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EM 2 > stroke > Flashcards

stroke Flashcards

1
Q
  • sudden onset of focal neurological deficits due to a vascular cause
  • needs imaging to distinguish between hemorrhagic & ischemic
A

stroke

progresses fast so triage with high importance even if deficits arent ba

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2
Q

3 types of ischemic strokes

A

thrombotic d/t atherosclerosis
embolic d/t cardiac source
lacunar/small vessel

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3
Q

typically causes pure motor OR pure sensory sx

A

lacunar ischemic stroke

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4
Q
  • Sudden onset of neurological or retinal symptoms (e.g., hemiparesis, hemi-sensory loss, aphasia, neglect, amaurosis fugax, hemianopsia, or ataxia)
  • Lasts < 24 hours before resolving completely (often < 15 min)
  • Not associated with any acute infarction on neuroimaging
A

TIA

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5
Q

clot formation causes narrowed lumen which blocks blood movement

what type of stroke

A

thrombotic stroke

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6
Q

clot or debris circulating that gets stuck in a brain vessel

“showered” from heart

A

embolic stroke

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7
Q

burst blood vessel that may allow blood to seep into brain tissue until clotting shuts off the leak

A

hemorrhagic stroke

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8
Q

what is the point of recanalization in the evolution of acute ischemic stroke

A

it makes it so the pneumbra (at risk area) is saved. the core (irreversible damaged area) stays infarcted

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9
Q

6 risk factors for AIS & which ones are modifiable

A
  • Older age
  • HTN, Hyperlipidemia
  • Smoking
  • DM
  • Hypercoagulability
  • Cardiac arrhythmias

bolded are modifiable!

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10
Q

general sx of AIS

A
  • weakness, numbness
  • aphasia
  • dysarthira
  • gaze deviation, vertigo
  • facial droop
  • ataxia, gait instability
  • vision changes, N/V
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11
Q

general MCA occlusion sx; Left & Right specific sx (4)

A
  • ipsilateral gaze deviation
  • contralateral sensory loss, facial droop, visual field deficit and arm weakness
  • Left MCA: aphasia
  • Right MCA: left hemi-neglect, speech intact
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12
Q
  • Crossed signs of CN deficits (gaze palsies, facial droop) mixed with contralateral weakness
  • Alternating hemiparesis or posturing
  • Locked-in syndrome
  • Acutely obtunded or comatose – with pinpoint pupils
  • Myoclonic jerks simulating status epilepticus

where is the occlusion

A

basilar/vertebral artery

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13
Q
  • Contralateral LEG weakness and sensory loss
  • Variable loss of executive function

where is the occlusion

A

ACA

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14
Q
  • Contralateral visual field deficit (complete or partial)
  • Occasional sensory deficits
  • Occasional contralateral leg > arm weakness
  • Occasional memory loss

where is the occlusion

A

PCA

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15
Q

differentiate stroke from bells palsy

A
  • bells has a more gradual onset
  • bells palsy is NOT forehead sparing (it wont raise)
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16
Q

central vs peripheral lesions

  • unilateral droop w/ intact forehead raise
A

central lesion

17
Q

how is bells palsy managed? what if its bilateral?

A
  • eye drops, tape eyelid shut at night
  • if bilateral, must r/o Lyme dz
18
Q

what should you do If your patient developed a focal neuro deficit within the last 24 hours

A

CALL STROKE CODE

19
Q

what is the door-to-needle time goal when there is a code stroke?

A

under 60 minutes

20
Q

parts of NIH stroke scale

A
  • level of consciousness (LOC)
  • LOC questions & commands
  • best gaze
  • visual fields
  • facial paresis
  • motor each arm & leg
  • limb ataxia
  • sensory
  • langauage/aphasia
  • dysarthria
  • extinction
21
Q

if no tPA, permissive HTN up to?
BP should be blow what prior to giving tPA?

A
  • permissive HTN up to 220/120
  • BP under 185/110 prior to tPA
22
Q

try to list 8 absolute C/I to IV tPA

A
  • Significant head trauma, stroke, intracranial or spinal surgery in prior 3 months
  • Prior history of ICH or intracranial neoplasm
  • GI malignancy or bleeding within 21 days
  • CT with ICH or large hypodensity (> 1/3 of cerebral hemisphere)
  • Currently taking DOACs or warfarin (in case of warfarin, INR > 1.7 = cutoff)
  • Platelet count < 100,000
  • Blood glucose < 50 mg/dL
  • BP sustained over 185/110 mmHg
23
Q

No antiplatelet agents, anticoagulation, or DVT chemoprophylaxis for ____ after tPA bolus

A

24 hours

24
Q

what is the BP goal when using tPA? how do you treat elevations?

A

SBP under 180, DBP under 105
tx w/ labetalol 10mg IV OR hydralazing +/- continuous nicardipine infusion

25
Q

TIA evaluation (4)

A
  • if sx still present, run code stroke
  • CT &/or MRI/MRA
  • labs & cardiac monitoring
  • ABCD2 score– admit if score over 3
26
Q

review ABCD2

A

Age over 60
BP over 140 or over 90
Clin features of TIA
Duration (over 1hr gets 2)
Diabetes

27
Q

Atherosclerotic vs embolic TIA meds

A
  • atherosclerotic– DAPT
  • emolic– long term anticoag
  • medical management after TIA focuses on risk factor modifications
28
Q

2 distribution signs that numbness is d/t CNS

A
  • generalized unilateral involvement
  • trunk involvement
29
Q

define plexopathy

A

involves one limb but more extensive (brachial plexus)

30
Q

C5, C6, C7 tests which reflex?

A
  • C5: bicepts
  • C6: brachioradialis
  • C7: triceps
31
Q

is acute/subacute onset numbness more likely to be emergent or non-emergent?

A

potentially emergent

32
Q

Whole body numbness evaluation

A

non-neurologic and does not require a specialized work-up

33
Q

numbness + motor deficits evaluation

A

emergent work up

EM 2 (4 decks)

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