Stroke Flashcards
Types of ischemic strokes
- Anterior Cerebral Artery Stroke
- Middle Cerebral Artery Stroke
- Posterior Cerebral Atery Stroke
- Lacunar Infarction
- Watershed areas
What are cortical signs?
- Speech
- Awareness
- Panning
cortex of brain = Cortical signs
MC ischemic stroke type?
Middle cerebral artery stroke
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
Anterior cerebral artery stroke
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)
Middle Cerebral Artery
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
Posterior Cerebral Artery Stroke
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
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
Lacunar stroke risk factors
- Chronic HTN -> HTN, Microangiopathy
- Atheromatous Dz
- Embolism
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 ____________
medulla oblongata
What do Medial vs Lateral structures in brainstem control?
Medial
- fine touch, vibration, proprioception
- eye mvmnt coordination
LATERAL
- pain, temp, crude touch, pressure
- Sympathetic outflow
- send info from muscle and joints -> CNS
What cranial nerves are from each part of the brainstem?
- Midbrain
- Pons
- Medulla
- Midbrain = CN 3-4
- Pons = CN 5-8
- Medulla = CN 9-12
Crossed findings =
brainstem stroke
Pt presents with LT sided arm and leg weakness and RT sided tongue numbness. Medial Medullary syndrome results from occlusion in the ______ artery
- Anterior Spinal Artery
tongue affected -> think CN 12
Medial pontine syndrome results from a _____ artery occlusion
basilar artery branch
Locked-In Syndrome = a complete block of the ____ artery
Basilar
Lateral Medullary Syndrome (Wallenberg Syndrome) occurs d/t _______ artery damage
PICA (Posterior Inferior Cerebellar)
Lateral Pontine Syndrome occurs d/t ____ artery damage
Anterior-Inferior cerebellar
Medial Midbrain CVA occurs d/t ____ artery damage
Posterior Cerebral
Thrombolytics Exclusion Criteria
- 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
Dyslipidemia can cause which type of strokes?
- Atherosclerotic
- Lacunar
Is alteplase or Tenecteplase MC given for stroke
Alteplase
Tenecteplase
- PRO = can be given as single dose IV bolus
- CON = cannot be given with dextrose
keep HgA1c ≤ ___ to prevent stroke
7
If you stop smoking for ____ - ___ years, you will be back down to the same risk for stroke as a non-smoker
2-4yrs clean = youre in the clear
Are subarachnoid or Intracerebral hemorrhages MC?
Subarachnoid
Most important modifiable risk factor for subarachnoid hemorrhage strokes
Smoking
1 ET for subarachoid hemorrhagic stroke
Trauma
MCC of a NON-TRAUMATIC, SPONTANEOUS Subarachnoid Hemorrhagic stroke
Saccular aneurysm rupture in a cerebral artery
- #1 anterior communicating artery
Ottawa Subarachnoid Hemorrhage Rule
- Age 40yo+
- Neck pain/stiffness, Limited neck flexion
- Witnessed loss of consciousness
- Onset during Exertion
- Thunderclap HA (instantly peaking pain)
Order a _____ if you suspect subarachnoid hemorrhage
lumbar puncture
- Yellow CSF d/t blood breakdown releasing bilirubin
- RBCs in CSF
Tx for HTN with Subarachnoid hemorrhage
- SBP <160 or MAP <110
- Labetolol or Nicardipine
NO NITROPRUSSIDE OR NITRO BC IT WILL INCR CEREBRAL/ICP = BAD)
2nd MCC of stroke
1 is ischemic stroke
Intracerebral hemorrhage
1 Risk factor for intracerebral hemorhage?
- # 1 HTN
- getting older
- ASIANS>BLACK>WHITE
- Antithrombotic meds (Warfarin, DOACs)
Is an early complication of subarachnoid hemorrhages hyper or hyponatremia?
hyponatremia
- SIADH
- Cerebral salt wasting
____ Cholesterol and ____ LDL increases risk of intracerebral hemorrhage
LOW? HIGH?
LOW, LOW
Which meds increase the risk of intracerebral hemorrhage?
- Warfarin
- DOACs (Dabigatran, Apixaban, Edoxaban, Rivaroxaban)
EKG changes d/t intracerebral hemorrhage
- long QT
- ST-T wave changes
What is the best indicator for Intracerebral hemorrhage prognosis?
HTN
If pt has intracerebral hemorrhage and has HTN, give…
Nicardipine or Labetolol
How does blood look on a CT W/O Contrast?
Hyperdense
Reversal agents?
- Warfarin?
- Dabigatran?
- Factor Xa inhibitors (Apixaban, Edoxaban, Rivaroxaban)?
- LMWH?
- Unfrx Heparin?
- 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
ICP Tx
- Midazolam sedation if intubated
- Mannitol bolus
- Hypetonic saline
- FLUIS
- elevate head of bed >30 degrees
Cushing Triad ss that are signs for ICP
bradycardia
resp depression
HTN
