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stroke > Stroke > Flashcards

Stroke Flashcards

0
Q

Wallenberg ipsilateral (6)

A 
Horner
Nystagmus
Ataxia
Hoarse
No facial pain
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1
Q

Wallenberg aka.

A

Lateral medullary syndrome

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2
Q

Wallenberg contra lateral

A

No limb pain appreciation

No limb temp spinal thalamus

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3
Q

Anton aka….

A

Top basilar syndrome

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4
Q

Patho of Anton

A

Occipital and deep

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5
Q

Mortality rate of basilar

A

80 percent

50 with intervention

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6
Q

Symptoms of Anton

A 
Learning and menmory hippo
Sleepy 
Mutism
Can't see
Can look to side
Can look up

Dumb jock Anton

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7
Q

What is the difference between a stroke screen and a stroke evaluation?

A

Stroke evaluation by speech therapist

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8
Q

Why is everyone npo who is a stroke?

A

Aspiration pneumonia is a common complication

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9
Q

What do you order for embolic stroke

A

Cardio consult
Heart monitor
Tee
Xeralto

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10
Q

Order for low blood sugar

A 
Glucose chewable 12g
Dextrose 40% gel 15 g
Glucagon inj 1 mg
Insulin lispo
Saline
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11
Q

Starting Dose of Lipitor for stroke?

A

20mg
Can work at 10
Give provastatin 40

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12
Q

Why no long term atypical antipsychotics

A

Increase risk for stroke

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13
Q

How do you treat an acute ischemic stroke without TPA.

A

Into rectal aspirin 300 mg or Plavix 300 mg which is a loading dose.

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14
Q

What is the dose of Lipitor for stroke.

A

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.

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15
Q

Why shouldn’t you get a CTA with a patient and INO

A

Doesn’t affect treatment. Get an MRI

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16
Q

What is a good sign for prognosis of stroke.

A

Show recovery in 2 weeks good sign.

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17
Q

Thalamus and motor deficit

A

4/5 real gets better

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18
Q

What happens to reflex overtime with stroke

A

Starts upper motor goes away over time.

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19
Q

Dose of Asa suppository. Order info for Asa

A

300 Asa suppository

Chew able 81

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20
Q

Pupil problem with syphylis

A

Argyle Robertson.

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21
Q

What did they do before ct for head aches.

A

Pneumocephalogram. Take out csf. Pump in air. X-ray

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22
Q

How much csf do you make

A

150 cc every 8 hr 270 ml per day

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23
Q

How much csf do you make per day
Per shift
Total volume

A

600 to 700/ day
125/shift
150 to 270 ml total

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24
Q

How often does an echo show anything in stroke

A

3%

That is why it is on the care plan

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25
Q

How can you tell if edema is stroke or tumor

A

Tumors have fingers projections.

Vasogenic

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26
Q

90 day risk with a Tia

A

17%

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27
Q

What percentage of of Tia have an intact

A

1/3rd

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28
Q

What are the two goals of imaging

A
  1. Rule out bleed with ct or MRI
  2. Assess risk factors stenosis and afib
    Pump an pipes.
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29
Q

How helpful is lowering you blood pressure in preventing stroke

A

Reduces by 30 to 40 percent

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30
Q

Best treatment for blood pressure

A

Fruits
Vegetables
Weight loss
Clean living

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31
Q

Best med for blood pressure

A

Diuretic Ace i

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32
Q

How to approach someone with bp issue with stroke

A

Wait. 1 day and 120/80

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33
Q

What happens when you give statins with someone with low cholesterol

A

Bleed

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34
Q

When would be the only time that you go in with intervention with a basilar stroke

A

If it’s a thrombus or in it within 24 hours- and it’s miraculous

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35
Q

When can you start prophylaxis for ICH pt? What is tx

A

48 hr

5000 bid

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36
Q

What blood sugar should you

A

240

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37
Q

What do you see with SAH lumbar puncture

A

Rbc. 1000, does wash out

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38
Q

What do you see if you look at a SAH after 2 hrs.

A

ISO density

So do lp

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39
Q

How do u categorizes SAH

A

Hunt and Hess 1- 5

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40
Q

On hunt Hess what signifies bad prognosis.

A

Grade 3 w/ mild focal paresis

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41
Q

What do you order with dx SAH

A

Angiogram is more sensitivity
MRI
Tox screen
Saline 80 to 100

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42
Q

How many people have more than 1 aneurysm?

