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PALS > Stroke > Flashcards

Stroke Flashcards

1
Q

Types of ischemic strokes

A
  • Anterior Cerebral Artery Stroke
  • Middle Cerebral Artery Stroke
  • Posterior Cerebral Atery Stroke
  • Lacunar Infarction
  • Watershed areas
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2
Q

What are cortical signs?

A
  • Speech
  • Awareness
  • Panning

cortex of brain = Cortical signs

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3
Q

MC ischemic stroke type?

A

Middle cerebral artery stroke

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4
Q

Which type of ischemic stroke is this?
- Sensory/motor loss in contralateral legs, Bladder loss
- loss of executive fn if affects the frontal lobe
- +/- Babinski reflex

A

Anterior cerebral artery stroke

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5
Q

What type of stroke is this?
- Sensory/motor loss in the contralateral ARMS & FACE
- Speech deficits if affects the dominant hemisphere of the pt (MC LT)

A

Middle Cerebral Artery

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6
Q

Which type of ischemic stroke is this?
- VISION problems (controlateral homonymous hemianopsia + macular sparing)

cant see out hald of eye in each
Ex. cant see RT field of vision in either eye

A

Posterior Cerebral Artery Stroke

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7
Q

Which type of ischemic stroke is this?
- NO CORTICAL SS (NO issues with speech, awareness, planning)
- +/- sensory numbness of face, arm, and leg on one side of the body
- +/- Pure muscle weakness on half side of body
- +/- MIXED type of motor and sensory

A

Lacunar strokes

cortical signs remain in tact d/t where it is located.
Occlusion to a single branch of a large cerebral a.
ET: HTN, Microangiopathy, Atheromatous Dz, Embolism

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8
Q

Lacunar stroke risk factors

A
  • Chronic HTN -> HTN, Microangiopathy
  • Atheromatous Dz
  • Embolism
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9
Q

In brainstem strokes, Motor/Sensory deficits are Contralateral bc Motor and sensory nerve pathways travel down from brainstem and cross at the level of the ____________

A

medulla oblongata

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10
Q

What do Medial vs Lateral structures in brainstem control?

A

Medial
- fine touch, vibration, proprioception
- eye mvmnt coordination

LATERAL
- pain, temp, crude touch, pressure
- Sympathetic outflow
- send info from muscle and joints -> CNS

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11
Q

What cranial nerves are from each part of the brainstem?
- Midbrain
- Pons
- Medulla

A
  • Midbrain = CN 3-4
  • Pons = CN 5-8
  • Medulla = CN 9-12
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12
Q

Crossed findings =

A

brainstem stroke

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13
Q

Pt presents with LT sided arm and leg weakness and RT sided tongue numbness. Medial Medullary syndrome results from occlusion in the ______ artery

A
  • Anterior Spinal Artery

tongue affected -> think CN 12

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14
Q

Medial pontine syndrome results from a _____ artery occlusion

A

basilar artery branch

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15
Q

Locked-In Syndrome = a complete block of the ____ artery

A

Basilar

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16
Q

Lateral Medullary Syndrome (Wallenberg Syndrome) occurs d/t _______ artery damage

A

PICA (Posterior Inferior Cerebellar)

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17
Q

Lateral Pontine Syndrome occurs d/t ____ artery damage

A

Anterior-Inferior cerebellar

18
Q

Medial Midbrain CVA occurs d/t ____ artery damage

A

Posterior Cerebral

19
Q

Thrombolytics Exclusion Criteria

A
  • CVA/Severe head trauma, Intracranial/spinal Sx in last 3mo
  • Intracranial neoplasm, GI Malignancy
  • Bleed within 21 days
  • Persistent SBP 185+ or DBP 110+
  • Infective Endocarditis
  • PLT Ct <100K
  • Current anticoagulant use + INR >1.7 or PT >15sec or PTT >40sec
  • LWMH within 24Hr
  • Direct thrombin inhibitor or direct factor Xa inhibitor within 48Hr
20
Q

Dyslipidemia can cause which type of strokes?

