Stroke Flashcards
Wallenberg ipsilateral (6)
Horner Nystagmus Ataxia Hoarse No facial pain
Wallenberg aka.
Lateral medullary syndrome
Wallenberg contra lateral
No limb pain appreciation
No limb temp spinal thalamus
Anton aka….
Top basilar syndrome
Patho of Anton
Occipital and deep
Mortality rate of basilar
80 percent
50 with intervention
Symptoms of Anton
Learning and menmory hippo Sleepy Mutism Can't see Can look to side Can look up
Dumb jock Anton
What is the difference between a stroke screen and a stroke evaluation?
Stroke evaluation by speech therapist
Why is everyone npo who is a stroke?
Aspiration pneumonia is a common complication
What do you order for embolic stroke
Cardio consult
Heart monitor
Tee
Xeralto
Order for low blood sugar
Glucose chewable 12g Dextrose 40% gel 15 g Glucagon inj 1 mg Insulin lispo Saline
Starting Dose of Lipitor for stroke?
20mg
Can work at 10
Give provastatin 40
Why no long term atypical antipsychotics
Increase risk for stroke
How do you treat an acute ischemic stroke without TPA.
Into rectal aspirin 300 mg or Plavix 300 mg which is a loading dose.
What is the dose of Lipitor for stroke.
20 limiter was a prudent 10 mg 80 mg is contraindicated. You don’t want to go to high with her because their limits might be too low.
Why shouldn’t you get a CTA with a patient and INO
Doesn’t affect treatment. Get an MRI
What is a good sign for prognosis of stroke.
Show recovery in 2 weeks good sign.
Thalamus and motor deficit
4/5 real gets better
What happens to reflex overtime with stroke
Starts upper motor goes away over time.
Dose of Asa suppository. Order info for Asa
300 Asa suppository
Chew able 81
Pupil problem with syphylis
Argyle Robertson.
What did they do before ct for head aches.
Pneumocephalogram. Take out csf. Pump in air. X-ray
How much csf do you make
150 cc every 8 hr 270 ml per day
How much csf do you make per day
Per shift
Total volume
600 to 700/ day
125/shift
150 to 270 ml total
How often does an echo show anything in stroke
3%
That is why it is on the care plan
How can you tell if edema is stroke or tumor
Tumors have fingers projections.
Vasogenic
90 day risk with a Tia
17%
What percentage of of Tia have an intact
1/3rd
What are the two goals of imaging
- Rule out bleed with ct or MRI
- Assess risk factors stenosis and afib
Pump an pipes.
How helpful is lowering you blood pressure in preventing stroke
Reduces by 30 to 40 percent
Best treatment for blood pressure
Fruits
Vegetables
Weight loss
Clean living
Best med for blood pressure
Diuretic Ace i
How to approach someone with bp issue with stroke
Wait. 1 day and 120/80
What happens when you give statins with someone with low cholesterol
Bleed
When would be the only time that you go in with intervention with a basilar stroke
If it’s a thrombus or in it within 24 hours- and it’s miraculous
When can you start prophylaxis for ICH pt? What is tx
48 hr
5000 bid
What blood sugar should you
240
What do you see with SAH lumbar puncture
Rbc. 1000, does wash out
What do you see if you look at a SAH after 2 hrs.
ISO density
So do lp
How do u categorizes SAH
Hunt and Hess 1- 5
On hunt Hess what signifies bad prognosis.
Grade 3 w/ mild focal paresis
What do you order with dx SAH
Angiogram is more sensitivity
MRI
Tox screen
Saline 80 to 100
How many people have more than 1 aneurysm?
15
Non aneurysm causes for SAH
Avm
Venous thrombosis
Vasculitis
% that rupture in 2 week SAH
20%
Peak for vasospasm with SAH
7 days
% of adults with aneurysm
2%
Risk of stroke with coil or clipping SAH
Risk of rupture per year
2%
- 7%
- big is bad
When do you treat SAH conservatively
Less than 10 mm
Serial imaging
Most important precaution to tell a SAH
Don’t smoke.
What doesn’t SAH have compared to ICH and ischemic
No focal sign
Uncommonly found in ischemic.
Head ache
Define Tia.
