Stroke

Question 1

Stroke is the __most common cause of ___

Answer 1

third

death in the United States

Question 2

The risk factors for stroke are

Answer 2

the same as those for myocardial infarction: hypertension, diabetes, hyperlipidemia, and tobacco smoking

Question 3

Stroke is caused by a sudden blockage in the flow of blood to the brain in __% of cases and by bleeding in __% of cases

Answer 3

85

15

Question 4

Emboli originate from: 2 main sources

Answer 4

heart

Carotid Stenosis

Question 5

Emboli originate from the heart because of:

Answer 5

atrial fibrillation
valvular heart disease
DVT paradoxically getting into the brain through a patent foramen ovale (PFO).

Question 6

Stroke presentation can be divided according 3 different affected arteries:

Answer 6

Middle cerebral artery (MCA) (more than 90% of cases)
Anterior cerebral artery (ACA)
Posterior cerebral artery (PCA)

Question 7

Middle cerebral artery stroke CXFX can be summarized in 3 aspects

Answer 7

1. • Contralateral Weakness or sensory loss
2. • Homonymous hemianopsia
3. • Aphasia

Question 8

Homonymous hemianopsia (MCA) means a loss of visual field on the ____ side of the stroke.
A left-sided MCA stroke results in loss of the __ visual fields.
eyes “look toward the _____ of the lesion.”

Answer 8

opposite
right

side

Question 9

tha MCA aphasia occurs if the stroke occurs on the _______ center. This is the ___ side in 90% of patients.

Answer 9

same side as the speech

left

Question 10

Speech is controlled by the same side as “____.” Right-handed people (__ brain dominant) have a speech center on the __-hand side of the brain.

Answer 10

handedness
left
left

Question 11

Anterior cerebral artery (ACA) stroke has 3 aspects on its CXFX

Answer 11

Personality/cognitive defects such as confusion
Urinary incontinence
Leg more than arm weakness

Question 12

Posterior cerebral artery (PCA) stroke: has 3 aspects on its CXFX

Answer 12

Ipsilateral sensory loss of the face, 9th and 10th cranial nerves
Contralateral sensory loss of the limbs
Limb ataxia

Question 13

The best initial test in any kind of stroke is

and why

Answer 13

CT scan of the head without contrast.
not because it is the most sensitive test for stroke, but in order to exclude hemorrhage as a cause of the stroke prior to initiating treatment

Question 14

The most accurate test is

Answer 14

an MRI.

Question 15

CT scan needs ___ to reach greater than 95% sensitivity. MRI needs ____ to reach
greater than 95% sensitivity.

Answer 15

4 to 5 days

only 24 to 48 hours

Question 16

tPA is used up to __ hours after onset of stroke if:

Answer 16

4.5

• Patient <80 years old
• NIH stroke scale <25
• Not a diabetic with a previous stroke

Question 17

The best initial therapy for a nonhemorrhagic stroke is:

Answer 17

Less than 3 hours since onset of stroke: thrombolytics: tissue plasminogen actvt. if no hystory of bleeding.

More than 3 hours since onset of stroke: aspirin

Question 18

Hemorrhagic stroke Tx

Answer 18

nothing
Hemorrhagic stroke has no
treatment to reverse it. Surgical drainage will not help outside posterior fossa.

Question 19

If the patient is already on aspirin at the time of the stroke, the answer is:

Answer 19

Add dipyridamole
or
Switch to clopidogrel

Question 20

how to manage an stroke with symptoms that last <24h

Answer 20

it’s a transient ichemic attack. Add Aspirin

Question 21

Treatment for prevention of a stroke is with either ______. Do not ___them!

Answer 21

aspirin or clopidogrel
combine

you can combine dipyridamole with aspirin as an equivalent of clopidogrel.

Question 22

Angioplasty______ answer.

why

Answer 22

apparently is the worng

it would rupture the vessel

Question 23

catheter retrieval of clot in stroke: It is useful up to ____ h after stroke.

Answer 23

6-12.