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neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

How much is RR reduced if pt is admitted to stroke unit vs non stroke unit?

A

17% RRR of death and disability

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2
Q

Window for giving tPA alone?

A

world consensus is 4.5hrs
- 6 hours based on lancet meta analysis

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3
Q

If there is evidence of pneumbra (perfusion imaging mismatch) and nil contraindications for tPA, what is the tPA time window?

A

Up to 9 hrs

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4
Q

If their is confirmed large vessel clot + core infart + perfusion imaging mismatch (penumbra), what is the ECR window?

A

up to 24 hrs

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5
Q

Should tPA be WH prior to ECR (assuming nil contraindications for tPA)?

A

No, should give tPA then ECR

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6
Q

Large vessel occlusive stroke, planned for tPA and ECR. Given alteplase vs tenecteplase?

A

tenecteplase achieved better recanilisation than alteplase prior to ECR

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7
Q

Best unit to treat hemorrhagic stroke pts?

A

Stroke unit (derives similar benefit from stroke unit care as an ischemic stroke pt)

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8
Q

Indication / criteria to close PFO in stroke pt?

A

Pt selection is key

Age <60
no other emobilic mechanism
large shunting PFO +/- atrial septal aneurysm

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9
Q

NAOC vs warfarin best for prevention of ischemic and haemorhagic stroke?

A

NOAC are best for non valvular AF
- ischemic and haeorhagic stroke RRR 19% wsith NOACs
- Haemorhagic stroke RR 51%

Note risk in GIT haemotrhage is increased with NOACs compared to warfarin

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10
Q

Absolute and relative contraindications for thrombinolysis?

A

Absolute:
- Acute ICH
- Extensive frank hypodensity on CT (>1/3 MCA territory) this should promt Ix of timing of stroke
- Active non compressible bleeding (ie GI bleeding)
- Known coagulopathy
- Plt count <100
- INR >1.7 (including on warfarin)
- theraputic LMWH within 24 hrs
- NOAC within 48hrs
- IE
- thorasic aorta dissection

Relative:
- uncontrolled HTN
- recetn intracranila surgery
some more

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11
Q

When should u start NOAC for NVAF following acute ischemic stroke?

A

2-6 days post depending on size and location of infarct

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12
Q

AF underlies a significant number of cryptogenic ischemic stroke. how can u improve survivial in these pts post stroke?

A

The longer u look for AF (ie with holter or loop recorder) the more AF u will find and (because u anticoagulate) the more future strokes us with prevent

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13
Q

What is andexanet? when is it used

A

MAB reversle agent for FXa inhibitor (apix and riva)

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14
Q

What is Idarucizumab?

A

Antidote to dabigatran
- Can be given to dabigatran pts, then tPA can be given imidiatly after

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15
Q

How long for DAPT therapy post minor stroke or TIA?

A

DAPT for 3 weeks to 3 months, then switch to monotherapy for life

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16
Q

WHen is teh risk of recurrent ischemic stroke teh highest post acute stroke or TIA?

A

first 2 weeks

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17
Q

Antricoagulent choiuce post cerebral artery dissection?

A

Any (no evidence to show one is better than the other)

18
Q

Target LDL post acute stroke?

A

target LDL <1.8 with statin +/- fibrate
(for non cardioembolic stroke. remember that AF pts can have noncardioembolic strokes too but is less likely than cxardioembolic)

19
Q

Which is better for treatment of severe asymptomatic carotid artery stenosis: CEA vs CAS?

A

CEA
- intervention for severe asymptomatic carotid artery stenosis remains controversial

20
Q

Strongest RF predicting stroke risk recurrance following TIA or stroke?

A

1 multiple infarcts on imaging

#2 large artery atherosclerosis in the associated region
# ABCD2 score 6-7

21
Q

Best anti HTN for control of HTN to reduce stroke risk?

A

Ca channel blockers
- BB actually increase stroke risk unless they are needed for heart (ie AF pt)

22
Q

Insulin pump vs sliding scale for difficult to control sugars in stroke pts?