No infarct
How long does it take to cause infarct
1 to 2 hrs
Why are Tia a term that is falling out of favor
Imaging is becoming more sensitive
5y risk with Tia
50 %
90 day risk for Tia
17%
Most important management step in Tia
Duplex ica
% of stroke that are cardio embolic.
15 to 30
Tell tail sign with cardio embolic cause
Sudden
Maximum at onset
Syndromes associated with cardio embolic
Hemianopsia with out paresis
Wernicks
Apraxia
Large stroke causes eyes to..
Large. Stroke away
The mgt of algorithm depends on
Stroke mechanism
Eyes with brain stem
Eyes look toward brainstem lesion
Transient eye loss
Amaris fugus
Large vessel stenosis percentage
15 %
LOC is associated w brain region
brain stem
Tips for embolic stroke
Single branch territory
What do you call a atherosclerotic plaque
Atheroma
Atheroma rarely extends into.
Surface vessels
Causes of mainstream branch
Embolic vs. Atherostenosis
Term for narrowing of arteries d/t plaques
Local Artherostenosis
Mult. Lenticulaostriate branches. Licensure cz by
Embolic not Lucian
How to dx foramen ovale
Bubble test - 10 ml saline agitates
How to look at atria wall for pfo
Contrast Transophageal echocardiography
Large vessel stenosis dx w
Duplex Doppler
Mra
Symptoms of large vessel stenosis
Shoulder is different than the hand
How to differentiate between inter arterial embolism and cardio embolic.
Intra arterial is smaller cortical than cardio embolic.
Cardio embolic decreases concious.
-cardio more likely to have an abnormal initial ct bc the clots from embolic are brighter.
What do u call it when fat breaks off and clogs an artery.
Embolic fragments arise from atherosclerotic plaques
Lacuna strokes account for %
15 to 20
Where do lacunae strokes occur
White matter in the subcortical area.
What brain region do lacuners occur in
Thalamus
Basal ganglia
Pons
Patho of lacunar
Lipohyalinosis on arteriolar wall
-fibrinoid necrosis
Small fat clot and small blood clot
MicroatheromaMicroemboli
Percent of people over 65 with a silent lacunar
20 %
Associates with lacunar
Hypertension
How many small deep infarct syndromes
70
% of strokes that have an undetermined after workup
40 % Aortic arch Ct to early Angio too late Hyperagulation Meds
Hyper coagulation states
Protein c Protein s Fibrinogen levels Factor 5 Lupus Anti cardio lipin
Symptoms of dissection vertebral and carotid
Neck trauma Neck Side of face Teeth Jaw Retro orbital
“Beaded look”
Granulomatous angitis of the brain
What is granulomarous angitis
Mult. Small infarcts in cx deep structures
Csf and granulomarous anagitis
100 protein
500 mononuclear
Images for vasculitis
Arterial narrowing on angiography
Intravenous heparin indication
Large vessel Stenosis
Cardio embolic or large 6h out
Cud
Vertebra basilar
If you don’t do an endarterectomy what can you do.
Stent
Monitor 3 to 12 mo
Risk with endarterectomy
Improvement of stroke
3 percent
50 percent in 5 yr
9 vs 26% in 2 yr
What if some fails Asa
Aggrenox unless migraines
25 do pu rid a mole
200 mg bid
Why use clopidogrel
No headache 1 time per day
% of. ICH
15%
ICH volume that is fatal
80
ICH with good prog
20 ml
Cost of aggrenox
115/ mo
Asa few dollors
Risk of bleeding on Asa
1.5%| yr/ gi dose dependent
What study showed plavix and Asa was not benificial.
Match
Mgt of antherothrombosis clop in high risk
Is Asa plus dipy rid a mol
Yes twice as effective
Esps2
What do you need to know about ticlopidine
Blood problems labs
Less bleeding
If someone is allergic to a sprain with stroke
Clopidogrel
Reason for plavix with comorvidities
CAD
Peripheral artery disease
Smoking
Mi
If they fail on Asa 81 mg
Go 162 Asa or platelets
Study that compared warfarin and Asa were similar in afib
Warss
But the pt were pretty sick
How does Asa work
Blocks cyclo oxygenate
Prevent prostaglandin
Thromboxane a2
From arachnid omit
M1 of mca supplies
Basal ganglia and internal capsule
Symptoms of aortic dissection
Neck pain
Head pain
Cause of vertebral dissection leading
Vertebral artery dissection
Reason for plavix and Asa combo
Afib
Diagnosis carotid dissection
CTA can’t if creatine high
Mra - can’t if stim
Carotid last resort
Reason for plavix and Asa combo
Afib
Who has intra vs extra artherosclerosia
White are extra
Hisp are intra
Do we give someone tpa who has a 10 that goes to a 5
Yes.
