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Clinical Neurosciences > Stroke > Flashcards

Stroke Flashcards

1
Q

what is the leading cause of permanent disability in adults

A

stroke

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2
Q

what is the 3rd leading cause of death in North America

A

stroke!

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3
Q

what time do strokes normally occur

A

in the morning between 8AM and 10AM

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4
Q

age group most affected by strokes

A

over the age of 65

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5
Q

which sex is more affected by strokes

A

males

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6
Q

what race is affected more by strokes

A

African Americans more than Caucasians

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7
Q

Reson why strokes often occur in the morning

A

due to blood pressure

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8
Q

risk factors fro stroke

A 
hypertension
heart disease
previous stroke or TIA
carotid bruit
diabetes mellitus
smoking
age
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9
Q

number for risk of stroke in hyptertension

A

6 X

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10
Q

number for risk of stroke in heart disease

A

2-6X

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11
Q

number for risk of stroke in previous stroke/TIA

A

10X

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12
Q

risk for stroke if carotid bruit

A

3x

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13
Q

risk of stroke for smoking

A

2x

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14
Q

age for stroke risk

A

doubles every 10 years after 55

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15
Q

number one risk factor for stroke

A

hypertension

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16
Q

examples of potential genetic risks factors for stroke

A

apolipoprotein e4
elevated homocysteine levels
factor V mutation

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17
Q

hemorrhagic stroke types

A

intracerebral and subarachnoid

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18
Q

types of ischemic strokes

A

atherothrombotic/embolic
cardioembolic
small vesel disease

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19
Q

cardiogenic emboli strokes are commonly caused by

A

atrial fibrillation

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20
Q

what type of emboli are usually larger, longer, lasting and MORE DAMAGING than other sources

A

atrial fibrillation emboli

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21
Q

what is nonbacterial thrombotic endocarditis

A

condition where you develop clots in the heart because you have cancer somewhere else

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22
Q

if both hemispheres are involved what should you look for

A

atrial fibrillation emboli

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23
Q

what is a transient ischemic attack

A

last less than 24 hours, a sudden FOCAL neurlogical deficit that is confined to an area of brain or eye perfused bya SPECIFIC artery

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24
Q

what is a RIND

A

reversible ischemic neurological decifit that lasts up to a week

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25
Q

Carotid TIA symptoms

A

unilateral weakness and numbness, aphasia, and monocular ision loss!

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26
Q

vertebrobasilar TIA symptoms

A

bilateral weakness, numbness and vision loss with a combination of diplopia, vertigo, ataxia, and dysphagia

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27
Q

partial or complete vision loss in one eye

A

amaurosis fugas

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28
Q

like a shade covered by eye

A

amaurosis fugax

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29
Q

how long does amaurosis fugas last

A

less than 5 minutes

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30
Q

embolic infract

A

seizure
focal deficit
sudden onset
hemorrhagic transformation

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31
Q

thrombotic infract

A

slowly progressive

preceded by TIA

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32
Q

symptoms of internal carotid occlusion

A

usually asymptomatic if circcle of willis is well developed

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33
Q

hemiplegia, hemianesthesia (leg more affected than face and arm, urinary symptoms, apathy)

A

ACA occlusion

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34
Q

apathy associated with

A

ACA occlusion

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35
Q

urinary symptoms associated more with

A

ACA occlusoin

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36
Q

homonomous hemianopia indicative of

A

MCA occlusion

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37
Q

aphasia if dominant hemispher affected

A

MCA occlusion

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38
Q

hemiplegia and hemianesthesia of face and arm more than leg

A

MCA occlusion

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39
Q

PCA occlusoin

A

homonomous hemianopia, hemiplegia, hemiparesis, affects the peduncles and brainstem

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40
Q

also known as nonfluent, expressive or anterior aphasia

A

brocas aphasia

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41
Q

characterized by broken difficulties producing speech but understanding is intact

A

brocas aphasia

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42
Q

also known as fluent, receptive or posterior aphasia

A

wernicke aphasia

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43
Q

characterized by impaired comprehension, paraphasia, neoglisms and gibberish

A

wenicke aphasia

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44
Q

lesion of posterior perisylvian region produces what type of aphasia

A

wernicke aphasia

45
Q

lesion of the arcuate fasciculus leads to

A

conduction aphasia

46
Q

common symptom of conduction aphasia

A

difficulty with reptition

47
Q

type occlusion resulting in global aphasia

A

MCA occlusion

48
Q

small vessel disease is also known as

A

lacunar infracts

49
Q

presentation of lacunar infarcts

A 
pure motor
pure sensory
pseudobulbar palsy
clumbsy hand
hemitaxic-hemiplegic
50
Q

how are lacunar infarcts diagnosed

A

clinical syndrome

51
Q

what are risk factors for small vessel disease

A

hypertension and diabetes

52
Q

recurrence rate of lacunar infarcts is high if what

A

if blood pressure is NOT controlled

53
Q

what is used to diagnose lacunar infarcts

A

MRI’s NOT CT SCAN!!!

