Stroke

Question 1

most freq site of athersclerotic lesions in cerebral vasculature? May result in transient monocular blindness known as:

Answer 1

Amaurosis fugax. Site: common carotid artery bifurcation

Question 2

contralateral weakness and sensory loss in face and arm? incidence?

Answer 2

Middle cerebral artery (MCA). Most common type of focal stroke (2/3 of infarcts).

Question 3

Which demographic is at highest risk?

Answer 3

A.Amer males, followed by A.Amer females. Overall, men slightly > females

Question 4

What is a TIA? Time frame?

Answer 4

transient (min to hours) of neurologic dysfunction wo/ evidence of acute infarction

Question 5

Focal neurologic deficit DDX?

Answer 5

Stroke, TIA, seizure, atypical migraine, hypoglycemia (DM)

Question 6

What do you image with TIA?

Answer 6

Definite carotid US and echo and probably CT. CBC, glucose, cholesterol, ECG, CXR

Question 7

Tx for TIA?

Answer 7

Tx Carotid disease or heart disease. Otherwise aggressive tx for HTN, cholesterol, DM…

Question 8

% of patients with TIA that will present again with TIA/stroke in 90 days?

Answer 8

23%

Question 9

Define stroke

Answer 9

sudden onset of focal neurologic deficit that persists for at least 24 hours due to cerebral circ deficit

Question 10

Define the subtypes and incidence of stroke

Answer 10

HEMORRHAGIC (17%): intracerebral and SAH and ISCHEMIC (83%): lacunar, lg vessel, embolism, crytogenic

Question 11

most common stroke with HTN and DM. Progession? CT findings?

Answer 11

Lacunar. May progess over 24-26 hrs! small lesions in brainstem, cerebellum, cerebrum seen as HYPODENSE area

Question 12

Most common disorder that leads to strokes? Most important RF for all strokes? other RF for stroke?

Answer 12

Atherosclerosis and HTN.

Smoking, DM, HLD (hyperlipidemia), Etoh

Question 13

What do you suspect with a rapid progession and HA?

Answer 13

HEMORRHAGE. HA is uncommon with ischemic stroke.

Question 14

History and PE?

Answer 14

ONSET. BP, pulse, CV exam, Fudoscopic, complete NEURO

Question 15

Prehospital stroke scale?

Answer 15

Cincinatti: open mouth and smile, hold arms out for 10 sec, “you can’t teach an old dog new tricks”

Question 16

What image do you want to order?

Answer 16

non-contrast CT. MRI can detect stroke better but ruling out HEMORRHAGE (thrombolytic CI)

Question 17

Contralateral leg weakness greater than arm weakness?

Answer 17

Anterior cerebral artery (ACA)

Question 18

visual cortex defects and decreased sharp and light-touch sensation?

Answer 18

Posterior cerebral artery

Question 19

hemianopsia seen sometimes with which vascular territory? What else might you lose?

Answer 19

MCA ass with hemianopsia and aphasia if dominant hemisphere is affected.

Question 20

abrupt onset HA in back of head ar upper neck with photophobia and N/V

Answer 20

SAH

Question 21

Tx of stroke

Answer 21

Stablize, hydrate, early nutrition, PREVENT ASPIRATION, treat FEVER, MOBILIZE within 24 hrs

Question 22

Criteria for tPA?

Answer 22

• Within 4.5 hours of symptom onset.
• CT rules out hemorrhage.
• No bleeding anywhere.
• N coags and platelets. INR < 1.7
• Not acute HTN
• No hx hemorrhagic stroke

Question 23

3 preventative therapies?

Answer 23

• Satin for CAD AND even AVG. LDL levels*
• anti-HTN (even in non-HTN)
• ASA for women (NOT men) NOT two agents

Question 24

DDX for severe HA, depressed consciousness, N/V

Answer 24

Intracerebral hemorrhage and SAH. ICH (bleeding into the ventricles or parenchyma) may result in hozizontal diplopia and papillemdema and pre-retinal bleed.