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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Name one similarity and one difference between a TIA and a stroke

A

Similarity: They both have the same symptoms with same pathophysiology

Difference: TIA lasts for less than 24 hours, stroke lasts for more than 24 hours. Duration of symptoms is determining difference

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2
Q

Two reasons why TIA does not cause permanent infarction

A

Reperfusion

  1. ) Embolus breaks up
  2. ) Collateral circulation
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3
Q

What is the risk of stroke in 5 years after a TIA

A

30%

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4
Q

What are the risk factors for TIA/Stroke

A

Primary: Age and Hypertension

Secondary: Smoking, diabetes, hyperlipidemia, atrial fib, CAD, family history, previous stroke/TIA, and carotid bruits

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5
Q

What are risk factors for TIA/Stroke in young people

A
  1. ) Oral contraceptives
  2. ) Hypercoaguble state (Protein C and S deficiency, antiphospholipid antibody syndrome)
  3. ) vasoconstrictive drug use (cocaine, amphetamines)
  4. ) Polycythemia vera
  5. ) Sickle Cell Disease
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6
Q

Which one is more common: Embolism or Thrombus

A

Embolism

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7
Q

What are the four main sources of embolic strokes

A
  1. ) Heart (most common) - afib
  2. ) Internal Carotid Artery
  3. ) Aorta
  4. ) Paradoxical (from peripheral veins through ASD, patent foramen ovale, or pulmonary AV fistula)
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8
Q

What are common places of thrombus, hence thrombotic strokes

A
  1. ) Large arteries (i.e. birfurciation of common carotid)

2. ) Middle cerebral artery (MCA)

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9
Q

Which sized vessels does lacunar stroke affect, and what are the common areas

A

Small vessels

Subcortical regions - Basal ganglia, thalamus, internal capsule, brainstem

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10
Q

Two risk factors of lacunar stroke

A
  1. ) HTN (main)

2. ) Diabetes

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11
Q

The source of an embolic stroke is evaluated by three things

A
  1. ) Echo
  2. ) Carotid dopplers
  3. ) ECG, holter monitoring
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12
Q

Pathophysiology of lacunar strokes

A

THICKENING of vessel wall

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13
Q

Common places of lacunar stroke:

A
  1. ) Small branches off MCA
  2. ) Circle of Willis arteriies
  3. ) Basilar and vertebral arteries
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14
Q

Clinical feature of thrombotic stroke

A

Symptoms rapid or stepwise, with classic awakening from sleep with neurologic deficits

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15
Q

If embolism went to MCA, what would you see clinically

A
  1. ) Contralateral hemiparesis and hemisensory loss
  2. ) Aphasia (if dominant hemisphere)
  3. ) Apraxia, contralateral body neglect, confusion (if nondominant)
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16
Q

Four major focal clinical features of lacunar stroke

A
  1. ) Pure motor (internal capsule)
  2. ) Pure sensory (Thalamus)
  3. ) Ataxic hemiparesis - incordination ipsilaterally
  4. ) Clumsy hand dysarthria
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17
Q

Five modalities ordered to diagnose stroke

A
  1. ) CT Scan w/o contrast - determines if intracerebral hemorrhage is present
  2. ) MRI - more sensitive, not in emergency
  3. ) ECG - Acute MI or Afib
  4. ) Carotid duplex - carotid stenosis
  5. ) MRA - definitive for stenosis and aneurysms - carotids, vertebro basilar circulation, circle of willis, ACA, PCA, MCA
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18
Q

Three complications of stroke

A
  1. ) Cerebral edema 1 to 2 days causing mass effect
  2. ) Hemorrhage into infarction
  3. ) Seizure
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19
Q

How to treat cerebral edema secondary to stroke

A

Hyperventilation and mannitol

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20
Q

What to use for treatment of acute stroke in ED

A

Supportive treatment and t-PA therapy within 3 hours

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21
Q

Contraindications to TPA due to risk of hemorrhagic transformation

A 
If time of stroke unknown
If more than 3 hours have passed
Uncontrolled HTN
Bleeding disorder
Anticoagulation
Recent trauma or surgery
22
Q

When to give TPA and when to give aspirin in acute treatment of stroke

A

TPA: Within 3 hours
Aspirin: After 3 hours (do not give both)
If aspirin not tolerated - clopidogrel, clopidogrel not tolerated - ticlopidine

Do not give heparin or warfarin in acute stroke

23
Q

The three conditions in which you are allowed to give BP medications during acute stroke

A
  1. ) BP above 220/120
  2. ) Acute MI, aortic dissection, severe heart failure, hypertensive encephalopathy
  3. ) Thrombolytic therapy already given
24
Q

