stroke Flashcards
stroke is the leading cause of _________ in the US.
disability
Most strokes ( 83%) are ?
ischemic,
the other 17% are hemmorhagic
which type of stroke can we do treat or do something about more readily?
ischemic, we can give tPA
what are some non-modifiable risk factors of stroke?
age, sex, family history
what are some modifiable risks of stroke?
hypertension diabetes smoking hyperlippidemia carotid stenosis atrial fibrilation
what is the key thing about the symptoms that would lead you to diagnose a stroke?
the sudden onset
what are some of the symptoms of stroke?
- numbness of the face,arm, leg esp on one side of the body.
- sudden confusion or trouble speaking or understanding speech
- trouble seeing in one or both eyes
- sudden trouble walking, dizziness, or loss of balance or coordination
- severe headache with no known cause
what are the 3 subtypes of ischemic strokes and which is most common?
small vessel thrombosis (20%)
large vessel thrombosis ( 30%)
embolic stroke ( most common 33%)
other 17% are hemorrhagic
what are the 2 subtypes of hemorrhagic stroke?
intracerebral hemmorage ( 10%) subarachnoid hemorrhage ( 7%)
name 5 things that stroke can mimic?
hypoglycemia, mass lesions, seizures and postictal states, migraine, psychogenic hemiparesis
symptoms affecting the leg and foot are likely due to a stroke in which artery?
the anterior cerebral artery because it supplies the mesial cortex which is where the foot and leg control are
a stroke in the left middle cerebral artery will lead to what?
right hemiparesis in the arm, face >arm> leg
eye fields, receptive and expressive language will also be affected
- left head ( if really not working i.e. extremely blocked) and left eye deviation( anterior division of artery affected)
-visual field deficits in the right eye ( posterior division of artery affected)
a stroke in the posterior cerebral artery would cause symptoms where?
thalamus, and visual cortex, mesial and inferior temporal lobe
a stroke in the right middle cerebral artery will lead to what?
left hemiparesis: face, hand > arm> leg
- left sided neglect
- right head ( if really not working i.e. extremely blocked) and right eye deviation( anterior division of artery affected)
- visual field deficits in the left eye ( posterior division of artery affected)
what are the major symptoms of posterior cerebral artery stroke?
- visual field deficit or cortical blindness if bilateral
- may have hemihypaesthhesia ( complete loss of sensation of contralateral face, arm, trunk, and leg.
what are the common presentations of basilar artery stroke?
altered consciousness or coma, oftener bilateral signs, cranial nerve lesion and crossed signs eg. right facial weakness and left arm and leg weakness.
crossed signs are an indication of a problem where?
in the brainstem
how do patients with lacunar syndromes present?
-pure motor hemiplegia ( internal capsule) and sensory hypaesthesia( thalamus) : internal capsuel ( face= arm= leg ( same amount of paralysis)
pure sensory
-dysarthria clumsy hand syndrome ( pons)
- ataxic hemiparesis
are all lacunar strokes symptomatic?
no some are asymptomatic
what is vertigo of central origin almost always associated with?
other cranial nerve deficits
what does vertical nystagmus ( dancing eyes) indicate?
brain stem ischemia until proven otherwise
neglect or hemi- inattention usually indicates?
right hemispheric stroke
aphasia usually corresponds to?
left hemispheric stroke, right sided weakness is also seen
When does a lenticulostriate hemmorage usually occur?
When hypertension is not controlled
If person has had multiple strokes what might that indicate to you?
that they might have embolic strokes due to atrial fibrilation
How might a brain tumor look in comparison to a stroke?
the brain will be pushed by the tumor and you will see that on the imaging
what are indications for giving a thrombolytic agent?
person is < 80
- it’s an acute ischemic stroke
- onset < 3 hours
- CT is normal or indicates early focal infarct
- NIHSS<24
- absence of exclusionary criteria
what are reasons that you might not give thrombolytic therapy?
Ct signs of hemorrhage or very large infarction
- undetermined time of oset
- uncontrollable hypertension or blood sugar
- recent trauma or major surgery or bleed
- abnormal coagulation profile
- rapidly resolving deficit
- hemodynamic compromise from MI
while thrombolytic therapy is beneficial in 30% of the pts what are the risks and which patients are particularly at risk?
risk: intracerebral hemmorhage
- pts with dense MCAsign are at higher risk ( these ppl have a huge stroke)
does giving a thrombolytic agent completely cure a person of stroke?
no because within 4-5 minutes of onset neurons start to die , but this agent can lead to a much smaller stroke with better outcomes for the pt
