Stroke Flashcards
What scale can be used to assess the liklihood of impending stroke in a patient with TIA?
Age>60 Blood pressure >140/90 Clinical (unilateral weakness = 2 points, speech impediment = 1) Duration (over 60 minutes = 2 points) Diabetes (= 1 point) 4-5 points = 4% risk 6-7 = 8% risk
What are the cortical signs?
aphasia
apraxia
neglect
field cut
A patient presents with leg weakness greater than arm weakness, numbness, abulia, perseveration. The area affected is..
ACA
A patient presents with contralateral hemiparesis, sensory loss, hemianopsia and difficulty speaking. This is..
left MCA
A patient presents with contralateral hemiparesis, sensory loss, hemianopsia and neglect and extinction. This is..
right MCA
A patient presents with contralateral hemiparesis, crossed sensory findings and cranial nerve findings. This is..
brainstem lesion
A patient presents with ataxia, vomiting, occipital headaches, gaze palsy and facial weakness. The location of this lesion is..
cerebellum
A patient prejsents with deep coma and paraplegia, pinpoint reactive pupils and decerebrate rigidity. Suspect…
pontine hemorrhage
What is the window of opportunity for stroke tPA?
3.5-4 hours
A patient presents with nystagmus, vertigo, ipsilateral face loss of pain and temperature, contralateral trunk and limb loss of pain and temperature. There may be associated weakness of muscles in the bulbar region as well as Horner’s syndrome. The lesion is…
lateral medulla - wallenburg syndrome
A patient presents with headaches, progressive mental decline and multiple neurologic defects after a SAH. Suspect..
subacute hydrocephalus
What are the contraindications to TPA treatment?
more than 4.5 hours recent surgery rapidly improving BP > 185/100 signs of hemorrhage no seizure INR > 1.7 head trauma, MI, stroke in last 3 months crazy off glucose prior hemorrhage or tumor
What are other steps that can be taken in management of ischemic stroke?
maintain bed at level
IV normal saline
remain normothermic
remain normaglycemic
What blood pressure should be maintained in stroke?
permissive hypertension - hold all antihypertensives, only lower if above 220
What are the major categories of etiology for stroke?
artery (hyperlipidemia, smoking, eg)
blood (coagulation disorder)
cardiac (e.g. atrial fibrillation)
Who are the patients that should receive carotid endarectomy?
symptomatic patients with 70-99% lesion or asymptomatic patients with 60-99% lesion
What steps should be taken in management of hemorrhagic stroke?
bed at 30 degrees below, lower BP
What is the most common cause of non traumatic ICH in the elderly?
amyloid angiopathy
What are some of the factors that determine prognosis in a patient with ICH?
infratentorial? blood volume >30cm age >80 intraventricular glasgow coma scale
What are some of the common causes of stroke in younger populations?
patent foramen ovale, carotid dissection AVMs, moyamoy disease - cerebral vasculopathy, drugs, TB,
What is the most common cause of acute new onset seizure in adults?
tumor or stroke until proved otherwise
If a patient has an aneurysm clipped and deteriorates a few days later, what might have happened? how do you treat?
vasospasm - treat with nimodipine
A 43 year old woman comes to the ER with LOC, severe headache and photophobia. CT shows no bleeding. What is your next step?
LP