When is carotid endarterectomy indicated

A

When patients are symptomatic with carotid artery stenosis of over 70%. For asymptomatic, give aspirin

25
Q

Prevention of strokes in both embolic and thrombotic disease

A

Aspirin and control of atherosclerotic risk factors

26
Q

Prevention of lacunar strokes

A

Control hypertension

27
Q

Most common cause of intracerebral hemorrhage

A

HTN (sudden increase - 50 to 60%) that ruptures small vessels in brain parenchyma

28
Q

Four minor causes of intracerebral hemorrhage

A
  1. ) Amyloid angiography
  2. ) Anticoagulant/antithrombolytic use
  3. ) Brain tumors
  4. ) AV malformations
29
Q

Three locations of intracerebral hemorrhage

A

Basal Ganglia (65%)Pons (10%)Cerebellum (10%)

30
Q

Four clinical features of intracerebral hemorrhage

A
  1. ) Abrupt onset of focal deficit worsening over 30 to 90 minutes
  2. ) Altered level of consciousness
  3. ) Headache, vomiting
  4. ) Signs of increased ICP
31
Q

Diagnosis of intracerebral hemorrhage

A

CT scan (95%) with coagulation panel and platelets

32
Q

Six complications of intracerebral hemorrhage

A 
Increased ICP
Seizures
Rebleeding
Vasospasm
Hydrocephalus
SIADH
33
Q

Treatment of acute intracerebral hemorrhage

A

Step 1: ICU admission
Step 2: ABC’s due to altered mental status
Step 3: BP reduction gradually - prevents hypotension (BP > 160 to 180/105) - nitroprusside
Step 4: Mannitol and diuretics only if ICP elevated
Step 5: Surgical evacuation of hematomas if they exist

34
Q

Should steroids be given in intracerebral hemorrhage

A

No

35
Q

Two major categories of hemorrhagic stroke

A
  1. ) Intracerebral hemorrhage - bleed into parenchyma

2. ) Subarachnoid hemorrhage - bleeding into CSF

36
Q

Three different pupillary findings in intracerebral hemorrhage depending on location

A

Pons - pinpoint pupils
Thalamus - poorly reactive pupils
Putamen - dilated pupils

37
Q

Common location of subarachnoid hemorrhage

A

Saccular aneurysms - bifurcations of arteries at circle of willis

38
Q

Three causes of subarachnoid hemorrhage

A
  1. ) Ruptured berry aneurysm - most common and most dangerous
  2. ) Trauma
  3. ) AV malformation
39
Q

Clinical features of subarachnoid hemorrhage

A

Worst headache of life, with loss of consciousness, vomiting, and meningeal irritation with photophobia and retinal hemorrhages

40
Q

Two diagnostic modalities of subarachnoid hemorrhage

A
  1. ) Noncontrast CT

2. ) Lumbar puncture if CT scan is negative - shows blood and xanthochromia - gold standard

41
Q

After diagnosis of subarachnoid hemorrhage, what test should be ordered to confirm diagnosis

A

Cerebral angiogram

42
Q

Complications of subarachnoid hemorrhage

A
  1. ) Rerupture
  2. ) Vasospasm
  3. ) Communicating hydrocephalus
  4. ) Seizures
  5. ) SIADH
43
Q

Surgical treatment options of subarachnoid hemorrhage

A

Berry aneurysms treated surgically

44
Q

Medical treatment of subarachnoid hemorrhage

A

Bed rest in quiet room, stool softeners to avoid straining, analgesis for headache, IV fluids for hydration, control HTN by BP lowering gradual, calcium channel blocker (nifedipine) for vasospasm

45
Q

What is a heat stroke and what is required to make the diagnosis

A

Thermoregulatory problem - hyperthermia > 40.5C

46
Q

How do patients with heat stroke present clinically

A

Acute confusion, tachycardia, coagulopathic bleed, hypotension

47
Q

What is a complication of heat stroke

A

Rhabdomyolosis

48
Q

What is wallenberg’s syndrome and what area of the brain does it affect

A

Occlusion of PICA or vertebral artery, affecting lateral medulla

49
Q

What are the symptoms of wallenberg syndrome, and what is spared?

A
  1. ) Pain/temp loss over ipsilateral face/contralateral body
  2. ) Vestibulocereballar impairment
  3. ) Horners syndrome

Spared: Motor function

50
Q

What is the diagnostic modality of choice for wallenberg syndrome

A

MRI

51
Q

What is the difference in symptoms between intracerebral hemorrhage of cerebellum, thalamus, and pons

A

Cerebellum - Occipal lobe affected and gait disturbed
Thalamus - pupils do not react, eyes deviate toward lesion
Pons - pinpoint pupils, paraplegia then deep coma within minutes

Neurology (9 decks)

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