stroke

Question 1

stroke is the leading cause of _________ in the US.

Answer 1

disability

Question 2

Most strokes ( 83%) are ?

Answer 2

ischemic,

the other 17% are hemmorhagic

Question 3

which type of stroke can we do treat or do something about more readily?

Answer 3

ischemic, we can give tPA

Question 4

what are some non-modifiable risk factors of stroke?

Answer 4

age, sex, family history

Question 5

what are some modifiable risks of stroke?

Answer 5

hypertension
diabetes 
smoking
hyperlippidemia
carotid stenosis
atrial fibrilation

Question 6

what is the key thing about the symptoms that would lead you to diagnose a stroke?

Answer 6

the sudden onset

Question 7

what are some of the symptoms of stroke?

Answer 7

• 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

Question 8

what are the 3 subtypes of ischemic strokes and which is most common?

Answer 8

small vessel thrombosis (20%)
large vessel thrombosis ( 30%)
embolic stroke ( most common 33%)
other 17% are hemorrhagic

Question 9

what are the 2 subtypes of hemorrhagic stroke?

Answer 9

intracerebral hemmorage ( 10%)
subarachnoid hemorrhage ( 7%)

Question 10

name 5 things that stroke can mimic?

Answer 10

hypoglycemia, mass lesions, seizures and postictal states, migraine, psychogenic hemiparesis

Question 11

symptoms affecting the leg and foot are likely due to a stroke in which artery?

Answer 11

the anterior cerebral artery because it supplies the mesial cortex which is where the foot and leg control are

Question 12

a stroke in the left middle cerebral artery will lead to what?

Answer 12

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)

Question 13

a stroke in the posterior cerebral artery would cause symptoms where?

Answer 13

thalamus, and visual cortex, mesial and inferior temporal lobe

Question 14

a stroke in the right middle cerebral artery will lead to what?

Answer 14

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)

Question 15

what are the major symptoms of posterior cerebral artery stroke?

Answer 15

• visual field deficit or cortical blindness if bilateral

- may have hemihypaesthhesia ( complete loss of sensation of contralateral face, arm, trunk, and leg.

Question 16

what are the common presentations of basilar artery stroke?

Answer 16

altered consciousness or coma, oftener bilateral signs, cranial nerve lesion and crossed signs eg. right facial weakness and left arm and leg weakness.

Question 17

crossed signs are an indication of a problem where?

Answer 17

in the brainstem

Question 18

how do patients with lacunar syndromes present?

Answer 18

-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

Question 19

are all lacunar strokes symptomatic?

Answer 19

no some are asymptomatic

Question 20

what is vertigo of central origin almost always associated with?

Answer 20

other cranial nerve deficits

Question 21

what does vertical nystagmus ( dancing eyes) indicate?

Answer 21

brain stem ischemia until proven otherwise

Question 22

neglect or hemi- inattention usually indicates?

Answer 22

right hemispheric stroke

Question 23

aphasia usually corresponds to?

Answer 23

left hemispheric stroke, right sided weakness is also seen

Question 24

When does a lenticulostriate hemmorage usually occur?

Answer 24

When hypertension is not controlled

Question 25

If person has had multiple strokes what might that indicate to you?

Answer 25

that they might have embolic strokes due to atrial fibrilation

Question 26

How might a brain tumor look in comparison to a stroke?

Answer 26

the brain will be pushed by the tumor and you will see that on the imaging

Question 27

what are indications for giving a thrombolytic agent?

Answer 27

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

Question 28

what are reasons that you might not give thrombolytic therapy?

Answer 28

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

Question 29

while thrombolytic therapy is beneficial in 30% of the pts what are the risks and which patients are particularly at risk?

Answer 29

risk: intracerebral hemmorhage

- pts with dense MCAsign are at higher risk ( these ppl have a huge stroke)

Question 30

does giving a thrombolytic agent completely cure a person of stroke?

Answer 30

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