A

15

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43
Q

Non aneurysm causes for SAH

A

Avm
Venous thrombosis
Vasculitis

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44
Q

% that rupture in 2 week SAH

A

20%

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45
Q

Peak for vasospasm with SAH

A

7 days

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46
Q

% of adults with aneurysm

A

2%

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47
Q

Risk of stroke with coil or clipping SAH

Risk of rupture per year

A

2%

  1. 7%
    - big is bad
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48
Q

When do you treat SAH conservatively

A

Less than 10 mm

Serial imaging

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49
Q

Most important precaution to tell a SAH

A

Don’t smoke.

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50
Q

What doesn’t SAH have compared to ICH and ischemic

A

No focal sign

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51
Q

Uncommonly found in ischemic.

A

Head ache

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52
Q

Define Tia.

A

No infarct

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53
Q

How long does it take to cause infarct

A

1 to 2 hrs

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54
Q

Why are Tia a term that is falling out of favor

A

Imaging is becoming more sensitive

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55
Q

5y risk with Tia

A

50 %

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56
Q

90 day risk for Tia

A

17%

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57
Q

Most important management step in Tia

A

Duplex ica

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58
Q

% of stroke that are cardio embolic.

A

15 to 30

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59
Q

Tell tail sign with cardio embolic cause

A

Sudden

Maximum at onset

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60
Q

Syndromes associated with cardio embolic

A

Hemianopsia with out paresis
Wernicks
Apraxia

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61
Q

Large stroke causes eyes to..

A

Large. Stroke away

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62
Q

The mgt of algorithm depends on

A

Stroke mechanism

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63
Q

Eyes with brain stem

A

Eyes look toward brainstem lesion

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64
Q

Transient eye loss

A

Amaris fugus

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65
Q

Large vessel stenosis percentage

A

15 %

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66
Q

LOC is associated w brain region

A

brain stem

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67
Q

Tips for embolic stroke

A

Single branch territory

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68
Q

What do you call a atherosclerotic plaque

A

Atheroma

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69
Q

Atheroma rarely extends into.

A

Surface vessels

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70
Q

Causes of mainstream branch

A

Embolic vs. Atherostenosis

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71
Q

Term for narrowing of arteries d/t plaques

A

Local Artherostenosis

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72
Q

Mult. Lenticulaostriate branches. Licensure cz by

A

Embolic not Lucian

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73
Q

How to dx foramen ovale

A

Bubble test - 10 ml saline agitates

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74
Q

How to look at atria wall for pfo

A

Contrast Transophageal echocardiography

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75
Q

Large vessel stenosis dx w

A

Duplex Doppler

Mra

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76
Q

Symptoms of large vessel stenosis

A

Shoulder is different than the hand

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77
Q

How to differentiate between inter arterial embolism and cardio embolic.

A

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.

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78
Q

What do u call it when fat breaks off and clogs an artery.

A

Embolic fragments arise from atherosclerotic plaques

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79
Q

Lacuna strokes account for %

A

15 to 20

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80
Q

Where do lacunae strokes occur

A

White matter in the subcortical area.

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81
Q

What brain region do lacuners occur in

A

Thalamus
Basal ganglia
Pons

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82
Q

Patho of lacunar

A

Lipohyalinosis on arteriolar wall

-fibrinoid necrosis

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83
Q

Small fat clot and small blood clot

A

MicroatheromaMicroemboli

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84
Q

Percent of people over 65 with a silent lacunar

A

20 %

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85
Q

Associates with lacunar

A

Hypertension

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86
Q

How many small deep infarct syndromes

A

70

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87
Q

% of strokes that have an undetermined after workup

A 
40 %
Aortic arch
Ct to early
Angio too late
Hyperagulation
Meds
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88
Q

Hyper coagulation states

A 
Protein c
Protein s 
Fibrinogen levels
Factor 5
Lupus
Anti cardio lipin
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89
Q

Symptoms of dissection vertebral and carotid

A 
Neck trauma
Neck 
Side of face
Teeth
Jaw
Retro orbital
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90
Q

“Beaded look”

A

Granulomatous angitis of the brain

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91
Q

What is granulomarous angitis

A

Mult. Small infarcts in cx deep structures

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92
Q

Csf and granulomarous anagitis

A

100 protein

500 mononuclear

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93
Q

Images for vasculitis

A

Arterial narrowing on angiography

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94
Q

Intravenous heparin indication
Large vessel Stenosis
Cardio embolic or large 6h out

A

Cud

Vertebra basilar

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95
Q

If you don’t do an endarterectomy what can you do.

