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Clinical Neuro Ex 2 > Stroke > Flashcards

Stroke Flashcards

1
Q

Epidemiology for Strokes

A

Males Over 65 years old African Americans > Whites

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2
Q

Top Risk factors for Stoke

A

Hypertension Heart Disease Previous Stoke/TIA Carotid Bruit Diabetes/Smoking

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3
Q

Modifiable Risk Factors

A

Hypertension Heart Disease Cholesterol

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4
Q

Genetic Risk Factors For Stroke

A

Factor V mutation, Elevated Homocysteine Levels(hypercoagubility state)

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5
Q

When to suspect Factor V problem?

A

younger patient presenting with stroke

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6
Q

Two Main Mechanisms of Stroke

A

Ischemic (85%) Hemorrhagic (15%)

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7
Q

Thrombosis Characteristics

A

symptoms gradually appear

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8
Q

Embolic Characteristics

A

sudden onset of symptoms

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9
Q

Atherosclerosis

A

plaque build up in the walls of the blood vessels

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10
Q

Ulcerated Plaque

A

rough plaque that the blood platelets stick and therefore, causes clot formation

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11
Q

Cardiogenic Emboli

A

Atrial Fibrillation Rheumatic Heart Disease Acute Myocardial Infarction Thrombus from Previous MI Prosthetic Valve

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12
Q

Atrial Fibrillation

A

blood stagnating in the atria that can cause clots

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13
Q

Rheumatic Heart Disease

A

platelets can bind to damaged tissue

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14
Q

Emboli Sources

A

lungs, heart, aortic arches Clots from A Fib. are the most damaging/severe

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15
Q

Which organ do you want to check in stroke patients?

A

heart

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16
Q

Mitral Valve Prolapse

A

fair common in people, small increase in risk for producing emboli

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17
Q

Nonbacterial Thrombotic Endocarditis

A

seen in cancer patients, the mucin produced by lung/ breast, can coagulate the blood, causes embolic formation (not common)

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18
Q

Infective Endocarditis

A

can cause emboli, because the bacteria makes a goo-like bioflim? that can dislodge and plug arteries

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19
Q
A

PCA Stroke, caused by A Fib

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20
Q
A

Patient should be sent home with an event monitor, keep moinotring the heart even if tests come out to negative (echo, telemonitor)

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21
Q
A

Air Emboli in the patient’s brain

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22
Q

Old TIA Definition Vs New TIA Definition

A

old: focal brain/eye symptoms resolve in less than 24 hours
new: focal brain/eye issues resolve within an hour, majority within in 30 mins

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23
Q

Are TIAs a medical emergency?

A

Yes, and they require a full workup even if the weakness was transient

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24
Q

SX for TIA resulting from Carotid Distribution

A

unilaterial weakness/numberbess

monoocular vision loss

aphaisa(depending on which side was effected)

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25
Q

SX of TIA resulting from a Vertebrobasilar Distribution

A

bilateral numbness/weakness, bilateral vision problems

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26
Q

Amaurosis Fugax

Sign of? Lasts for? Cause? Presenting SX?

A

sign of transient TIA, shade over the eye

lasts less than 5 mins

thrombotic or embolic>

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27
Q

Significance of TIA

A

50% of people will have a stroke in the next year

36% will have stroke in the next month

high probability of stroke, NEED TO BE ADDRESSED

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28
Q

TIAs with multiple similar events

A

Thrombus

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29
Q

TIAs with dissimilar events

A

embolic, because clot is traveling to different locations causing different symptoms

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30
Q

Thrombus vs Embolic

A

thrombus: collateral branches can form, progressive
embolic: suddent onset, seizure at oneset

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31
Q

DDX of TIA

A

focal seizure, hypoglycemica, subdural hematoma, carpal tunnel syndrome, migraine, syncope, labyrinthitis (vertigo), Myasthenia Gravis

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32
Q

Somatotopy

A
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33
Q

Hemiplegia

A

one side of the body is paralyzed

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34
Q

Internal Carotid Occlusion Symptoms

A

generally asymptomatic because there is collateral supply from the circle of willis however, some people have variation in their circle of willis (may be occluded or not formed)