A
  • Atherosclerotic
  • Lacunar
21
Q

Is alteplase or Tenecteplase MC given for stroke

A

Alteplase

Tenecteplase
- PRO = can be given as single dose IV bolus
- CON = cannot be given with dextrose

22
Q

keep HgA1c ≤ ___ to prevent stroke

A

7

23
Q

If you stop smoking for ____ - ___ years, you will be back down to the same risk for stroke as a non-smoker

A

2-4yrs clean = youre in the clear

24
Q

Are subarachnoid or Intracerebral hemorrhages MC?

A

Subarachnoid

25
Q

Most important modifiable risk factor for subarachnoid hemorrhage strokes

A

Smoking

26
Q

1 ET for subarachoid hemorrhagic stroke

A

Trauma

27
Q

MCC of a NON-TRAUMATIC, SPONTANEOUS Subarachnoid Hemorrhagic stroke

A

Saccular aneurysm rupture in a cerebral artery
- #1 anterior communicating artery

28
Q

Ottawa Subarachnoid Hemorrhage Rule

A
  • Age 40yo+
  • Neck pain/stiffness, Limited neck flexion
  • Witnessed loss of consciousness
  • Onset during Exertion
  • Thunderclap HA (instantly peaking pain)
29
Q

Order a _____ if you suspect subarachnoid hemorrhage

A

lumbar puncture
- Yellow CSF d/t blood breakdown releasing bilirubin
- RBCs in CSF

30
Q

Tx for HTN with Subarachnoid hemorrhage

A
  • SBP <160 or MAP <110
  • Labetolol or Nicardipine

NO NITROPRUSSIDE OR NITRO BC IT WILL INCR CEREBRAL/ICP = BAD)

31
Q

2nd MCC of stroke

A

1 is ischemic stroke

Intracerebral hemorrhage

32
Q

1 Risk factor for intracerebral hemorhage?

A
  • # 1 HTN
  • getting older
  • ASIANS>BLACK>WHITE
  • Antithrombotic meds (Warfarin, DOACs)
33
Q

Is an early complication of subarachnoid hemorrhages hyper or hyponatremia?

A

hyponatremia
- SIADH
- Cerebral salt wasting

34
Q

____ Cholesterol and ____ LDL increases risk of intracerebral hemorrhage

LOW? HIGH?

A

LOW, LOW

35
Q

Which meds increase the risk of intracerebral hemorrhage?

A
  • Warfarin
  • DOACs (Dabigatran, Apixaban, Edoxaban, Rivaroxaban)
36
Q

EKG changes d/t intracerebral hemorrhage

A
  • long QT
  • ST-T wave changes
37
Q

What is the best indicator for Intracerebral hemorrhage prognosis?

A

HTN

38
Q

If pt has intracerebral hemorrhage and has HTN, give…

A

Nicardipine or Labetolol

39
Q

How does blood look on a CT W/O Contrast?

A

Hyperdense

40
Q

Reversal agents?
- Warfarin?
- Dabigatran?
- Factor Xa inhibitors (Apixaban, Edoxaban, Rivaroxaban)?
- LMWH?
- Unfrx Heparin?

A
  • Warfarin -> Vit K
  • Dabigatran -> Idaricizumab
  • Factor Xa inhibitors (Apixaban, Edoxaban, Rivaroxaban) -> 4-factor PCC or Andexanet Alfa
  • LMWH -> Andexant Alfa or Protamine Sulfate
  • Unfrx Heparin? -> Protamine Sulfate
41
Q

ICP Tx

A
  • Midazolam sedation if intubated
  • Mannitol bolus
  • Hypetonic saline
  • FLUIS
  • elevate head of bed >30 degrees
42
Q

Cushing Triad ss that are signs for ICP

A

bradycardia
resp depression
HTN

PALS (7 decks)

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