A

Stent

Monitor 3 to 12 mo

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96
Q

Risk with endarterectomy

Improvement of stroke

A

3 percent
50 percent in 5 yr
9 vs 26% in 2 yr

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97
Q

What if some fails Asa

A

Aggrenox unless migraines
25 do pu rid a mole
200 mg bid

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98
Q

Why use clopidogrel

A

No headache 1 time per day

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99
Q

% of. ICH

A

15%

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100
Q

ICH volume that is fatal

A

80

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101
Q

ICH with good prog

A

20 ml

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102
Q

Cost of aggrenox

A

115/ mo

Asa few dollors

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103
Q

Risk of bleeding on Asa

A

1.5%| yr/ gi dose dependent

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104
Q

What study showed plavix and Asa was not benificial.

A

Match

Mgt of antherothrombosis clop in high risk

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105
Q

Is Asa plus dipy rid a mol

A

Yes twice as effective

Esps2

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106
Q

What do you need to know about ticlopidine

A

Blood problems labs

Less bleeding

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107
Q

If someone is allergic to a sprain with stroke

A

Clopidogrel

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108
Q

Reason for plavix with comorvidities

A

CAD
Peripheral artery disease
Smoking
Mi

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109
Q

If they fail on Asa 81 mg

A

Go 162 Asa or platelets

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110
Q

Study that compared warfarin and Asa were similar in afib

A

Warss

But the pt were pretty sick

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111
Q

How does Asa work

A

Blocks cyclo oxygenate
Prevent prostaglandin
Thromboxane a2
From arachnid omit

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112
Q

M1 of mca supplies

A

Basal ganglia and internal capsule

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113
Q

Symptoms of aortic dissection

A

Neck pain

Head pain

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114
Q

Cause of vertebral dissection leading

A

Vertebral artery dissection

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115
Q

Reason for plavix and Asa combo

A

Afib

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116
Q

Diagnosis carotid dissection

A

CTA can’t if creatine high
Mra - can’t if stim
Carotid last resort

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117
Q

Reason for plavix and Asa combo

A

Afib

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118
Q

Who has intra vs extra artherosclerosia

A

White are extra

Hisp are intra

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119
Q

Do we give someone tpa who has a 10 that goes to a 5

A

Yes.

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120
Q

If you have an nih 1 or 2 what type of stroke

A

It is goig to be a lacunar

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121
Q

Problem synthesis of SAH

A

Man w/ severe headache, AMS, stiff neck, photophobia, cn 3

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122
Q

Why is previcol better than Lipitor

A

More lipophilic

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123
Q

Percentage who wake up with stroke

A

20 percent

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124
Q

How long does it take to get tpa if you call 911

A

84 min

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125
Q

How long does it take if you drive yourself.

A

270

3.5 hrs

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126
Q

When did tpa get approved by FDA

A

95

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127
Q

Why do some get worse after tpa.

A

Reocclusion

1/3 rd reocclusion early

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128
Q

Risk factor for bleed

A 
Elevated fibrin
Baseline hyperglycemia 
Nih score over 20
Major arteries
Severe neurological impairment
Violating thrombo lytic protocol
Fall
Not Asa
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129
Q

What happens if you give thrombotic after 12 hr

A

Cardiac rupture

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130
Q

Drug that is related to tongue edema anaphylaxis.

A

Ace inhibitor

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131
Q

What is heparin

A

Glucos amino glycans mixture

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132
Q

How does heparin work

A

Inactivated thrombin
By binding to anti thrombin 3
Inhibits factor 10 but activates 11

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133
Q

How does heparin affect platelet function

A

Platelet factor 4

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134
Q

What do you have to know about heparin and its anti inflation effects

A

Only in the infractionated form

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135
Q

How do you test heparin efficacy

A

APTT 1.5 times control

Factor 10 .3 units/ml to .5

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136
Q

What reverses heparine

A

Prot amine sulfate

1mg counteracts 100 units of heparin

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137
Q

Why is heparin bad to use

A

Too variable hard to dose accurately. Weight bases.

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138
Q

How would you dose heparin

A

Weight based nomogram

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139
Q

Trick with administering prot amine

What happens?

A

Give slowly bc it causes hypotension

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140
Q

Why is low molecular weight heparin better than unfractionated 5

A
  1. Small - less bleed
  2. More stable
  3. Longer half life
  4. No affect aPTT
  5. Neuroprotective effects
    No anti inflammatory effects
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141
Q

How to treat high blood pressure with stroke

A

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

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142
Q

Plasma dose

A

10 to 20 ml

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143
Q

How do you fix fibrinogen levels

A

200 mg/dl of cryo

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144
Q

If tpa cause bleed! Oh shit

A 
Stop tpa
Ct
Labs
Cryo and plasma
Neuro consult and heme
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145
Q

Percent of seizures after stroke

A

5 to 10

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146
Q

Percent of stroke complicates by dysphagia

A

45 percent

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147
Q

How long does dysphagia last

A

About a week

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148
Q

Image for arterial dissection

A

Axial t1 weighted image w fat suppression of neck

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149
Q

Do you need an echo if you know they have a fib

A

No. You are going to treat anyway.

