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Rachel Flash cards > Stroke > Flashcards

Stroke Flashcards

1
Q

Criteria for tPA

A

within 3 hrs of sxs, adult (not elderly), neg CTH for blood, SBP <185, INR <1.7, plt >100k, stroke territory involves <1/3 of MCA territory

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2
Q

INR for cardiac embolic cause of stroke

A

2-3

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3
Q

thromboembolism from carotid stenosis use

A

ASA/dipyridamole

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4
Q

if carotid stenosis >70% and symptomatic

A

CEA

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5
Q

If thrombotic stroke use

A

ASA 81 mg

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6
Q

What vessel connects posterior and anterior circulation together

A

posterior communicating artery

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7
Q

what connects bilateral ACAs

A

A comm

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8
Q

what connects LV to 3rd ventricle?

A

foramen of monroe

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9
Q

what connects 3rd and 4th Ventricles

A

cerebral aqueduct

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10
Q

What comes off of 4th ventricle

A

foramen of Magendie (medial)
Luschka (lateral

then goes back up to the Lateral ventricle

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11
Q

medial lemniscus

A

touch and proprioception and vibration (midline)

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12
Q

Lesion of MLF

A

ipsilateral internuclear ophthalmoplegia (left lesion, left eye cannot adduct to the other side)

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13
Q

midline CN motor nuclei (divide evenly by 12)

A

3,4,6,12

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14
Q

lateral brainstem structures

A

spinothalamic tract (contralateral body temp/pain loss), spinocerebellar tract (ipsilateral cerebellar ataxia) sensory nucleus of CN 5 (ipsilateral deficit of pain/temp on face), sympathetic pathway (ipsilateral horner syndrome, ptosis, miosis, anhydrosis)

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15
Q

ACA stroke

A

leg > arm weakness, incontinence, if bilateral then exectuive function and personality deficits

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16
Q

MCA stroke

A

conotrallateral face, arm , hand weakness /numbness with either aphasia (lef) or hemineglect (right), usually due to cardiac emboli,

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17
Q

superior div MCA stroke

A

superior division broca aphasia, with contralateral upper limb weakness

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18
Q

inferior div MCA stroke

A

wernicke aphasia or contralateral hemineglect

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19
Q

transcortical aphasias

A

transcontinental railroad, you can repeat [that trip]!!!

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20
Q

mixed transcortical

A

non fluent, cannot comprehend, CAN repeat

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21
Q

conduction aphasia

A

fluent, can comprehend, cannot repeat , damage to arcuate fasiculus between Broca and Wernicke area

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22
Q

melodic intonation

A

recruit right sided brain to help with left lesions, helps with brocas aphasia

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23
Q

PCA stroke

A

contralateral homonymous hemianopia , bilateral anton syndrome (bilateral visual cortex stroke cortical blindness)…can also get alexia, transcortical SENSORY aphasia, prospagnosia (face recognition problems), CN3 and 4 deficits.

ALEXIA without agraphia

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24
Q

lesion of optic chiasm

A

bitemporal hemianopia

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25
Q

stroke in subthalamic nucleus gives you

stroke in caudate nucleus

A 
contralateral hemiballimus
contralateral hemichorea ( Benedikt syndrome can cause a contralateral chorea as it affects the red nucleus.  The red nucleus contributes to coordination and body positioning.)
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26
Q

Dysarthria clumsy hand syndrome lesion

A

contralateral pontine lesion- PONS

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27
Q

Wallenberg syndrome

A

lateral medullary syndrome
Dr. Horner Wallenberg at the VA says dont PICA horse that cant eat (Va/PICA stroke, hoarse voice CN 9, dysphagia CN 10, ipsilateral Horner synd, may have cerebellar ataxia (PICA is cerebellar artery)…..no weakness! lateral structure!!

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28
Q

Weber syndrome

A

Im paralyzed by 3 webs
contralateral hemiparesis, ipsilateral CN 3 palsy, medial midbrain lesion, if its midbrain it’s probably PCA culprit

can also have parkinson features if involvement of substantia nigra

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29
Q

Medial medullary syndrome

A

you lick your wounds (CN 12), medial in the medulla is motor pathway so contralateral hemiparesis, medial lin the medulla has medial lemniscus so contralateral numbness…insult of penetrating branches of vertebral artery or anterior spinal artery.