54
Q

how are lacunar infarcts treated

A

control blood pressure
antiplatelet agents
carotid endartectectomy

55
Q

what are some common causes of a carotid dissection

A

migraines
oral contraceptive in smokers
cocaine and vasoactive agents

56
Q

third nerve palsy and contralateral hemiplegia from midrain stroke

A

weber syndrome

57
Q

occlusion of verteral or PICA resulting in ipsilateral facial numbness, ataxia, horners, dysphagia, hoarseness, loss of taste, numbness, and CONTRALATERAL pain and temperature

A

wallenberg syndrome

58
Q

what should you do to prevent ischemic penumbra from growing

A

relative hypotention
hypoxia
hyperglycemia (over 200)
hyponaturemia

59
Q

what are neuroprotetive agents for ischemic penumbra

A

NMDA, NO, GABA, calcium, and free radicals

60
Q

examples of antiplatelet agents

A

aspirin
ticlopidine
clopidogrel
dipyridamole (modofied release)

61
Q

which antiplatelt drug requires monitoring

A

ticlopidine (neutropenia and thrombocytopenia)

62
Q

what drug is used to lower cholesterol

A

pravastatin

63
Q

anticoagulative drugs

A

heparin

64
Q

lowering cholesterol drugs

A

pravastatin (normal LDL<70)

65
Q

patients with asymptomatic carotid stenosis

A

60% stenosis did better with surgery

66
Q

symptomatic carottid stenosis

A

greater than 70% stenosis did beter with surgery

67
Q

asymptomatic carotid stenosis approach

A

control risk factors
educate about TIA symptoms
cardiac workup
surgery if indicated

68
Q

what are the indications for anticoagulation

A

progressive TIA
known source of emboli
Afib
hypercoagulable states

69
Q

what are some contraindications of for haparin

A

sensitivity to heparin
bleeding
uncontrolled hypertension
large infracts

70
Q

what are some complications of heparin therapy

A 
hemorrhage
excessive anticoagulation
hypertension
large infracts 
embolic infarcts
thrombocytopenia
71
Q

what is TPA

A

converts plasminogen to plasmin resulting in fibrinolysis and must be used within the first

72
Q

what drug do you use first to control someones blood pressure before administrating TPA

A

labetalol

73
Q

what are the features hypertensive encephalopathy

A

headache, confusion, seizure, and focal deficit

74
Q

what is transient global amnesia

A

sudden loss of memory that occurs in middle age to elderly that’s cause ins most likely vascular in nature with a benign prognosis

75
Q

what decades are associated with giant cell arteritis

A

6-8th decades

76
Q

features of temporla arteritis

A

headache, fever, anorexia, blidness and tender artery and aching stuf muscles

77
Q

treatment of temporal arteritis

A

self limited, steroids

78
Q

what are the causes of idiopathic intracranial hypertension

A

pregnancy
sinus thrombosis
obesity
vitmain A, old tetracycline and steroids

79
Q

features of IIH

A

headache, papiledema, Cranial Nerve 6 Palsy

80
Q

spinal tap pressure greater than 250 indicates

A

increased pressure

81
Q

how do you treat idiopathic intracranial hypertension

A

self limited, diruetics, surgerym succcessive spinal taps

82
Q

venous thrombosis caused by

A

idiopathic, pregnancy, trauma, infection, tumors, oral contraceptives, malnutrition, hematological

83
Q

features of venous thrombosis

A

papilledema, seizures, cranial nerve deficits, proptosis, chemosis, and focal deficits

84
Q

located in the white matter and is associated with a tumor or hematoma

A

vasogenic edema

85
Q

result of cellular swelling and involves both the gray and white matter and is associated with hypoxia and infraction

A

cytotoxic edema

86
Q

how do you treat cerebral edema

A

hyperventilation
mannitol/glycerol
steroids
diruetics–pee off the fluid

87
Q

what is the most common cause of intraparenchymal hemorrhage

A

hypertension due to rupture of small penetrating arteries

88
Q

location of intraparenchymal hemorrhage

A

putamen, thalamus, pons cerebellar lobar

89
Q

blood in CSF is indicative of

A

subarachnoid hemorrhage

90
Q

95% of subarachnoid hemorrhages are located in the

A

anterior circulation

91
Q

what two diseases are associated with subarachnoid hemorrhage

A

polycystic kidney disease and coarctation of the aorta

92
Q

clinical features of subarachnoid hemorrhage

A

sudden worst headache of life, nuchal rigidity, alert to coma, focal deficits, and may have warning leak

93
Q

Hess and Hunt grading scale type 1

A

asymptomatic, slight headache

94
Q

Hess and Hunt grading scale type 2

A

moderate to severe headache; nuchal rigidity

95
Q

Hess and Hunt grading scale type 3

A

drowsy, mild focal deficits

96
Q

hess and hunt graiding type IV

A

semicomatose, posturing

97
Q

hess and hunt grading type V

A

deep coma, decerebrate rigidity

98
Q

complications to subarachnoid hemorrage

A

vasopasm
rebleeding
hydrocephalus

99
Q

diagnosis of subarachnoid hemorrhage

A

H and P
CT scan
lumbar puncture
angiogram

100
Q

nimodipine

A

calcium channel blocker that has been shown to prevent vasospasm from happening due to subarachnoid hemorage

101
Q

treatment of subarachnoid hemaorrhage

A

nimodipine, bed rest, sedation, control bp, stool softener, pain, surgery, coiling

102
Q

caused by septic emboli which lodges and weakens the blood vessel walls and is associated with bacterial endocarditis

A

mycotic aneurysms

103
Q

what should you NOT DO WITH mycotic aneurysms

A

do NOT anticoagulate

104
Q

features of areteriovenous malformation

A

headache, seizure, bruit, and hemorrhage

105
Q

lucid interval

A

epidural hematoma

106
Q

laceration of middle meningeal artery

A

epidurla hematoma

107
Q

type of hemorrhage where are most often comatose from the start

A

acute subdural hematoma

108
Q

tearing of briding veins

A

acuete subdural hematoma

109
Q

signs of subdural hematoma

A

blown pupil, hemiplegia, cushingg’s reflex, and altered respirations

Clinical Neurosciences (16 decks)

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