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150
Q

How long after a stroke do you see central pain syndrome.

A

A month

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151
Q

Thalamic lesion cause what symptoms

A

Pure sensory hemi anesthesia

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152
Q

Name for loss of pin prick

A

Hemianalgesia

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153
Q

Name for no touch

A

Hemianesthesia

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154
Q

Anatomy of pseudo bulbar dementia

A

Subcortical dementia

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155
Q

What is weber syndrome

A

Contralateral weakness face, arm leg

Ipsilateral cn3

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156
Q

Where is weber located anatomically

A

Midbrain

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157
Q

Where is foville’s located

A

Pons

158
Q

What is foville’s symptoms

A

Contralateral weakness
Ipsilateral cn 7
Small pupils

159
Q

Spinal cord lesions described as line

A

Sensory level

160
Q

Browns sequard

A

Hemi cord syndrome

161
Q

Symptoms of anterior horn ALS

A 
Fasciculations 
Upper extremity wasting
Spastic legs
Huperreflexia
Wasted uppers and hyper legs
162
Q

Stocking glove distribution suggests what type of neuropathy

A

Poly neuropathy

163
Q

How can you differentiate spinal level, acute cord and transverse myelitis

A

Traverse myelitis has hyper decreased ste and then later hyper reflex is

164
Q

Can. Stroke cause Parkinsonism

A

Yes it is call vascular Parkinson’s

165
Q

Most telling sign of Parkinson’s

A

One sided asymmetric.

166
Q

Summary of Parkinson’s

A

Asymmetric symptoms without cognitive, hallucinations pyramidal

167
Q

Early signs of Parkinson’s

A

Decrease blinking
Arm swing
Trouble with make up
Rolling over in bed

168
Q

Early complains of pd

A 
Hypophonia
Micrographia
Handling utensils
Shaving
Fine motor problems
169
Q

Signs of diffuse Lewy body

A

Delirium
Hallucinations
Early dementia

170
Q

Signs of supra nuclear palsy

A

Downward gaze palsy
Balance problems
Prominent neck rigidity

171
Q

Signs of multisystem atrophy

A

Incontinence
Dysphagia
Orthostatic hyptension

172
Q

Signs of corticobaasal ganglionic degredation

A

Asymmetric
Myoclonus
Apraxia
Alien limb

173
Q

Test to differentiate Parkinson’s

A

Pet shows hyper metabolism in the striatum of a true pet scan.

174
Q

Which drugs neuroprotective for pd

A

Q10
Agilect
Perhaps senimet

175
Q

Agilect aka

A

Ra SAg iline

176
Q

What age is consided old that would receive sine my first line

A

75

177
Q

Starting dose of sine met

A

25 bid

Work up to three time a day

178
Q

How does sinemet compare in efficacy to sinemet cr

A

70 percent

So 70 short acting - 100 long acting

179
Q

What happens if someone on sinemet cr get gi issue

A

Pretty common when old

Switch to short acting

180
Q

What if someone has Parkinson’s who can’t swallow.

A

Parcopa sublingal

Disintegration tablet

181
Q

What is stalevo

A

Carbidopa/levodopa/comt

182
Q

Doses of stalevo

A

50 100 150

183
Q

How is com pt inhibitor improve stalevo 2

A

Makes levodopa 1.3 time more effective

Lasts longer

184
Q

Starting dose of stalevo

A

50 tid

185
Q

What is the max comt dose

A

1600 or 8 tabs bc all stalevo has 200 mg of comt

186
Q

Side effect and percentage of stalevo

A

1 in 20 get diarrhea

187
Q

Most common side effect of levodopa

A

Nausea and hypotension

188
Q

What is the minimum dose of carbidopa pa per day

A

75/day

189
Q

What if pt gets nausea with sinemet

A

Take with meals
Or add lodsyn or carbidopa
Take with ginger preparation

190
Q

Tx for urinary problems hyperactive with Parkinson’s

A

Detail la has fewer cognitive problems
Ditropan has more confusion
Check uti

191
Q

Parkinson’s hypo active bladder

A

Flowmax

192
Q

What must you check before you give Detrol

A

Orthostatic

193
Q

Treatment for orthostatic changes

A 
Stockings
Dec dopamine drugs
Dec hypertension drugs
Fludrocortisone  .1mg
Midrodrine 2.5 mg
194
Q

