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OMS - 2 Neuro Final > Stroke > Flashcards

Stroke Flashcards

1
Q

Define stroke

A

Acute focal injury are the central nervous system by vascular cause → deficit

(irreversible brain damage, brain cell death)

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2
Q

Two main different types of stroke

A
  • Ischemic ~80% (TOAST)
  • Hemorrhagic ~20% (SAH & ICH)
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3
Q

New criteria for dx stroke

A

TOAST

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4
Q

stroke is the _______ MC cause of death in the US

A

3rd

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5
Q

Types of ischemic Strokes

A
  • Large artery
  • Lacunar
  • Cryptogenic (unknown origin)
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6
Q

Difference between a ischemic stroke and “mini stroke”

A
  • TIA = “mini stroke”: FND (focal neurologic deficit) resolves in minutes, imaging normal
  • Ischemic stroke: permanent, irreversible FND
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7
Q

Modifiable risk factors for stroke (5)

A
  1. HTN
  2. Hyperlipidemia
  3. DM
  4. Heart: CAD, A-fib
  5. Diet/lifestyle: Tobacco
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8
Q

Stroke: non-modifiable risk factors (4)

A
  1. Age (increases every year, 60+)
  2. Sex (young male & 65+ females MC)
  3. Genetics
  4. Fam Hx
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9
Q

What is included in the ABCD2 score?

A
  • Age
  • BP >140/90
  • Clinical feature: weakness 2 points, speech=1
  • Duration
  • Diabetes 2
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10
Q

3 Types of TIA

A
  1. Embolic
  2. Lacunar
  3. Large artery
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11
Q

2 Types of hemorrhagic stroke

A
  1. Intraparenchymal
  2. Subarachnoid hemorrhage

(star of death: aneurysm)

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12
Q

Watershed stroke looks like ______ on imaging

A

linear pattern

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13
Q

2 Causes of ischemic stroke

A
  1. cardio (clots from heart or emobli from sepsis)
  2. atherosclerosis
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14
Q

What is an important reference for determining where the acute ischemic stroke is in the brain?

A

Motor homunculus

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15
Q

ACA territory stroke: symptoms (5)

A
  1. Contralateral leg weakness
  2. Urinary incontinence
  3. Akinetic Mutism
  4. Tactile agnosia
  5. Gait impairment

(supplies frontal lobe & parietal lobe)

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16
Q

MC LVO’s

A

MCA territory stroke

(usually dominant (left) hemisphere)

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17
Q

PCA territory stroke: presentation

A
  • Contralateral homonymous hemianopia
  • Hemisensory loss

(occipital lobes

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18
Q

MCA territory stroke: symptoms

A
  1. Contralateral hemiparesis
  2. Contralateral hemisensory loss
  3. Hemianopia
  4. Aphasia: depends on location/size
  5. Hemispatial neglect (cannot preceive one half of the world around them)
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19
Q

Thalamic stroke (aka Lacunar Strokes (means “little lake”)) is a _____ etiology.

A

hypertensive

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20
Q

Pure motor stroke (lacunar stroke syndrome): deficit

A

Contralateral hemiparesis: weak face, arm, leg

(pure sensory is numb face, arm, leg)

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21
Q

Thalamic stroke sensory deficits (aka Pure sensory stroke or lacunar stroke syndrome) & nuclei involved.

A
  1. VPL of thalamus (L for Limb)
  2. VPM nucleas for face (M for mask, meaning face)
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22
Q

Pure sensory stroke (lacunar stroke syndrome): presentation

A

Contralateral hemisensory loss: numb face, arm, leg

(pure motor is contralateral hemiparesis: weak face, arm, leg)

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23
Q

Thalamocapsular stroke (aka sensorimotor stroke or lacunar stroke syndrome) is combined ____ deficits. Damage to the ____ (2).

A
  • Contralateral paresis and sensory loss
  • Internal capsule + thalamus

(mix between pure motor & pure sensory)

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24
Q

Dysarthria-Clumsy Hand (lacunar stroke syndrome): presentation (2)

A
  1. Slurred speech
  2. Weakness of contralateral hand; decreased fine motor skills
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25
Q

Dysarthria-Clumsy Hand (lacunar stroke syndrome): damage to _____

A

pons (CN V-VII)

(it can localize anywhere outside the CNS)

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26
Q

Ataxia-Hemiparesis (lacunar stroke syndrome): presentation

A
  1. Weak leg
  2. incoordination of ipsilateral arm & leg

(Contralateral hemiparesis and ataxia)

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27
Q

CADASIL is due to a ______ mutation

A

notch 3

(AD)

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28
Q

Fabry’s Disease genetic inheritance

A

X-linked

29
Q

Fabry’s disease causes stroke and is due to _______.

A

lysosomal alpha-galactosidase A deficiency

30
Q

CADASIL patients have recurrent ______

A

small vessel strokes

31
Q

Initial evaluation: Stroke code

A
  1. Straight to the scanner! (“time is brain”~ 2 million neurons die/min)
  2. CT head
  3. MRI
  4. CBC, PT/INR, CMP, glucose
  5. TTE

(don’t need contrast for CT or MRI, only w/angio)

32
Q

What is one of the most important questions when working up a patient with a possible stroke?

A

“When was the patient last known well?”

(we need to know when the symptoms started)

33
Q

What is evaluated in an NIHSS score?

A
34
Q

Define ischemic penumbra

A

Potential irreversible brain tissue injury caused by hypoperfusion after a stroke

(can be calculated and mapped)

35
Q

What is this (image to the right)?

