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Foundations 4 SG > Stroke 1 > Flashcards

Stroke 1 Flashcards

1
Q

64 y/o R hand dom female w/ PMHx of HTN/HLD awakes w/ slurred speech and R arm wkness. Presents to ED within 30 mins, what is next step in tx?

A

CT scan of head without contrast (look for head bleed)

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2
Q

Which vessel provides large part of blood to brain?

A

MCA superior division

(Middle Cerebral aa)

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3
Q

Sudden focal neurological deficit or acute impairment caused by the interruption of blood flow to a specific region of the brain

  • Sudden brain damage
  • Lack of blood flow
A

Stroke

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4
Q

2 types of stroke

A
  • Hemorrhagic
  • Ischemic
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5
Q
  • 85% of strokes are _____.
  • 50 - 80% of all strokes are ____ through risk factor management
  • 5th leading cause of death in US.
  • Leading cause of serious disability in US w/ over 7 million survivors
A
  • ischemic
  • preventable
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6
Q
  • FAST
  • List the prevalence of stroke by race (3)
A
  • F: Face drooping
  • A: Arm weakness
  • S: Speech difficulty
  • T: Time to call 911
  1. Blacks
  2. Hispanic/Latino
  3. White
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7
Q
  • Which race compared to Caucasians have nearly double the incidence of strokes?
  • And suffer more extensive physical impairments
  • And are twice as likely to die from stroke
A

African Americans

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8
Q

5 risk factors of African Americans for Stroke

A
  • HTN
  • Obesity
  • DM
  • Smoking
  • Sickle Cell Anemia

(HODSS)

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9
Q
  • Which race has a higher incidence of strokes as compared to Caucasians, but not as much as African Americans?
A

Hispanics

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10
Q

Which race?

  • Increased risk for all types of stroke and Transient Ischemic Attacks (TIA) at younger ages than Caucasians?
A

Hispanics

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11
Q

Which race are less likely to know the stroke sxs?

A

Spanish-speaking Hispanics

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12
Q

Males or females suffer strokes more often?

Which age range?

A

Females (only slightly more)

80+ yrs

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13
Q

The 3 R’s

A
  • Reduce: stroke risk
  • Recognize: stroke sxs
  • Respond: at first sign of stroke, call 911 immediately
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14
Q

3 components of the Cincinnati Pre-Hospital Stroke Scale

What is the sensitivity/ specificity if pt has all 3?

A
  • Facial Droop
  • Arm Drift
  • Abnormal Speech

Sens: 100% Spec: 88%

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15
Q
  • Unilateral weakness
  • Unilateral numbness / tingling
  • Incoordination / clumsiness on one side of body
  • Sudden speech/language change
  • Acute confusion
  • Loss of vision in both or esp. ONE eye
  • Diplopia
  • Sudden/Severe HA
A

Focal sxs of stroke

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16
Q

When taking a focused hx of stroke, ask what 3 things to which 3 people?

A
  • When was pt last at neuro baseline (normal)
  • Pattern of onset (sudden or gradual)
  • Sz at onset w/ associated bladder/bowel incontinence
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17
Q

5 goals of examination

A
  • ABCDEFG’s (glucose)
  • R/o mimics of stroke
  • Localize lesions (focal vs diffuse) (UMN/LMN)
  • Identify comorbidities
  • Identify conditions which may influence tx decisions (recent surg/trama/active bleed/infection)
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18
Q

6 components of focused physical exam of stroke pt

-What scoring system should be used?

A
  • Level of consciousness
  • Language
  • Visual fields / eye movements
  • Strength / drift / reflexes
  • Coordination
  • Sensation

NIHSS (National Institutes of Health Stroke Scale)

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19
Q
  • Standardized method used by health care professionals to measure level of impairment caused by stroke
  • Used to see if tPA needs to be given
  • Usable for research (objective comparison of efficacy of diff stroke txs)
  • Determines if change in exam has occurred
  • Scores are totaled to determine level of severity
A

National Institiute of Health Stroke Scale

(NIHSS)

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20
Q
  • NIHSS is a ___ item scoring system w/ a __ minute exam.
  • Integrates ____ exam components
  • 6 components of exam?
  • Minimal score is ___ (normal)
  • Max score is ___ (severe stroke)
  • Scores greater than ___ to ___ are more severe
A
  • 13 / 7
  • neurologic
  • CN (visual), motor, sensory, cerebellar, inattention, language, LOC
  • 0
  • 42
  • 15-20
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21
Q

NIHSS Interpretation

  • Score for no stroke
  • Score for Severe Stroke
A
  • 0
  • 21 - 42
22
Q
  • < ___ to ___ will have an 80% good/excellent outcome
  • ___ to ___ will have a less than 20% good/excellent outcome
  • _____ pts had the BEST outcomes**
A
  • 12 - 14
  • 20 - 26
  • Lacunar Infarct
23
Q

National Institute of Neurological Disorders & Stroke

  • Benefit at ___ hours is not significant
  • ____ dependent
  • Tx pts are ___ % more likely to have minimal/no disability at ___ months.
A
  • 24 hours
  • Time (earlier the better)
  • 30% / 3 months
24
Q

Stroke Types:

  • Clot occluding artery
  • Bleeding INTO brain
  • Bleeding AROUND brain

Which ones cause focal brain dysfunction?

Which ones cause diffuse brain dysfunction?

