Stroke Flashcards
Anti-hypertensives in TIA
ACEi and diuretics
Types of stroke
TIA: stroke syndrome + neuro sx lasting mins - 24hrs w/ complete resolution
Ischemic: embolic or thrombotic
Lacunar
Non lacunar (large artery atherosclerosis, cardioembolic, cryptogenic)
Hemorrhagic: intracerebral or subarachnoid
RF
Age
Obesity
Fam hx
HTN
MI
AFin
DM
Dyslipidemia
Smoking
OCP
Sx Right hemispheric stroke
Hemispatial neglect
Deficit + neglect of left visual field
Right gaze preference
Impulsive
Sx Left hemispheric stroke
Aphasia, agraphia, alexia
Slow behaviour
Deficit in right visual field
Left gaze preference
Sx Anterior cerebral
Contralateral sensorimotor deficit (foot + leg)
Arm paresis
Gait ataxia
Bladder incontinence
Personality changes
Amnesia
Sx Middle cerebral
Contralateral sensorimotor deficit (face, arm, leg)
Contralateral homonymous hemianopsia
Contralateral hemispatial neglect
Aphasia, alexia, agraphia
Dysarthria
Sx Posterior cerebral
Pure homonymous hemianopsia
N/V
Ataxia, vertigo
Weakness, sensory loss, dysarthria
Sx Vertebro basilar
Vertigo
Limb + gait ataxia
Cranial nerve dysfunction
Coma
Diplopia
Bilateral motor deficits
Dysarthria, dysphagia
Sx Thalamic
Altered senses
Loss of pain sensation
Contralateral hemiplegia
Hyper-sensitivity to stimuli
Amnesia
Sx Lacunar
Pure motor hemiparesis
Ataxic hemiparesis
Dysarthria + clumsy hand syndrome
Pure sensory stroke
Lifestyle management
Diet: fruit, veg, fibre, low saturated fat + cholesterol (Mediterranean)
Moderate intensity exercise
Smoking cessation
Maintain healthy wt
Limit alcohol
DC OCP + HRT
Primary prevention
HTN: keep BP <140/90
Lipids: Rosuvastatin
AFib: anticoagulant
Carotid stenosis: ASA + carotid endarterectomy
Secondary prevention
HTN: thiazide + ACEi target <140/90 or <130/80 if DM
Lipids: statin, target LDL <1.8
DM: metformin, GLP1 (ASCVD) or SGLT2i (HF or CKD), A1C <7%
AFib: apixaban
Carotid stenosis: carotid US within 24hrs, carotid endartectomy if symptomatic + >50% stenosed
ABCD score >4 = ASA + clopidogrel for 1 mo, then ASA 81mg forever
Management
Non contrast CT or MRI
If arrival within 6hr: + CTA
BW: CBC, INR, PTT, BG, Cr, lytes, ALT, trop, ECG
NPO + swallowing assessment within 24hrs
Alteplase:
<4.5hrs from onset of sx
0.9mg/kg, max 90mg over 60mins
MDT: PT, OT, SW, physiatry, neuro
Evaluate need for supports
Cane/ walker
Home care
Complications
Screen for depression: CBT, SSRI
Vascular cognitive impairment: MOCA, cholinesterase inhibitors or NMDA
Post stroke fatigue
Swallowing/ dysphagia/ aspiration PNA
Bedridden/ decubitus ulcers
Balance/ mobility/ falls
Urinary/ bowel incontinence
Spasticity
Ddx
TIA, brain tumor, hypoglycemia, subdural hematoma, SAH
Complications of stroke
pressure ulcers, aspiration PNA, depression, muscular atrophy, dementia, incontinence, sz, disability
Bells vs stroke difference
Strokes spares forehead
Rx for Bells palsy
lubricant eye drops, steroids, antivirals if severe
What is the Ramsay Hunt triad?
Ipsilateral facial paralysis, ear pain, vesicles in auditory canal
What would you examine in ?Ramsay Hunt?
Auditory canals
TIA ABCD2 score
age >60
BP >140/90
clinical features (uni weakness, speech disturbance)
duration of TIA (10-59 mins = 1, >60 mins = 2)
DM
Ischemic vs hemorrhagic sx stroke
ischemic is early, focal sx, hemorrhagic often starts w/ HA, vomiting then late focal effects
How to answer acute management scenarios
ABC MOVIES w/ actions: airway - check patency and use adjuncts if needed, breathing - apply O2, circulation - 2 wide bore IV, vitals inc neuro vitals, fluids, ECG, sugar check
Acute stroke management in ED
ABC MOVIES
stroke scale
labs (Na, K, Hb, iNR, apTT, Cr, trop, glucose)
2 noncontrast head CTs
- if 4.5-6hrs after sx, add CT angiogram from vertex to arch
- if 6-24hrs add CT angio + CT perfusion, treat fever + BP
Aside from thrombolytics, what else can be used to treat a stroke?
Endovascular thrombectomy (aspiration, vacuum or removable stent)
Indications for thrombolytics
stroke dx + neuro deficit, treatment within 3-4.5hrs, >18y/o
Indications for thrombectomy
acute ischemic stroke, ant circulation, large vessel