If you have an nih 1 or 2 what type of stroke
It is goig to be a lacunar
Problem synthesis of SAH
Man w/ severe headache, AMS, stiff neck, photophobia, cn 3
Why is previcol better than Lipitor
More lipophilic
Percentage who wake up with stroke
20 percent
How long does it take to get tpa if you call 911
84 min
How long does it take if you drive yourself.
270
3.5 hrs
When did tpa get approved by FDA
95
Why do some get worse after tpa.
Reocclusion
1/3 rd reocclusion early
Risk factor for bleed
Elevated fibrin Baseline hyperglycemia Nih score over 20 Major arteries Severe neurological impairment Violating thrombo lytic protocol Fall Not Asa
What happens if you give thrombotic after 12 hr
Cardiac rupture
Drug that is related to tongue edema anaphylaxis.
Ace inhibitor
What is heparin
Glucos amino glycans mixture
How does heparin work
Inactivated thrombin
By binding to anti thrombin 3
Inhibits factor 10 but activates 11
How does heparin affect platelet function
Platelet factor 4
What do you have to know about heparin and its anti inflation effects
Only in the infractionated form
How do you test heparin efficacy
APTT 1.5 times control
Factor 10 .3 units/ml to .5
What reverses heparine
Prot amine sulfate
1mg counteracts 100 units of heparin
Why is heparin bad to use
Too variable hard to dose accurately. Weight bases.
How would you dose heparin
Weight based nomogram
Trick with administering prot amine
What happens?
Give slowly bc it causes hypotension
Why is low molecular weight heparin better than unfractionated 5
- Small - less bleed
- More stable
- Longer half life
- No affect aPTT
- Neuroprotective effects
No anti inflammatory effects
How to treat high blood pressure with stroke
Lab 10mg Iv over 2 min, doub q 10 min , max 300mg, can inf .5-2ng/min
Nicardapine. 5mg/ hr, inc by 2.5/hr q 5 min (max 15mg)
Nitroprusside .5 to 10 micron/kg/min
Plasma dose
10 to 20 ml
How do you fix fibrinogen levels
200 mg/dl of cryo
If tpa cause bleed! Oh shit
Stop tpa Ct Labs Cryo and plasma Neuro consult and heme
Percent of seizures after stroke
5 to 10
Percent of stroke complicates by dysphagia
45 percent
How long does dysphagia last
About a week
Image for arterial dissection
Axial t1 weighted image w fat suppression of neck
Do you need an echo if you know they have a fib
No. You are going to treat anyway.
How long after a stroke do you see central pain syndrome.
A month
Thalamic lesion cause what symptoms
Pure sensory hemi anesthesia
Name for loss of pin prick
Hemianalgesia
Name for no touch
Hemianesthesia
Anatomy of pseudo bulbar dementia
Subcortical dementia
What is weber syndrome
Contralateral weakness face, arm leg
Ipsilateral cn3
Where is weber located anatomically
Midbrain
Where is foville’s located
Pons
What is foville’s symptoms
Contralateral weakness
Ipsilateral cn 7
Small pupils
Spinal cord lesions described as line
Sensory level
Browns sequard
Hemi cord syndrome
Symptoms of anterior horn ALS
Fasciculations Upper extremity wasting Spastic legs Huperreflexia Wasted uppers and hyper legs
Stocking glove distribution suggests what type of neuropathy
Poly neuropathy
How can you differentiate spinal level, acute cord and transverse myelitis
Traverse myelitis has hyper decreased ste and then later hyper reflex is
Can. Stroke cause Parkinsonism
Yes it is call vascular Parkinson’s
Most telling sign of Parkinson’s
One sided asymmetric.
