Stroke 3- SG

Question 1

Prevent Complications (7 things)

• NPO until swallowing eval
• Sequential compression devices if stroke was <48hrs / Heparin
• Avoid foley catheters
• Docusate for all pts
• H2 blockers / PPI
• Acetaminophen + abx if needed

Answer 1

• NPO: Aspiration
• Seq / Heparin: DVT
• Foley: UTI
• Docusate: Constipation
• Decubitus Ulcers
• H2 blocker / PPI: UGI bleed
• Acet: Fever

Question 2

Post-Stroke Depression

• Suspect this if sxs persist ___ after stroke
• Occurs in ___% of stroke pts
• May affect _____
• Often resolves within ___
• Tx?

Answer 2

• 1 - 2 weeks
• 50%
• Rehab & Recovery
• 1 year
• SSRIs, unless pt on Warfarin:
  
  • Escitalopram
  • Citalopram
  • Sertraline

Question 3

Secondary Stroke Prevention

Hypercholesteremia

• DO or DO NOT discontinue Statins on admission?
• Obtain LDL within ___ of stroke onset
• If LDL ___ or greater, use hi-dose statin to decrease stroke/MI/death
• If LDL
• Outpatient LDL goal is

Answer 3

• DO NOT, put all pts on Statins regardless of LDL
• 48 hrs
• 100
• 100
• 70 (but give statins to all pts)

Question 4

• What are the 2 Carotid Stenosis Procedures?
• Which one is done in only high risk pts?

Answer 4

• Carotid Endarterectomy (CEA)
• Carotid Angioplasty/Stenting (CAS) –> high risk pts

Question 5

The benefits of CEA (Carotid Endarterectomy) are greatest in what 4 situations?

Answer 5

• Men
• Older pts
• Recent cerebral ischemia
• Ulcerated plaque

Question 6

CEA (carotid endarterectomy) has a lower risk of what 2 things?

Answer 6

• Peri-procedural stroke or death
• Less risk of restenosis

Question 7

Carotid Angioplasty (CAS) / Stenting has a lower risk of what 2 things?

Answer 7

• Cranial Nerve Injury
• MI

Question 8

Secondary Stroke Prevention / Risk Factor Modification

• Alcohol should be:
  
  • < __ oz for men
  • < __ oz for women
• Which type of diet?
• Exercise type and how often?
• Sleep apnea tx?

Answer 8

• 2 men
• 1 women
• Mediterranean diet
• aerobic, over 20 mins, over 3 d/wk
• CPAP

Question 9

Secondary Stroke Prevention

Risk Factor Modification

• Prescribe what 2 drugs?
• Avoid which 4 drugs?

Answer 9

Prescribe:

• Antithrombotic (warfarin)
• Statin (regardless of cholesterol)

Avoid:

• Estrogen (OCP, HRT)
• Sympathomimetic agents (decongestants , diet pills)
• NSAIDS (asa + ibu = bad)
• PPIs (if pt on Plavix)

Question 10

Prognosis

• Dependent on what 2 things?
• Better for infarction or hemorrhage?
• ___ = worse outcome
• 25-35% of stroke pts will ____
• Recurrent strokes often have higher _____
• Must manage risk factors ____/

Answer 10

• Time of arrival to hospital / Extent of infarct/insult
• Infarction
• LOC
• have another stroke within their lifetime
• rate of death
• aggressively

Question 11

5 stroke mimcs

Answer 11

• Encephalitis
• HTN encephalopathy
• Hypoglycemia
• Migraine
• Seizures

Question 12

Another 5 stroke mimics

Answer 12

• Stroke reactivation
• TIA
• Toxic / Metabolic
• Tumor (do not give tPA)
• Conversion disorder / psychogenic
  
  • no true CNS features
  • Signs/Sxs in non-vascular, non-neuro distribution