Surgery for of tremor

A

Thalam otomy
-Ventral is intermediis thalamus
-part of thalamus that receives cerebellar afferent
-

195
Q

Problems associated with bilateral thalmotomy

A

Dysarthria

Speech issues 50%

196
Q

Problem with unilateral pallidotomy

A

Only lasts 6mo to 2 year

197
Q

Side effect of pallidotomy

A

Hypophonia

198
Q

Problems with palli do tiny

A

Only works for Parkinson’s with cardinal feature

They miss the gpi

199
Q

The average improvement with deep brain stimuli

A

40 to 60 bilateral

200
Q

Why can’t crazy people get DBS

A

Your depression must be well controlled

201
Q

Side effects of DBS bilateral

A

Confusion

202
Q

Why would you only implant 1 DBS at a time

A

1 side might be all it takes

203
Q

Treatment for essential tremor

A

Thalamic

204
Q

Tx for DBS and Parkinson location

A

STM or gpi

205
Q

What do you call it when we over treat high blood pressure

A

I at tro genic hypotension

206
Q

How long does Todd paralysis last

A

20 min to 24 hr

207
Q

How long does a seizure take to march

A

2 min

208
Q

How long does a migraine take to march

A

10 to 30 min

209
Q

Evidence for lacuna stroke

A 
Stutter
Classic pattern
Straight forward
All sensory
All motor 
All speech
210
Q