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35
Q

Anterior Cerebral Artery (ACA) Occlusion

A

damages the feet, urinary symptoms

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36
Q

Middle Cerebral Artery Occlusion

A

face and arms affected, possible phasia if the language dominant side is affected

homonomous hemianopia

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37
Q

Homonomous Hemiaponia

A

same visual field lost in both eyes

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38
Q
A

plaque buildup in the MCA

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39
Q

Broca’s Aphasia

A

they have difficulty producing speech and comprehension is intact

fontal lobe lesion

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40
Q

Wernicke Aphasia

A

not able to comprehend, able to produce speech but it is senseless

lesion in posterior perisylvian region

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41
Q

Paraphasia and Neologisms

A

Paraphasia: substituting similar words

Neologisms: making new words

42
Q

Conduction Aphasia

A

unable to repeat phrases due to damage to the arcuate fibers

43
Q

Global Aphasia

A

MCA occlusion, affects both wernicke and brocas area

44
Q

Posterior Cerebral Artery Occlusion

A

homonomous hemianopia, hemiplegia

face/arm paralysis and visual defect

45
Q

Lacunar Infarcts

A

blockage of small vessels

SX: ataxia, dysarthria, sensory/motor impairment,

DX: clinical syndrome

46
Q

Lacunar Infarcts Mortality rate? Reoccurance? Risk factors?

A

Low bc small vessels

High if bp is not reduced

hypertension

47
Q

Lacunar Infart Treatment

A

Reduce BP (antihypertensive medication)

Antiplatelet medications

Carotid Endarterectomy (removal of the plaque)

48
Q

Other Causes of Lacunar Infarct

A

Carotid Dissection, Migraine (pts on Birth control and smokers)

Cocaine/Vasoactive Medications (cold medicine)

49
Q

Weber Syndrome

A

CN 3 Palsy, contralateral hemiplegia in midbrain stroke

50
Q

Wallenberg Syndrome

A

Lateral Medullary Syndrome

PICA, vertbral artery

ipsilateral face numbness, and contralateral loss of pain/temp

51
Q

Stroke Prevention

A

keep blood pressure down , 74% reduction

52
Q

Ischemic Prenumbra

A

area surrounding the core damaged area, damaged but, viable neurons

53
Q

Salvaging Ischemic Penumbra

Avoid? Things that help?

A

Avoid

Relative Hypotension(bring down pressure slowly)

hypoxia (swallowing test)

hyperglycemia

hyponatremia

Neuroprotective Agents (GABA, NMDA, NO) none are too effective

54
Q

Workup for Lacunar Infarct

A

Labs-HgA1C, CBC, platelet count, homocysteine levels

MRI, carotid ultrasound, echocardiogram, angiogram, cardiac monitor

55
Q

CT Scan Angiogram

A

quick way of vascular imaging

56
Q

Treatment of Lacunar Infarctions

A

Medications (BP meds, antiplatelets)

Patient Education (call 911 immediately if numbess/weakness occurs)

Surgery

57
Q

Treatment for High homocysteine Levels

A

folic acid levels

58
Q

Aspirin

A

reduce changes of stroke by 25%

higher doses can cause GI symptoms

59
Q

Ticlopidine

A

decreases the chances of clotting,

causes neutropenia (low neutrophil count), thrombocytopenia (decreased platelet count)

requires CBC monitoring

60
Q

Dipyridamole

A

can be used with aspirin, problem is patient tolerance due to headaches

61
Q

Pravastatin

A

used to decrease cholesterol levels

62
Q

Candidates for Carotid Endarterectomy

A

patient with >60% stenosis of the carotid artery

63
Q

Asymptomatic Carotid Bruit and Stenosis association with TIA

A

significant amount of TIA/Minor Stroke patients present with a carotid bruit

64
Q

Approach to Asymptomatic Carotid Bruit

A

control risk factors (hypertension/cholesterol)

cardiac workup

surgery if indicated (greater than 60%)

patient education about TIA

65
Q

Differenece between Warifrin(coumadin) and Heparin

A

Warifin(long term treatment)

Heparin = acute (injection)

66
Q

Contradications for Heparin

A

senstivity to heparin, bleeding

unctollable hypertension(gasket ready to blow)

more flow when blood is thinner

large infarcts

67
Q

Complications with Heparin

A

hemorrhage + thrombocytopenia

68
Q

Heparin Therapy

A

PTT(clotting time)

Get CT: to rule out bleeding

switch to warfarin after a few days

69
Q

Tissue Plasminogen Activator (TPA)

MOA? When to use? Contraindicated?

A

converts plasminogen to plasmin

Plasmin cause fibrinolysis

should be given in first 3 hours of stroke

Need CT to r/o bleed however it takes 12 to 24 hours to show up in CT

70
Q

TPA and High Blood Pressure

A

Bring blood pressure down to 185/110 mm Hg first with labetalol

71
Q

Contraindications for TPA? Interaction with which med?

A

active internal bleeding

recent trauma, surgery, or stroke

uncontrolled hypertension

intracranial tumor,

on warfarin

72
Q

Hypertensive Encephalopathy Sx? Tx?

