stroke what is the first quetion you ask?

Answer 3

is it hemorrhagic or ischemic

Question 4

What are some things that can be confused with stroke?

Answer 4

• migraine
• seizure
• hypo/hyperglycemia
• “functional”
• etc

Question 5

If you have had a hemorrhagic stroke what do you have to differentiate between?

Answer 5

subarachnoid hemorrhage (SAH) vs intracerebral hemorrhage (ICH)

Question 6

If you have had an ischemic stroke, what do you have to differentiate between?

Answer 6

embolic vs thrombotic (large vs small vessel)

Question 7

If you have a patient with a super bad headache. what should you suspect?

Answer 7

a SAH caused by a ruptured aneurysm

Question 8

What is the progression of an intracerebral hemorrhage?.

Answer 8

slow, smooth progressive deterioration within the first few hours

Question 9

(blank) typically give you max neurological deficit at onset.

Answer 9

Embolic strokes

Question 10

(blank) typically gives you a saw tooth appearance of symptomology due to collaterals helping out

Answer 10

thrombotic

Question 11

If you want to see an acute intracranial hemorrhage what imaging should you use? What about subarachnoid?

Answer 11

CT

MRI

Question 12

What is an exertional thundercloud headache symptomatic of?

Answer 12

a ruptured berry aneurysm causing subarachnoid hemorrhage that is sentinal (low volume bleed)

Question 13

(blank) strokes show step wise progression

Answer 13

ischemic

Question 14

What is this:
A 46-year-old Afro-American female with hypertension and insulin dependent diabetes presents with acute dysarthria and left face, arm and leg numbness and weakness. Within hours she develops stupor and a complete right gaze palsy. Within 12 hours of admission she is densely stuporous and appears to be quadriplegic.

Answer 14

Basilar artery thrombosis with posterior circulation step wise stroke

Question 15

What is this:
A 57-year-old retired marine colonel experiences 11 episodes of left eye amaurosis fugax over a 3 day period. While eating breakfast with his family he is suddenly unable to speak intelligibly and develops severe right body weakness. His deficits persist but improve over the next hour.Non-contrasted brain CT in the ED is normal.

Answer 15

Embolus of MCA caused by thrombus in the internal carotid artery

Question 16

What are the three ways you can get strokes?

Answer 16

vascular, electricity or trauma

Question 17

What is this
A 56-year-old Afro-American male with a history of poorly controlled hypertension abruptly develops “dizziness” and difficulty walking. When he presents to the ED later that day he is unable to sit or stand, consistently falling towards the left.Six hours after admission you are called to see him because he is unarousable and exhibits midposition, light-fixed pupils bilaterally.

How do you treat this?

Answer 17

Cerebellar hemorrhagic intracerebral stroke caused by htn arteriopathy

surgery

Question 18

Where does htn typically cause strokes?

Answer 18

basal ganglia, pons and cerebellum