When do you order a tee

A

When you are suspecting afib

If you already know there in afib what is the point just anticoagulate

211
Q

Small stroke is caused by

A

Lipohylinosis with clot formation

212
Q

Most important part of treating small vessel

A

Cholesterol and plavix

213
Q

Why is cea better than stent ing

A

Because stent ing has more risk of death

214
Q

When to do stenting 2

A

Large stenosis w recurrent symptoms

Or if on plavix cea not a candidate

215
Q

Treatment with atherosclerotic aortic with mobility component

A

Warfarin

216
Q

Cardiac sources of stroke

A

Afib
Ef 25
Wall motion
Pfo

217
Q

What does pfo risk for

A

Atrial septal aneuysm

Not a risk of stroke

218
Q

How does statin work

A

Decrease inflammation assiciated with arherosclerotic

219
Q

Enzyme assoc with statin

A

Hmg co at reductase inhibitor

220
Q

Optimum bp after stroke

A

140

221
Q

Three things to tell pt after tia

A

Stop smoking
Get bp down
Get cholesterol down

B
C
S

222
Q

Treatment of high bp with stroke sys 180

A

Monitor

223
Q

Bp control w tpa sys 231

A

Iv labetolol 20

224
Q

Iv labetolol diastolic over 140

A

Nitroprusside

225
Q

Bp and tpa dia 105

A

Lab 10

226
Q

Systolic 180 bp and tpa

A

Lab 10

227
Q

When does edema peak

A

3 to 5 days

228
Q

After you give tpa what are you looking for

A

Any reason stop tpa, drop, and tpa roll

229
Q

How do treat copd desat

A

Keep them at the baseline

230
Q

Most deviates toon complication of stroke

A

Icp dt edema

231
Q

Things that worsen icp with stroke

A

Heat co2 hypercapnia

232
Q

Reversing edema with stroke to Prev uncle

A

Hypertonic saline

Hypervent

233
Q

When do you order an EEG to check for non convulsive status

A

Fluctuating consciousness

234
Q

What do you call it when they have secret seizures

A

Non convulsants status epileptics

235
Q

How common is a seizure after stroke

A

4 to 40; recurrent up to 80

236
Q

When and how to prevent dvt

A

Start sq heparin 5000 bid

237
Q

How to prevent bed sore

A

turn pt every 2 hr

238
Q

How to treat bed sores

A

Wet to dry

239
Q

How long do you delay using warfarin for cardioembolic

A

5 day asparin then start warfarin after ct

240
Q

Explain hemorrhagic stroke transformation

A

If recanulization occurs

Blood now can enter infect tissue. Which can lead tonic bleeding

241
Q

When do we treat htn in pt patient wo tpa

A

Not for days unless over 220 or 120

242
Q

Do we tx bp fast or slow

A

Slow use drip 10 percent

243
Q

When so we treat glucose low

A

Below 80

244
Q

Knowing temp can make stroke worse what do you do with stroke and fever

A

Tylenol

245
Q

What percent of population US has a stroke

A

2.5%

246
Q

What percent of pt w ischemic stroke get tpa

A

3 to 5 percent

247
Q

What do you call it when you give tpa and the recover immediately

A

Lazarus effect

248
Q

How many neurologists believe a stroke is worse than death

A

70%

249
Q

How many die of stroke each year

A

160000

250
Q

Hemorrhage explain

A

Bursting pipes

251
Q

What is the differential for echolalia

A 
Autism 
dementia 
schizo
Tourette's 
Caratonia
252
Q

Vertebrobasilar ischemic symptoms 4

A

Diplopia
Dysarthria
Dysphagia
Drop attacks

253
Q

Defining meunière 3

A

Recurrent
Hearing loss
Tinnitus

254
Q

What suggests brainstem issues

A

Slurred speech
Vestibular nuclei
Bilateral weakness

255
Q

How often is stroke misdiagnosed in Ed

A

10 percent

256
Q

What does a stroke scale emphasize

A

Lateralized motor findings

257
Q

Ed misdiagnosed Tia

A

36 percent

258
Q

What thiings distract you from making Tia diagnoses

A

Headache
Involuntary movements
Dizzy

259
Q

Is syncope or seizure more common

A

Syncope

260
Q

What percent o ischemic stroke are missed by MRI

A

2 perc

261
Q

Occipital stroke treatment

A

CTA
Formal visual test ophthalmology test
OT

262
Q

Having a stroke puts at what risk

A

5 fold more likely

263
Q

Pure sensory stroke in lower face

A

Ventroposteromedial nucleus
Vpm nucleus
Pure sensory

264
Q

What does gaze prefernce suggest

A

Large vessel

265
Q

What does dysarthria plus arm weakness but alert and reaponding appropriate mean

A

Lacunar

266
Q

If you can do an MRI after tpa what do you do

A

Repeat ct in 2 days

267
Q

Pt e stroke and headache over 50

A

Esr

Stroke

268
Q

If you see episodic aphasia or visual issues

A

Think Tia
Think migraine
Think Tia

269
Q

Who wrote and when did Alice in wonderland come out

A

Lewis Carroll

1865

270
Q

What is Alice and wonderland syndrome

A

Migraine with Lilliputian hallucinations

They believe their body parts are larger or smaller then they actually are

271
Q

6 treatable risk factors

A 
Htn
Heart
Alcohol
Smoking
Sugar
Fat
C
272
Q

Where do aneurysm occur.

A

Bifurcation

273
Q

Rupture means. Aka

A

App plebiscite

274
Q

3 aspects of time course

A

Speed - sudden chronic
Subsequent - spread parts, modality
Multiplicity - frequency: recurrence

275
Q

Value of multiplicity in Neuro

A 
Spells - migraine. Seizure ms
Are the always the same seizure migraine
Per day - seizure
Per week - migraine
Per year - ms
276
Q

What percent of lacunars have a tight carotid

A

8%

277
Q

What cancer can mimic a stroke

A

Wedge shape Gliomas can mimic a small infarct

278
Q

Vermis atrophy suggests

A

Alcohol

Heel to shin is fine laying down but ataxic gate

279
Q

Parietal stroke and arm drift

A

Arm drifts up

280
Q

Cerebellar lesion and arm drift

A

Arm drifts lateral

281
Q

What if there tremor during finger to nose gets better with eye closed

A

Proproception problem not cerebellar

282
Q

Active study and a fib

A

Asa and plavix w small stroke for three weeks
Not someone going to nurse home
W small stroke
You need a compliant

283
Q

How long does plavix take work

A

3 to 11 days

284
Q

Percent who wake up with stroke

A

40 to 50 schoonover

285
Q

Study regarding vertibrobasilar studying mortality

A

Ucla

286
Q

How long is the plavix take to clear from the body

A

5 days

287
Q

Regions involved in ataxia

A

Pons

Cerebellar

288
Q

How does Asa compare to warfarin

A

Asa reduces stroke by 20 percent

Warfarin reduces by 60 percent

289
Q

How long does it take for eliquis to clear enough for surgery

A

2 days

290
Q

Percent of people with myopathy w statin

A

1%

291
Q

Indication for Asa and plavix

A

Small stroke or Tia who is a good pt

Afib with fall

292
Q

Relative risk reduction of Asa for stroke

A

22% ischemic atc antirhromcotic trial it’s collaboration

293
Q

How sensitive is a tee

A

Very. Need an MRI to test it. If not on tee don’t treat with warfarin

294
Q

Do we put pt on Asa and Lipitor who has avm

A

No just put them on a statin, unless Neurosx says they coiled and say it is stable.