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30
Q

Locked in syndrome

A

basilar artery occlusion, RAS and consciousness is ok, tetraplegia with spared ability to move the eyes vertically and blink

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31
Q

Rood technique

A

applying stretch, heat , ice “that’s rood” applying cutaneous stimuli to help promote recovery

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32
Q

Proprioceptive neuromuscular facilitation

A

using diagonal movements with eyes closed

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33
Q

Contraint induced movement therapy

A

restraining the good limb and using the bad limb, will not work with hemineglect, need 10 deg active wrist extension and also need to voluntarily move fingers

34
Q

tongue and soft palate rise as tongue compresses bolus and sents into esoph, tongue moves posterior to delivery bolus to esoph

A

oral phase, voluntary

35
Q

aspiration happens in what phase

A

pharyngeal phase , involuntary

36
Q

Fiberoptic endoscopic eval

A

direct visual of swallowing, limited by presence of scope , MBSS is gold stand

37
Q

intention tremor is a what lesion

A

cerebellar lesion

38
Q

PD tremor

A

resting tremor, pill rolling , 3-5 hz

39
Q

dystonia treatment

A

some small percentage have dopa responsive dystonia, botox

40
Q

anterocollils culprit

A

b/l SCM

41
Q

retrocollis culprit

A

bilateral splenius capitis, spinal erectors

42
Q

torticollis culprit

A

contralateral SCM, ipsi splenius capitis, levator scapula

43
Q

Hunt Hess Scale

A

SAH:

Grade 1: roughly asymptomatic (potentially mild symptoms) with no neurologic deficits. Grade 2: Severe headache, neck stiffness are present with no major neurologic deficit or confusion. Grade 3: Headache, neck stiffness, confusion, with focal neurologic deficit. Grade 4: Extremely confused (think heavily inebriated), headache, neck stiffness, with severe focal neurologic deficit. Grade 5: coma.

44
Q

Side effects of phenobarbital

A

Phenobarbital is often associated with dizziness, irritability, confusion, rash, and cerebellar signs. Apparently also gingival hyperplasia but this is classic for phenytoin

45
Q

Side effects of gabapentin

A

fatigue, somnolence, ataxia, dizziness

46
Q

Bobath

A

inhibit primitive reflexes, work from proximal to distal muscles

47
Q

wheelchair for hemiplegic patient

A

Hemi-height chairs are made lower to the ground and allow the user to propel the chair with the unaffected arm and leg. Fixed leg rests would be inappropriate for individuals propelling wheelchairs with their lower limbs. Tilt-in-space systems (entire seat and back are tilted posteriorly as a single unit) pre

48
Q

Carotid artery stenosis guidelines

carotid artery comes off subclavian artery

A

For men with recently symptomatic carotid stenosis of 50 to 69 percent, who have a life expectancy of at least five years, CEA is suggested rather than medical management (Grade 2A).
For women with recently symptomatic carotid stenosis of 50 to 69 percent, medical management rather than CEA is suggested.

For patients with recently symptomatic carotid stenosis of 70 to 99 percent who have a life expectancy of at least five years, CEA is recommended rather than medical management alone (Grade 1A).

49
Q

transcranial magnetic stimulation to the un-injured hemisphere in stroke patients showed improvement in what?

A

Aphasia

50
Q

Prolonged PTA puts you at increased risk for

A

late post traumatic seizures

51
Q

palatal myoclonus involves what area of brain

A

The central tegmental tract

52
Q

which structure is responsible for voice hoarseness and dysphagia

A

Nucleus ambiguous which affects CN 9 and 10

53
Q

Unfavorable outcome after stroke is seen with

A

poor sitting balance, prior stroke, coma at onset, significant cardiovascular disease, unilateral hemineglect, poor upper extremity motor function, older age, bowel and bladder incontinence, lack of motor recovery after 1 month, and greater severity of stroke.

54
Q

obstruction of the paramedian branches of the posterior cerebral artery. It causes ipsilateral cranial nerve (CN) III paralysis (hence the ptosis, and dilated, downward, and out pupil) and contralateral hemiplegia.