Summary of Parkinson’s
Asymmetric symptoms without cognitive, hallucinations pyramidal
Early signs of Parkinson’s
Decrease blinking
Arm swing
Trouble with make up
Rolling over in bed
Early complains of pd
Hypophonia Micrographia Handling utensils Shaving Fine motor problems
Signs of diffuse Lewy body
Delirium
Hallucinations
Early dementia
Signs of supra nuclear palsy
Downward gaze palsy
Balance problems
Prominent neck rigidity
Signs of multisystem atrophy
Incontinence
Dysphagia
Orthostatic hyptension
Signs of corticobaasal ganglionic degredation
Asymmetric
Myoclonus
Apraxia
Alien limb
Test to differentiate Parkinson’s
Pet shows hyper metabolism in the striatum of a true pet scan.
Which drugs neuroprotective for pd
Q10
Agilect
Perhaps senimet
Agilect aka
Ra SAg iline
What age is consided old that would receive sine my first line
75
Starting dose of sine met
25 bid
Work up to three time a day
How does sinemet compare in efficacy to sinemet cr
70 percent
So 70 short acting - 100 long acting
What happens if someone on sinemet cr get gi issue
Pretty common when old
Switch to short acting
What if someone has Parkinson’s who can’t swallow.
Parcopa sublingal
Disintegration tablet
What is stalevo
Carbidopa/levodopa/comt
Doses of stalevo
50 100 150
How is com pt inhibitor improve stalevo 2
Makes levodopa 1.3 time more effective
Lasts longer
Starting dose of stalevo
50 tid
What is the max comt dose
1600 or 8 tabs bc all stalevo has 200 mg of comt
Side effect and percentage of stalevo
1 in 20 get diarrhea
Most common side effect of levodopa
Nausea and hypotension
What is the minimum dose of carbidopa pa per day
75/day
What if pt gets nausea with sinemet
Take with meals
Or add lodsyn or carbidopa
Take with ginger preparation
Tx for urinary problems hyperactive with Parkinson’s
Detail la has fewer cognitive problems
Ditropan has more confusion
Check uti
Parkinson’s hypo active bladder
Flowmax
What must you check before you give Detrol
Orthostatic
Treatment for orthostatic changes
Stockings Dec dopamine drugs Dec hypertension drugs Fludrocortisone .1mg Midrodrine 2.5 mg
Surgery for of tremor
Thalam otomy
-Ventral is intermediis thalamus
-part of thalamus that receives cerebellar afferent
-
Problems associated with bilateral thalmotomy
Dysarthria
Speech issues 50%
Problem with unilateral pallidotomy
Only lasts 6mo to 2 year
Side effect of pallidotomy
Hypophonia
Problems with palli do tiny
Only works for Parkinson’s with cardinal feature
They miss the gpi
The average improvement with deep brain stimuli
40 to 60 bilateral
Why can’t crazy people get DBS
Your depression must be well controlled
Side effects of DBS bilateral
Confusion
Why would you only implant 1 DBS at a time
1 side might be all it takes
Treatment for essential tremor
Thalamic
Tx for DBS and Parkinson location
STM or gpi
What do you call it when we over treat high blood pressure
I at tro genic hypotension
How long does Todd paralysis last
20 min to 24 hr
How long does a seizure take to march
2 min
How long does a migraine take to march
10 to 30 min
Evidence for lacuna stroke
Stutter Classic pattern Straight forward All sensory All motor All speech
When do you order a tee
When you are suspecting afib
If you already know there in afib what is the point just anticoagulate
Small stroke is caused by
Lipohylinosis with clot formation
Most important part of treating small vessel
Cholesterol and plavix
Why is cea better than stent ing
Because stent ing has more risk of death
When to do stenting 2
Large stenosis w recurrent symptoms
Or if on plavix cea not a candidate