A

uncontrolled hypertension, body loses autoregulation ability

sx: headache, confusion seizure

TX: control blood pressure

73
Q

Transient Global Amnesia

Prognosis? Cause?

A

sudden loss of memory

benign prognosis, due to vasculature

74
Q

Temporal Arteritis

Affected population? Sx? Treatment? Associated with?

A

50 years and up

Sx: Headache, blindness, fever, anorexia, tender artery

Treatment: steroids (reduce inflamation which could cause more problems)

Polymyalgia Rheumatica: aching stiff muscles

75
Q

Idiopathic Intracranial Hypertension

Also called? Causes? Tx? Sx?

A

Pseudotumor Cerebri

idiopathic but, pregnancy, obesity

Tx: self limiting, diuretics (decrease ICP)

SX: inc ICP, inc Cerebral Spinal Fluid (>250 mm H2O) (during spinal tap)

76
Q

Venous Thrombosis

A

Causes: idiopathic, pregnancy, trauma (anything that can cause hypercoaguability)

can cause strokes

features: papilledema, seizures, Cn problems, bulging ees (proptosis)

77
Q
A

suprerior sagital sinus, this is a clot

you can dissolve by adding TPA directly into the brain via a catheter

78
Q

Brain Herniation

A

brain is squeezed through various structures due to high ICP

79
Q

Cerebral Edema

Sx? Causes?

A

increased water and sodium in the brain (herniation)

major cause of death and morbidty

caused by: hypoxia, stroke, tumor, trauma

80
Q

Vasogenic Edema

A

located in the white matter

caused by tumor

increased extracellular fluid due to increased capillary permeability

81
Q

Where is the white matter and the gray matter located in the brain?

A

the gray is more on the periphery with the expection of the core

the white matter is more on the interior

82
Q
A

Vasogenic Edema, Gray White Junction

83
Q

Cytotoxic Edema

Areas affected? Causes? SX?

A

affects both the gray and white areas (not just at the junction)

cellular swelling

caused by hypoxia, infarction

84
Q
A

Cytotoxic Edema

affects both gray and white areas equally

85
Q

Interstitial Edema

A

due to CSF obstruction (blocked aqueduct)

hydrocephalus, increased periventricular extracellular fluids

86
Q
A

Interstitial Edema, enlarged ventricles

87
Q

Cushing’s Effect

A

increased systolic blood pressure

decreased pulse

(they should be in opposite directions)

sign of something wrong in the brain

88
Q

Treatment Cerebral Edema

A

steroids (only for vasogenic)

diuretics(only buys you time)

Osmotherapy (need intact blood flow i.e. tumor)

pulls fluid via concentration gradient

89
Q

Intraparenchymal Hemorrhage

A

caused by hypertension and ruptures a small penetrating artery

treatment depends on location

more interior: no tx

more external: surgery

90
Q

Subarachnoid Hemorrhage

Where is blood? Majority of cases? Defect in?

Clinical Features?

A

blood in CSF,

majority of cases located in the anterior circulation

Defect: internal elastic lamina/vessel bifurcation

clinical: worst headache of their life, may have warning leak/headache

91
Q

Hess and Hunt Grading Scale

A

higher on the scale worse the headache/less conscious

92
Q

Subarachnoid Hemorrhage Dx

A

HP

CT Scan newer ones are fairly accurate

Lumbar puncture

Angiogram 4 Vessel Study (Gold Standard)

93
Q

Subarachnoid Hemorrhage Tx

A

Bed Rest

Sedation

NMDA/Nimodipine (Ca2+ blocker: prevents cell death)

control blood pressure, stool softener, Antifibrinolytic

Coiling

94
Q

Subarachnoid Hemorrhage Prognosis? Course?

A

Patients who rate on the Hess and Hunt scale I-III should be given surgery with a chance of an excellent outcome

Patients IV-V should be given supportive care

95
Q

Mycotic Aneurysms

A

septic emboli usually caused by bacterial endocarditis

should not be treated anticoagulants but antibiotics for infection

96
Q

Vascular Malformations

Presenting age?

Treatment? Sx?

A

should treat when they become symptomatic

seen before age of 30

hemorrhage, seizure

97
Q

Epidural Hematoma

Damage to what vessel?

Sx? Dx?

A

middle meningeal artery

lucid interval

CT Scan ( see bone fracture as well)

98
Q

Subdural Hematoma

Vessels damaged? Sx?

A

comatose from the start

tearing of bridging veins

blown pupil, cushing reflex, altered respirations

99
Q

Chronic Subdural Hemorrhage

A

seen in eldery patients with brain atrophy

100
Q
A

Clinical Neuro Ex 2 (5 decks)

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