295
Q

When do you use t2

A

Blood, not used often

296
Q

What lights up in dw MRI

A

Stroke
Ms
Cancer
Seizure

297
Q

How long do you let permissive htn

A

24 to 48. 48 is better

140 to.160 perfect

298
Q

Left posterior cerebral artery distribution

A 
No read, yea write
Alexia w/o agraphia
Poor color naming
Right sensory 
Hemisensory bad
Motor strip is fine
299
Q

RPCA issues

A

Neglect - parietal
Left sensory deficit
Visual neglect

300
Q

Limitation of nih score

A

Light on cerebellar and cranial nerve

301
Q

When/who nih scale

A

Brott 89

Luden 99

302
Q

How many items on nih scale

A

15

303
Q

Max scale on MOHs

A

42

304
Q

Indication for spinal tap w head

A

Sudden and severe

Sucks to suck

305
Q

How often do you see stroke mimics

A

30 percent of time

306
Q

Can’t read term

A

Alexia

307
Q

What percent of cancer pt say there symptoms started 1 day ago

A

6

308
Q

How does a tumor cz sudden symptoms 3

A

Seizure
Bleed into itself
Obstructive hydrocephalus - mass effect

309
Q

How common are stroke mimics %

A

19 to 31%

310
Q

Most common stroke mimic is

A

Postfix yak 21 %

311
Q

What do u call it when a stroke mimics something else

A

Stroke chameleon

312
Q

Define encephalopathy

A

Diffuse hemispheric dysfx

313
Q

What type of stroke mimics encephalopathy

A

Strokes hitting the limb ic cortex

Orbitofrontal

314
Q

Def pseudo encephalopathy

A

Focal ischemic injury to the temporal or orbital that look like confusion

315
Q

What strokes cz chest pain4

A

Thalamic
Coronia radiata
Lateraledullary

316
Q

What peripheral nerve can be involved in strokes

A

Radial

Ulnar

317
Q

What gives you high suspicion in stroke

A

Sudden

Risk of cv issues

318
Q

Can a stroke cause distal weakness

A

Yes, focal cerebral ischemia

319
Q

What is dot sign

A

Hypersensitive in sylvian fissure

320
Q

How long do you wait for a large hemorrhagic stroke before you start an anticoag like eliquis

A

10 to 14 days

321
Q

Explain smile and basal ganglia and cx stroke

A 
BG = involuntary
Cx = voluntary
322
Q

If you think you see a little bleed on ct but aren’t sure

A

MRI gradient echo

Pain to order

323
Q

What is the difference bw brain arteries vs cardio blood vessels

A

Brain has fewer laminar more fragile

324
Q

Explain expressive aphasia w a rmca stroke in a right hander

A

Mechanical

Speech association center

325
Q

What are the odds of havin a bleed in a healthy brain, say a psych stroke pt

A

Less than 1%

326
Q

How do cancer cells cause strokes

A

They release pro coagulation factors

327
Q

Causes of thrombosis 6

A 
Artherosclerosia mcc
Dissection
Fibromyscular
Vasospasm
Inflammation
Infection
Radiation 
Moyamoya
328
Q