Treatment with atherosclerotic aortic with mobility component
Warfarin
Cardiac sources of stroke
Afib
Ef 25
Wall motion
Pfo
What does pfo risk for
Atrial septal aneuysm
Not a risk of stroke
How does statin work
Decrease inflammation assiciated with arherosclerotic
Enzyme assoc with statin
Hmg co at reductase inhibitor
Optimum bp after stroke
140
Three things to tell pt after tia
Stop smoking
Get bp down
Get cholesterol down
B
C
S
Treatment of high bp with stroke sys 180
Monitor
Bp control w tpa sys 231
Iv labetolol 20
Iv labetolol diastolic over 140
Nitroprusside
Bp and tpa dia 105
Lab 10
Systolic 180 bp and tpa
Lab 10
When does edema peak
3 to 5 days
After you give tpa what are you looking for
Any reason stop tpa, drop, and tpa roll
How do treat copd desat
Keep them at the baseline
Most deviates toon complication of stroke
Icp dt edema
Things that worsen icp with stroke
Heat co2 hypercapnia
Reversing edema with stroke to Prev uncle
Hypertonic saline
Hypervent
When do you order an EEG to check for non convulsive status
Fluctuating consciousness
What do you call it when they have secret seizures
Non convulsants status epileptics
How common is a seizure after stroke
4 to 40; recurrent up to 80
When and how to prevent dvt
Start sq heparin 5000 bid
How to prevent bed sore
turn pt every 2 hr
How to treat bed sores
Wet to dry
How long do you delay using warfarin for cardioembolic
5 day asparin then start warfarin after ct
Explain hemorrhagic stroke transformation
If recanulization occurs
Blood now can enter infect tissue. Which can lead tonic bleeding
When do we treat htn in pt patient wo tpa
Not for days unless over 220 or 120
Do we tx bp fast or slow
Slow use drip 10 percent
When so we treat glucose low
Below 80
Knowing temp can make stroke worse what do you do with stroke and fever
Tylenol
What percent of population US has a stroke
2.5%
What percent of pt w ischemic stroke get tpa
3 to 5 percent
What do you call it when you give tpa and the recover immediately
Lazarus effect
How many neurologists believe a stroke is worse than death
70%
How many die of stroke each year
160000
Hemorrhage explain
Bursting pipes
What is the differential for echolalia
Autism dementia schizo Tourette's Caratonia
Vertebrobasilar ischemic symptoms 4
Diplopia
Dysarthria
Dysphagia
Drop attacks
Defining meunière 3
Recurrent
Hearing loss
Tinnitus
What suggests brainstem issues
Slurred speech
Vestibular nuclei
Bilateral weakness
How often is stroke misdiagnosed in Ed
10 percent
What does a stroke scale emphasize
Lateralized motor findings
Ed misdiagnosed Tia
36 percent
What thiings distract you from making Tia diagnoses
Headache
Involuntary movements
Dizzy
Is syncope or seizure more common
Syncope
What percent o ischemic stroke are missed by MRI
2 perc
Occipital stroke treatment
CTA
Formal visual test ophthalmology test
OT
Having a stroke puts at what risk
5 fold more likely
Pure sensory stroke in lower face
Ventroposteromedial nucleus
Vpm nucleus
Pure sensory
What does gaze prefernce suggest
Large vessel
What does dysarthria plus arm weakness but alert and reaponding appropriate mean
Lacunar
If you can do an MRI after tpa what do you do
Repeat ct in 2 days
Pt e stroke and headache over 50
Esr
Stroke
If you see episodic aphasia or visual issues
Think Tia
Think migraine
Think Tia
Who wrote and when did Alice in wonderland come out
Lewis Carroll
1865
What is Alice and wonderland syndrome
Migraine with Lilliputian hallucinations
They believe their body parts are larger or smaller then they actually are
6 treatable risk factors
Htn Heart Alcohol Smoking Sugar Fat C
Where do aneurysm occur.