A
  • Ischemic stroke (MC at 85%)
  • Intracerebral Hemorrhage (10%)
  • Subarachnoid Hemorrhage (LC at 5%)

Focal: Ischemic / Intracerebral

Diffuse: Subarachnoid / Intracerebral

25
Q

2 Types of Stroke

  1. Caused by blocked blood vessel in brain or vessel that feeds brain
  2. Caused by ruptured blood vessel in brain
A
  1. Ischemic
  2. Hemorrhagic
26
Q

Most common type of ischemic stroke, and results from the occlusion of small penetrating arteries that provide blood to the brain’s deep structures.

A

Lacunar Infarct / Stroke

27
Q

What is the most common vascular obstruction leading to thrombosis?

(thrombotic stroke)

A

Atherosclerosis

28
Q

What are the 2 most common sources of emboli?

(embolic stroke)

A
  • Left sided cardiac chambers
  • Artery to artery stroke (detachment of a thrombus from ICA-internal cardotid artery at site of plaque)
29
Q

3 etiologies of Ischemia Stroke

A
  • Cardioembolic
  • Large Vessel Disease (atherosclerosis)
  • Small Vessel Disease (Lacunar infarction)
30
Q
  • Sudden onset
  • Focal neuro sxs
  • Interuruption in blood supply to part of brain
  • >24 hrs
  • Typically >1 hr
  • Permanent damage
A

Acute Ischemic Stroke (AIS)

31
Q
  • Sudden onset
  • Focal neuro sxs
  • Transient lack of blood supply & focal ischemia
  • <24 hours
  • Typically <1 hr (90%)
    NO permanent damage to brain
A

Transient Ischemic Attack (TIA)

32
Q

TIA

  • Originally defined as a focal neurologic event lasting <24 hours
  • Revised guidelines change this to consider _____, NOT _____.
A
  • Consider amount of injury, NOT timeline
33
Q

TIA

  • _____ can lead to permanent brain damage
  • Will injury show up on MRI?
  • What is the pathophys of TIA?
A
  • Brief ischemia
  • Up to half of traditionally defined pts w/ TIA show injury on MRI
  • Similar to stroke, but unknown why similar events produce TIA only
34
Q

What % of people who experience TIA do not report it?

A

50%

35
Q

AHA - Endorsed Revised Definition of TIA

  • A transient episode of neurological dysfunction caused by focal ___, ___, or _____ischemia, WITHOUT acute infarction
  • The reference to _____ was not helpful as is does not demarcate events with and without tissue infarction.
A
  • brain, spinal cord, or retinal
  • a 1 hour time point
36
Q

One quarter to one half of strokes that occur within 3 months of TIA occur within what time frame?

A

Within the first 2 days

37
Q

Which 2 risk stratifications predict short term risk of stroke well in independent popualations of pts presenting acutely after a TIA?

A
  • The California score
  • ABCD score
38
Q

What is the newer score which provides a more robust prediction standard and incorporates elements from both the prior scores?

A
  • ABCD2
39
Q

ABCD2

  • Age ___ or older
  • BP ___/___ or over on first evaluation
  • Clinical sxs of ___ or ____
  • Duration of ___ minutes or greater or __ - ___ mins
  • D?
A
  • 60+
  • 140/90
  • Focal weakness w/ spell or Speech impairment w/o weakness
  • 60 mins / 10-59 mins
  • Diabetes
40
Q
  • What dx test (including diffusion sequences), should be considered a preferred test in investigation of pt w/ potential TIAs?
  • May confirm focal ischemia as cause of pt’s deficit improves accuracy of dx of vascular localization & etiology of TIA
  • Assesses extent of pre-exisiting cerebrovascular injuries
A

MRI

41
Q

Class 1 Recommendations:

  • Pts w/ TIA should preferably undergo ____ within ____ hours of symptom onset.
  • What is the preferred brain dx imaging modality?
  • What is second best brain dx imaging?
A
  • neuroimaging evaluation / 24 hrs
  • MRI, including DWI (diffusion weighted imaging)
  • Head CT
42
Q

Class 1 Recommendations of TIA

  • What should be performed routinely as part of evaluation of pts w/ suspected TIAs?
A

Non-invasive imaging of the cervicocephalic vessels

43
Q
A
44
Q

Class 1 Recommendations of TIA

  • ___ reliably excludes the presence of intracranial stenosis
  • Pts w/ suspected TIA should be evaluated as soon as possible after event
A
  • Non-invasive testing of the intracranial vasculature
45
Q

Class 2 Recommendations

  • Initial assessment of extracranial vasculature may involve what 4 tests? (depending on local availability and expertise)
A
  • Carotid US
  • TCD (transcranial doppler)
  • MRA
  • CTA
46
Q

Class 1 or 2? (TIA)

  • Electrocardiography should occur as soon as possible after TIA
  • Prolonged cardiac monitoring (Holter Monitor) is useful in pts w/ unclear etiology
A

2

47
Q

Class 2 Recommendations of TIA

  • _____ is reasonable in eval of pts w/ suspected TIAs, esp when pt has no cause identified by other elements of work up.
  • Is useful in identifying Patent Foramen Ovale and Aortic Arch Atherosclerosis, and Valvular disease
A
  • Echocardiography (at least TTE)
  • TEE
48
Q

Zone of reversible ischemia around the core of irreversible infarction

(salvageable in first few hours after ischemic stroke onset)

A

Penumbra

49
Q

Penumbra is damaged by what 4 things?

A
  • Hypoperfusion
  • Hyperglycemia >400
  • Fever
  • Seizure
50
Q
A

Foundations 4 SG (19 decks)

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