stroke Flashcards
etiology?
-thrombosis in carotid, cerebral, or vertebral arteries
-embolus from:
heart source (recent MI, endocarditis, prosthetic valve, A Fib)
distant atherosclerotic plaque
-hypercoagulable state in phospholipid syndrome
-hypoperfusion (watershed infarcts)
-paradoxical embolism from DVT
risks?
age >65
male gender bcz estrogen protective
race (indians/african-american)
hypertension
DM
hyperlipidemia
smoking
obesity
excessive alcohol use
atherosclerosis
cardiovascular dx (carotid art stenosis/ a fib)
OCP
symptoms by cerebral artery affected?
anterior: lower limbs > upper limbs, personality changes
middle: upper limbs > lower limbs, contralateral homonymous hemianopia with ipsilateral gaze deviation
posterior: contralateral homonymous hemianopia with macular sparing , visual agnosia
diagnosis?
-BRAIN CT TO EXCLUDE HEMORRHAGE (ischemia is hypodense, hemorrhage is hyperdense)
-carotid duplex for carotid stenosis
-lab studies:
blood sugar for hypoglycemia and DKA
CBC for infection and bleeding
troponin for MI
coagulation profile to assess bleeding risk
ECG for MI and a fib
Echocardiography
management?
- neuroprotective measures:
-maintain normothermia (tx of T>38)
-AVOID hypotension
-keep BP <220/120 if not on tPA and <185/110 if on tPA
-AVOID hyperglycemia keep glucose <7.8 - once hemorrhage is excluded and within 3-4.5hr time window, start tPA, wait for 24hr then start aspirin. IF NOT WITHIN TIME WINDOW start aspirin
IF ALREADY ON ASPIRIN add dipyridamole or switch to clopidogrel - start high dose statins for anti inflammatory effect regardless of LDL
- IV NS avoid dextrose
- monitor for high ICP (ICP: tx with hyperventilation and mannitol)
what are inclusion and exclusion criterias for starting thrombolytic therapy?
inclusion: NIHSS score more or equal to 4
no hemorrhage on brain CT
exclusion:
-blood on CT- (recent 2wk surgery or bleeding or ischemic stroke, severe head trauma in past 3 months, previous ICH, coagulation problems)
-BP >185 or >110
-glucose <2.8 or >22