Bifurcation
Rupture means. Aka
App plebiscite
3 aspects of time course
Speed - sudden chronic
Subsequent - spread parts, modality
Multiplicity - frequency: recurrence
Value of multiplicity in Neuro
Spells - migraine. Seizure ms Are the always the same seizure migraine Per day - seizure Per week - migraine Per year - ms
What percent of lacunars have a tight carotid
8%
What cancer can mimic a stroke
Wedge shape Gliomas can mimic a small infarct
Vermis atrophy suggests
Alcohol
Heel to shin is fine laying down but ataxic gate
Parietal stroke and arm drift
Arm drifts up
Cerebellar lesion and arm drift
Arm drifts lateral
What if there tremor during finger to nose gets better with eye closed
Proproception problem not cerebellar
Active study and a fib
Asa and plavix w small stroke for three weeks
Not someone going to nurse home
W small stroke
You need a compliant
How long does plavix take work
3 to 11 days
Percent who wake up with stroke
40 to 50 schoonover
Study regarding vertibrobasilar studying mortality
Ucla
How long is the plavix take to clear from the body
5 days
Regions involved in ataxia
Pons
Cerebellar
How does Asa compare to warfarin
Asa reduces stroke by 20 percent
Warfarin reduces by 60 percent
How long does it take for eliquis to clear enough for surgery
2 days
Percent of people with myopathy w statin
1%
Indication for Asa and plavix
Small stroke or Tia who is a good pt
Afib with fall
Relative risk reduction of Asa for stroke
22% ischemic atc antirhromcotic trial it’s collaboration
How sensitive is a tee
Very. Need an MRI to test it. If not on tee don’t treat with warfarin
Do we put pt on Asa and Lipitor who has avm
No just put them on a statin, unless Neurosx says they coiled and say it is stable.
When do you use t2
Blood, not used often
What lights up in dw MRI
Stroke
Ms
Cancer
Seizure
How long do you let permissive htn
24 to 48. 48 is better
140 to.160 perfect
Left posterior cerebral artery distribution
No read, yea write Alexia w/o agraphia Poor color naming Right sensory Hemisensory bad Motor strip is fine
RPCA issues
Neglect - parietal
Left sensory deficit
Visual neglect
Limitation of nih score
Light on cerebellar and cranial nerve
When/who nih scale
Brott 89
Luden 99
How many items on nih scale
15
Max scale on MOHs
42
Indication for spinal tap w head
Sudden and severe
Sucks to suck
How often do you see stroke mimics
30 percent of time
Can’t read term
Alexia
What percent of cancer pt say there symptoms started 1 day ago
6
How does a tumor cz sudden symptoms 3
Seizure
Bleed into itself
Obstructive hydrocephalus - mass effect
How common are stroke mimics %
19 to 31%
Most common stroke mimic is
Postfix yak 21 %
What do u call it when a stroke mimics something else
Stroke chameleon
Define encephalopathy
Diffuse hemispheric dysfx
What type of stroke mimics encephalopathy
Strokes hitting the limb ic cortex
Orbitofrontal
Def pseudo encephalopathy
Focal ischemic injury to the temporal or orbital that look like confusion
What strokes cz chest pain4
Thalamic
Coronia radiata
Lateraledullary
What peripheral nerve can be involved in strokes
Radial
Ulnar
What gives you high suspicion in stroke
Sudden
Risk of cv issues
Can a stroke cause distal weakness
Yes, focal cerebral ischemia
What is dot sign
Hypersensitive in sylvian fissure
How long do you wait for a large hemorrhagic stroke before you start an anticoag like eliquis
10 to 14 days
Explain smile and basal ganglia and cx stroke
BG = involuntary Cx = voluntary
If you think you see a little bleed on ct but aren’t sure
MRI gradient echo
Pain to order
What is the difference bw brain arteries vs cardio blood vessels
Brain has fewer laminar more fragile
Explain expressive aphasia w a rmca stroke in a right hander
Mechanical
Speech association center
What are the odds of havin a bleed in a healthy brain, say a psych stroke pt
Less than 1%
How do cancer cells cause strokes
They release pro coagulation factors
Causes of thrombosis 6
Artherosclerosia mcc Dissection Fibromyscular Vasospasm Inflammation Infection Radiation Moyamoya
What is responsible for large subcortical infarcts
Microatheroma which is a plaque that clots the entire penetrating artery
Fibroid necrosis assoc w
Htn
Granulated eosinophilia
Focal dilation in small vessel wall
Charcot Bouchard aneurysm
Local tissue pressure is influenced by what in a stroke
Collaterals and blood pressure increase
-edema lowers local tissue pressure
How much do you have clamp you artery to see neurological signs