A
  • this identifies the ischemic penumbra
  • green = penumbra
  • red = ischemic core
36
Q

Acute stroke therapy: 2 options

A
  1. Thrombolysis: TPA, tenecteplase
  2. Endovascular
37
Q

Thrombolysis (TPA): inclusion criteria (2)

A

NIH>2 or disabling sx

38
Q

tPA relative contraindications

A

glucose < 40

(make sure the sx aren’t due to hypoglycemia)

39
Q

Thrombolysis: exclusion criteria (5)

A
  1. Intracranial hemorrhage (last 3 mo.)
  2. Hypertensive (SBP must be <185/110)
  3. Active internal bleeding
  4. Bleeding at non-compressible site
  5. symptoms for >4.5 hrs
40
Q

Endovascular therapy (mechanical thrombectomy) indications (2)

A
  1. Can be performed up to 24 hours after onset of symptoms
  2. NIH > 5
41
Q

Endovascular (mechanical thrombectomy): inclusion criteria

A
  • Evidence of large vessel occlusion on CT angio / perfusion
  • Sizable ischemic penumbra relative to ischemic core
42
Q

Post-acute stroke therapy management (after thrombectomy) (2)

A
  1. CTP
  2. CTA
43
Q

Post-acute stroke therapy management (after tPA) (4)

A
  1. Close neurologic monitoring in ICU for 24 hours
  2. BP control between 160-185 mmHg
  3. no anti-platelet or anti-coagulation for 24 hours
  4. repeat CT
44
Q

Post-acute stroke therapy: blood pressure must be ________.

A

between 140-185

(can reduce by 20 mmHg over the next 24 hours)

45
Q

Define young stroke

A

Strokes in patients less than 50 years old

46
Q

Workup for patients who present with a stroke who are less than 50 years old (3).

A
  1. Hypercoagulable panel
  2. Transesophageal echocardiogram (Patent foramen ovale)
  3. Long-term cardiac monitoring (A fib)
47
Q

Hypercoagulable panel includes (5)

A
  1. factor deficiency
  2. protein deficiency
  3. mutations
  4. antiphospholipid Ab syndrome
  5. lipoprotein
48
Q

Gold standard for ischemic stroke evaluation

A

MRI

(more detail of brain tissue, stroke territory, edema)

49
Q

Left:

Right:

A
  • Diffusion-weighted: white = ischemia
  • Paired diffusion co-efficient map: black = ischemia

(confirms stroke: if white on diffusion-weighted and dark or “drop out” on co-efficient map)

50
Q

Acute stroke management after TPA or thrombectomy (3)

A
  1. PT/TOT
  2. speech therapy
  3. screen for depression
51
Q

Stroke complications (3)

A
  1. cerebral edema
  2. epilepsy
  3. depression
52
Q

Stroke: prevention recommendations

A
  1. Diet (Mediterranean diet: fruit, veggie, lean meat, nuts)
  2. Exercise: 150 min moderate/week or 30 min x 5 days
  3. Blood pressure control
  4. Blood glucose control
  5. Weight control
53
Q

hyperhomocysteinuria can cause stroke and is due to _______.

A

impaired cystathionine B-synthase

(AR)

54
Q

Fibromuscular dysplasia can have a stroke due to _______.

A

arterial dissection

55
Q

polycystic kidney disease is associated with ______ & _____.

A
  • berry aneurysms
  • SAH
56
Q

Marfan’s orr Ehlers-Danlos type IV is associated with stroke due to _____.

A

dissection

57
Q

MELAS can cause stroke and is due to ________.

A

mitochondrial disease w/metaboic stroke-like brain lesions

58
Q

FAST

A
  • Face : can they smile
  • Arms : can they raise arms
  • Speech
  • Time
59
Q

Right-hemisphere stroke deficits (2)

A
  1. left side movement & sensation
  2. analytical & perception tasks
60
Q

Left-hemisphere stroke deficits (2)

A
  1. right-sided movement/sensation
  2. speech/language ability
61
Q

Gaze preference

A

they look toward the side of the stroke

62
Q

cerebellar stroke patients will present with ______.

A

balance & coordination deficits

63
Q

Brain stem strokes will present with ______ (4) deficits.

A
  1. eye movement
  2. hearing
  3. speech
  4. swallowing
64
Q

Dominant hemisphere stroke sx (2)

A
  1. aphasia
  2. contralateral hemiplegia: arm/face>leg
65
Q

Non-dominant hemisphere stroke sx (2)

A
  1. contralateral hemi-neglect
  2. contralateral hemiplegia arm/face>leg
66
Q

Parietal-occiptal stroke deficit (3)

A
  1. visual
  2. sensory
  3. language
67
Q

Stroke/lesion location: facial numbness, weak jaw, lateral rectus palsy, facial weakness

A
  • CN V – facial numbness, weak jaw movement
  • CN VI – lateral rectus palsy
  • CN VII – facial weakness
68
Q

Stroke/lesion location: vertigo/hearing loss, dysphagia, weak palate or tongue weakness

A
  • CN VIII – vertigo, hearing loss
  • CN IX, X – dysphagia, weak palate
  • CN XII – tongue weakness
69
Q

metabolic workup for stroke patient (5)

A
  1. lipid panel
  2. HbA1C
  3. TSH
  4. Blood glucose
  5. T/PTT/INR

OMS - 2 Neuro Final (36 decks)

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