Stroke

Question 1

what is a stroke?

Answer 1

–cerebral vascular accident (CVA)
–problem with blood supply to the brain

Question 2

ischemic attack

Answer 2

–87%
–thrombotic/embolic
–hemorrhagic conversion
–area of brain supplied by clogged vessel loses blood supply

Question 3

types of stroke

Answer 3

–ischemic
–hemorrhagic

Question 4

risk factors for strokes

Answer 4

–HTN
–HLD
–tobacco use
–DM
–obesity
–ETOH abuse
–family hx
–race
–oral contraceptives
–age
–gender
–sickle cell anemia
–physical inactivity
–arterial disease
–hx of TIA
–A Fib
–drug abuse (IV, cocaine)
–heart failure (EF<25%)

Question 5

symptoms of CVAs

Answer 5

–numbness or weakness on one side of body
–sudden confusion
–trouble speaking
–slurred speech (dysarthria)
–trouble seeing
–ataxia
–severe headache

Question 6

ischemic stroke

Answer 6

–occlusion of cerebral artery
–thrombus vs. embolus

Question 7

patho of ischemic stroke

Answer 7

–decrease blood supply
–oxygen deprivation
–neuro deficits within 1 minute
–continued loss of supply leads to irreversible damage

Question 8

causes of thrombotic ischemic stroke

Answer 8

–atherosclerosis
–hypercoagulable state

Question 9

cardiac sources of ischemic strokes

Answer 9

–mural thrombus
–A Fib
–venous clot if atrial septal defect or patent foramen ovale
–thrombus of vegetation of valves

Question 10

how to detect a carotid plaque?

Answer 10

presence of carotid bruit

Question 11

penumbra

Answer 11

ischemic area that is still viable

Question 12

goal with ischemic stroke

Answer 12

salvage the penumbra 3 hours

Question 13

hemorrhagic stroke

Answer 13

–bleeding within the brain parenchyma
–aneurysm
–large area affected (increase ICP with inflammation, herniation, death)

Question 14

what is a hemorrhagic stroke associated with?

Answer 14

long standing, severe HTN
–38% mortality

Question 15

aneurysm

Answer 15

bulging of blood vessel

Question 16

prognosis for hemorrhagic stroke

Answer 16

–age
–location and size
–how rapid the bleed causes brain distortion and shift on scan

Question 17

difference between hemorrhagic and ischemic strokes

Answer 17

hemorrhagic: blood leaks into brain tissue
ischemic: clot stops blood supply to an area of the brain

Question 18

intracranial hemorrhage in epidural

Answer 18

–skull fractures
–arterial
–injury is usually less severe

Question 19

intracranial hemorrhage for subdural

Answer 19

–bridging veins
–brain moves within skull, vessels don’t
–rapid decline
–can be slow 2-10 days

Question 20

subarachnoid hemorrhage

Answer 20

–space between outer arachnoid membrane and pia mater
–area filled with CSF
–rupture of : cerebral aneurysm, arterio-venous

Question 21

AVM presentation

Answer 21

–age 30-60 years
–high morbidity and mortality rates
–serious disabilities
–“worst headache of my life” (hemorrhagic)
–rapid change in LOC
–irritation of meninges (nuchal rigidity, photophobia)

Question 22

tell tale sign of subarachnoid hemorrhage

Answer 22

blood in CSF

Question 23

things to consider with subarachnoid hemorrhage management

Answer 23

–bedrest with sedation
–BP tightrope
–surgical clipping ASAP
–prophylactic anticonvulsant
–nimodipine
–triple H (HTN, hypervolemia, hemodilution)
–risk of re-bleeding especially in 1st 24 hours

Question 24

BEFAST

Answer 24

B: balance
E: eyes
F: face
A: arm
S: speech
T: time to call 911

Question 25

what is the key time period for stroke treatment?

Answer 25

within 3 hours