50 suddenly
How much do you have to clamp the ica to see permanent neurological effects
30% acutely
How low does cbf have to drop to street slow down
23ml per min
Mehta data suggest cea are effective
Synonym 77
What are we hoping the cbf maintains at during a 3 hr mca occlusion
More than. 5ml per minutes
What is the minimum amount of cbp nesssary to maintain the brain for three hours
Over 18 ml per 100 mg per min
What is term for ischemic intolerance
Blood flow thresholds
Does white or gray matter have lower ischemic threshold
Gray has lower ischemic threshold
Die quicker
Define penumbra
Hypo perfumed but viable
Like a fetus has potential
What does ischemic penumrum represent
Functional impairment but structurally intact
Easy way to explain the penumbrum
Salvageable tissue
What term is for mild hypoperfused tissue effective below 22 ml mg min
Oli gemia
Importants of oligemia
If you drop blood pressure oligemia tissue dies or fever acidosis
Why does penumbra shrink over time
Over time the penumbrum turns into the core
What state is the penembrum
Transitional state life or death
What happens to the penumbra electro physiologically
Continuous firing making it metabolically unstable
How do you measure penumbra
You need an MRI. Subtract dwi minus perfusion weighted
Dwi vs pwi
At risk tissue
But is not accurate dt dwi not able to dis derm what is reversible
How large is the penumbrum
40 percent
Does the size of the core or penumbrum affect out come
Core is the real problem
Term for frequency
Poll aquaria
Can you get loc with Tia
Not likely
What protease plays a bug role in destroying the bbb
Metalloprotease 9
What protease increases the risk of transformation after tpa
Mettaloproteinase 9
Mergenthaler 2004
What comprises neurovascular unit
Neuron
Astrocytes
Endothelium
When did tpa first get approved by FDA
1996
What 2 studies randomized studies provide evidence for tpa
NINDS study (nat institute of Neuro dz)
Stroke rt pa stroke study
Phase 3
What study support intra arterial tpa delivery
Furlan. 99
What thrombo lytic came out in 99
Prourrokinase
But thee was only 1 study
When was intra artery delivery become approved
99 furlan
When was merci retriever approved
2005
What evidence supports the merci retriever
Single arm phase 2 trial
What is Iv tpa in acute ischemic stroke
Cornerstone of evidence based
What percentage of ischemic stroke pt are disabled after a stroke
50 percent
How many patient do you need to treat to save 1 from disability
1 in 8. Ninds 95
How many pt do you need to treat to see any improvement.
1 in. 3
What the ninds study only study that looked at stroke
No, graham 2003
What evidence suggests faster administration works better
Hacke 2004
Marler 2000
How does ssri help stroke patients
Decreases inflammation associated w glia
More hopeful
Why don’t we give anticoags in stroke
Risk of stroke to high
Mnemonic for modifying risk factors for stroke
Abc old Age Bp Cigs Obesity Lipids Dm
What can infarct the basal ganglia bilaterally
Leigh’s disease
Prop ionic academia
Carbon monoxide
Cyanide
What is delta sign and what does it suggest
Thrombus at occipital at intersection of transverse and Sagittal and strait
How often is htn related to hemorragic
50
How doe a angio pathy lead to hemorrhage
Amyloid deposit along vessel wall in lobes
Weakens the vessel
Requires biopsy
How accurate can cus be?
Off by 20%
What percentage of syncope is cause by stroke
5 to 10
Reticular activating
Classifying strokes
Location
Ischemic vs hemmorrhage
Thrombotic vs. embolic
Large vs small
What does lacunar mean
Lakes small
Example of artery to artery embolic
Stenosis segmented if ica
What is danger of patent foramen ovals
Venous clots can skip lung and go straight to the brain.
Do thrombotics affect large vessels
Yes. Only proximal
Stroke risk factors 6
Prior stroke Htn Dm Family Hx Hypercholesterolemia
Young stroke differential
Dissection
Pfo
TIA aka
Brain attack
Class of drugs of tpa
Thrombolitic
What did they used to give stroke pt’s That didn’t get tpa
Heparin drip
What do you call lacune that knocks out sensory and motor
Sensorimotor
Tha lam o capsular
Sensory stroke
Ventral posterior lateral
Vpl thalamus
Of people give tpa how many were mimics
3% experienced
21 percent- cher ny shev nonexperienced
Seizure
Migraine
Conversion
Percent of strokes with troponins elevated
Up to 1/3rd
If you dont know if seizure or stroke
Ct perfusion
How sensitive is the cincinnati stroke scale
78 percent