A

sliding scale
insulin pump is associated with more adverse risk of recurrent stroke

23
Q

Encourage mobilization or rest in firs 24 hrs post stroke?

A

rest

Mobilisation pre 24hrs increases risk of further stroke

24
Q

What is evolocumab and Alirocumab?

A

Treatment of resistant hypercholesterolaemia on top of statin therapy
- reduces CV death, MI and stroke by 20% in pts with CVD but VERY difficult to access

25
Q

Classification of strokes?

A

Haemorhagic 15%
- Parenchymal
- SAH

Ischemic 85%
- Atherosclerotic disease (large vessel) leading to hypoperfusion, arterioembolic event
- Small vessel arteriosclerosis (lacunar infact)
- Cardioembolic stroke
- Cryptogenic stroke
- Other

26
Q

Timeline / phases of an acute stroke?

A

Hyperacute period (first 6 hours from onset)
- Can given tPA without looking for salvageable penumbra

Late hyperacute period (6-24hrs)
- revasc in select cases (ie penumbra)

Acute stroke (24-72hrs)

Subacute (72hrs to 3 week)

Chroinic >3 weeks

27
Q

Clinical assessment tools for stroke?

A

modified rankin score - functional status
NIHSS - score from 0 to 42
- changes from second to second and from observor to observor

28
Q

What is amyloid angiopathy? Demographic, features on imaging

A

Cerebral amyloid angiopathy (CAA) is a type of cerebrovascular disorder characterized by the accumulation of amyloid within the leptomeninges and small/medium-sized cerebral blood vessels. [1] The amyloid deposition results in fragile vessels that may manifest in brain bleeds

Usually lobar distribution of bleeds / microbleds, multiple at once
Elderly patient with cognitive impairment

29
Q

In contrast to amyloid angiopathy, where do HTN related bleeds occur?

A

Deep (ie basal ganglia, cerebellum, brain stem)
Lobar bleeds in the elderly are amyloid

30
Q

Imaging features of SAH?

A

Star pattern in basal cistern on CTA
- due to berry aneurysm

31
Q

BP target in hemorrhagic stroke?

A

SBP <140 for first 2 weeks

32
Q

CT negative thunderclap headache? what is next test and when to do?

A

LP for xanthochromia, wait at least 12 hrs for this to develop

33
Q

Only 2x risk factor that increases your risk of an aneurysm rupture?

A

Previous aneurysm rupture
- other things like smoking, hep C, HTN, etoh, FHx are not risk factors for rupture

Size of aneurysm
- Ant circ aneurysms >7mm - treat
- post circ aneurysms >5mm -treat

34
Q

Treatment for unruptured AVM, ? surgical intervention vs nil?

A

nil
- they do bleed but usually not too badly
- do worse if intervene

35
Q

In hyperacute stroke, MRI DWI mean …. ? FLAIR means…?

A

DWI - cytotoxic oedema, not infarcted yet
FLARI - infarcted (irreversible ischemic injury)

36
Q

Intervention that reduce risk or death and morbidity in acute stroke?

A

thrombinolysis
ECR
Stroke unit care
aspirin
hemicraniectomy

37
Q

Is tPA beneficial in >80yrs?

A

Yes, no age limitations
- although increased risk of bleeding

38
Q

What are the FSS targets for an acute stroke pt?

A

Fever
- temp <37.5

Swallow
- dont eat unti SP review or asasisted swallow

Sugars
- miantain <11.1

39
Q

DVT prevention in acute stroke?

A

Proph LMWH
SCDs - sequential compression device

Dont use TEDs

40
Q

WHen is hemicraniectomy indicated in acute stroke?

A

Extensive MCA stroke in fit pt <60 years (TACI syndrome ie NIHSS >20 usually)

41
Q

Treatment for cerebral venous sinus thrombsis?

A

Anticoagulation with hepartin or LMWH
Continue even if they bleed

42
Q

What is valvular AF?

A

AF associated with mitral stenosis, mechanical heart valve, or rheumatic heart disease

neurology (6 decks)

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