What is responsible for large subcortical infarcts

A

Microatheroma which is a plaque that clots the entire penetrating artery

329
Q

Fibroid necrosis assoc w

A

Htn

Granulated eosinophilia

330
Q

Focal dilation in small vessel wall

A

Charcot Bouchard aneurysm

331
Q

Local tissue pressure is influenced by what in a stroke

A

Collaterals and blood pressure increase

-edema lowers local tissue pressure

332
Q

How much do you have clamp you artery to see neurological signs

A

50 suddenly

333
Q

How much do you have to clamp the ica to see permanent neurological effects

A

30% acutely

334
Q

How low does cbf have to drop to street slow down

A

23ml per min

335
Q

Mehta data suggest cea are effective

A

Synonym 77

336
Q

What are we hoping the cbf maintains at during a 3 hr mca occlusion

A

More than. 5ml per minutes

337
Q

What is the minimum amount of cbp nesssary to maintain the brain for three hours

A

Over 18 ml per 100 mg per min

338
Q

What is term for ischemic intolerance

A

Blood flow thresholds

339
Q

Does white or gray matter have lower ischemic threshold

A

Gray has lower ischemic threshold

Die quicker

340
Q

Define penumbra

A

Hypo perfumed but viable

Like a fetus has potential

341
Q

What does ischemic penumrum represent

A

Functional impairment but structurally intact

342
Q

Easy way to explain the penumbrum

A

Salvageable tissue

343
Q

What term is for mild hypoperfused tissue effective below 22 ml mg min

A

Oli gemia

344
Q

Importants of oligemia

A

If you drop blood pressure oligemia tissue dies or fever acidosis

345
Q

Why does penumbra shrink over time

A

Over time the penumbrum turns into the core

346
Q

What state is the penembrum

A

Transitional state life or death

347
Q

What happens to the penumbra electro physiologically

A

Continuous firing making it metabolically unstable

348
Q

How do you measure penumbra

A

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

349
Q

How large is the penumbrum

A

40 percent

350
Q

Does the size of the core or penumbrum affect out come

A

Core is the real problem

351
Q

Term for frequency

A

Poll aquaria

352
Q

Can you get loc with Tia

A

Not likely

353
Q

What protease plays a bug role in destroying the bbb

A

Metalloprotease 9

354
Q

What protease increases the risk of transformation after tpa

A

Mettaloproteinase 9

Mergenthaler 2004

355
Q

What comprises neurovascular unit

A

Neuron
Astrocytes
Endothelium

356
Q

When did tpa first get approved by FDA

A

1996

357
Q

What 2 studies randomized studies provide evidence for tpa

A

NINDS study (nat institute of Neuro dz)
Stroke rt pa stroke study
Phase 3

358
Q

What study support intra arterial tpa delivery

A

Furlan. 99

359
Q

What thrombo lytic came out in 99

A

Prourrokinase

But thee was only 1 study

360
Q

When was intra artery delivery become approved

A

99 furlan

361
Q

When was merci retriever approved

A

2005

362
Q

What evidence supports the merci retriever

A

Single arm phase 2 trial

363
Q

What is Iv tpa in acute ischemic stroke

A

Cornerstone of evidence based

364
Q

What percentage of ischemic stroke pt are disabled after a stroke

A

50 percent

365
Q

How many patient do you need to treat to save 1 from disability

A

1 in 8. Ninds 95

366
Q

How many pt do you need to treat to see any improvement.

A

1 in. 3

367
Q

What the ninds study only study that looked at stroke

A

No, graham 2003

368
Q

What evidence suggests faster administration works better

A

Hacke 2004

Marler 2000

369
Q

How does ssri help stroke patients

A

Decreases inflammation associated w glia

More hopeful

370
Q

Why don’t we give anticoags in stroke

A

Risk of stroke to high

371
Q

Mnemonic for modifying risk factors for stroke

A 
Abc old
Age
Bp
Cigs
Obesity
Lipids
Dm
372
Q

What can infarct the basal ganglia bilaterally

A

Leigh’s disease
Prop ionic academia
Carbon monoxide
Cyanide

373
Q

What is delta sign and what does it suggest

A

Thrombus at occipital at intersection of transverse and Sagittal and strait

374
Q

How often is htn related to hemorragic

A

50

375
Q

How doe a angio pathy lead to hemorrhage

A

Amyloid deposit along vessel wall in lobes
Weakens the vessel
Requires biopsy

376
Q

How accurate can cus be?

A

Off by 20%

377
Q

What percentage of syncope is cause by stroke

A

5 to 10

Reticular activating

378
Q

Classifying strokes

A

Location
Ischemic vs hemmorrhage
Thrombotic vs. embolic
Large vs small

379
Q

What does lacunar mean

A

Lakes small

380
Q

Example of artery to artery embolic

A

Stenosis segmented if ica

381
Q

What is danger of patent foramen ovals

A

Venous clots can skip lung and go straight to the brain.

382
Q

Do thrombotics affect large vessels

A

Yes. Only proximal

383
Q

Stroke risk factors 6

A 
Prior stroke
Htn
Dm
Family
Hx
Hypercholesterolemia
384
Q

Young stroke differential

A

Dissection

Pfo

385
Q

TIA aka

A

Brain attack

386
Q

Class of drugs of tpa

A

Thrombolitic

387
Q

What did they used to give stroke pt’s That didn’t get tpa

A

Heparin drip

388
Q

What do you call lacune that knocks out sensory and motor

A

Sensorimotor

Tha lam o capsular

389
Q

Sensory stroke

A

Ventral posterior lateral

Vpl thalamus

390
Q

Of people give tpa how many were mimics

A

3% experienced

21 percent- cher ny shev nonexperienced

Seizure
Migraine
Conversion

391
Q

Percent of strokes with troponins elevated

A

Up to 1/3rd

392
Q

If you dont know if seizure or stroke

A

Ct perfusion

393
Q

How sensitive is the cincinnati stroke scale

A

78 percent

stroke (13 decks)

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