A

weber syndrome

55
Q

caused by lesions to the basilar artery and results in ipsilateral CN VI and CN VII palsies with contralateral hemiplegia (lateral rectus and facial muscles)…

A

Millard-Gubler syndrome

56
Q

anomic aphasia area

A

temporo parietal injury, angular gyrus….fluent, good comprehension and repitition, but decreased output of nouns and word finding difficulties….alexia and agraphia may be present

57
Q

Huntington manifestation, speech and other

A

Persons with Huntington’s disease often display psychiatric conditions as the first manifestation of their illness. Sometimes psychosis develops and depression is common. Movements may appear fidgety, but ultimately a choreoathetoid movement disorder develops. Speech rate and loudness become variable, and articulation becomes increasingly imprecise (hyperkinetic dysarthria).

58
Q

Muscles for swallowing
soft palate elevation
laryngeal elevation
adduction of vocal cords to protect airway
coordinated pharyngeal constriction and cricopharyngeal relaxation

A 
The cricopharyngeus (needs to relax for swallowing)
pharyngeal constriction.

pharyngeal phase is reflexion, short , bolus propelled into esophagus , req soft palate elevation, laryngeal elevation, and coordination of pharyngeal constriction and cricopharyngeal relaxation

59
Q

transcortical motor area

A

frontal lobe, anterior or superior to broccas area or in subcorticl region deep to broca area

60
Q

prevention of secondary vasospasm after sah/ich

A

nimodipine x21 days

61
Q

blood on T2

A

dark

62
Q

infarction on T2

A

bright white

63
Q

INR goal for cardiac cause of stroke

A

INR 2-3, can also use Xa /direct thrombin inhibitor (rivaroxaban, apixaban, dabigatran)

64
Q

if thromboembolism from carotid stenosis, what pharm combo

A

ASA and dipyridamole

65
Q

if thrombotic stroke, secondary prevention with

A

asa 81 mg

66
Q

motor neucleu

A

CN 3,4,6,12

67
Q

dysphagia I, II, III

A

I: Puree, no chewing
II: mechanically altered
III: soft, some chewing required

68
Q

watershed lesion that isolatse brocas and wernicke’s areas, lesion to the posterior INFERIOR temporal lobe

A

perisylvian speech centers, transcortical sensory aphasiaa….

69
Q

lesion to arcuate fasiculus (parietal operculum)

A

conduction aphasia- normal fluency, normal comprehension and impaired repetition.

70
Q

lesion to the border zone of frontal, parietal and temporal areas would produce

A

transcortical mixed aphasia- imapaired fluency, impaired comprehension, normal repetition.

71
Q

blood in the sylvian fissures, basal cisterns, or intrahemispheric fissue typically indicate ** aneurysm as opposed to traumatic cause

A

saccular aneurysm rupture (for SAH)

72
Q

obstruction of interpenducular branches of posterior cerebral artery or posterior chorodial artery or both causes what

A

weber syndrome (ipsilateral CN 3, contralateral hemiparesis , contralateral parkinson’s signs

73
Q

are of brain for wernicke’s aphasia

A

posterior superior temporal gyrus

74
Q

area of brain for brocas area

A

posterior inferior frontal lobe

75
Q

contraindictation to tPA BP and blood glucose

A

BP >185/110, glucse <5o or >400

76
Q

vertebral artery stroke

A

crossed signs (motor/sensory deficits on ipsi face and contra body) nystagmus, vertigo, absence of cortical signs (aphasias/cog deficit)

77
Q

Which segment of the MCA supplies the subcortical structures?

A

M1

78
Q

vertebral artery comes off of

A

subclavian artery

79
Q

Antihypertensive med initiated at what MAP?

A

130 mmHg

80
Q

A large, typically left MCA stroke that involves the perisylvian region will likely result in what type of aphasia

A

global aphasia

81
Q

what area of stroke is most associated with seizure?

A

temporal

82
Q

With an upper division MCA stroke, the inferolateral portion of the primary motor cortex is affected. Therefore, the legs or arms will be more affected????

what about a lower division MCA stroke????

A

legs will be stronger than the arms and face.

lower division strokes are usually without motor or sensory impairment. However, language, visual deficits and awareness of deficits are usually significant.

Rachel Flash cards (24 decks)

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