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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
Prevention of strokes in both embolic and thrombotic disease
Aspirin and control of atherosclerotic risk factors
26
Prevention of lacunar strokes
Control hypertension
27
Most common cause of intracerebral hemorrhage
HTN (sudden increase - 50 to 60%) that ruptures small vessels in brain parenchyma
28
Four minor causes of intracerebral hemorrhage
1. ) Amyloid angiography 2. ) Anticoagulant/antithrombolytic use 3. ) Brain tumors 4. ) AV malformations
29
Three locations of intracerebral hemorrhage
Basal Ganglia (65%)Pons (10%)Cerebellum (10%)
30
Four clinical features of intracerebral hemorrhage
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
Diagnosis of intracerebral hemorrhage
CT scan (95%) with coagulation panel and platelets
32
Six complications of intracerebral hemorrhage
``` Increased ICP Seizures Rebleeding Vasospasm Hydrocephalus SIADH ```
33
Treatment of acute intracerebral hemorrhage
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
Should steroids be given in intracerebral hemorrhage
No
35
Two major categories of hemorrhagic stroke
1. ) Intracerebral hemorrhage - bleed into parenchyma | 2. ) Subarachnoid hemorrhage - bleeding into CSF
36
Three different pupillary findings in intracerebral hemorrhage depending on location
Pons - pinpoint pupils Thalamus - poorly reactive pupils Putamen - dilated pupils
37
Common location of subarachnoid hemorrhage
Saccular aneurysms - bifurcations of arteries at circle of willis
38
Three causes of subarachnoid hemorrhage
1. ) Ruptured berry aneurysm - most common and most dangerous 2. ) Trauma 3. ) AV malformation
39
Clinical features of subarachnoid hemorrhage
Worst headache of life, with loss of consciousness, vomiting, and meningeal irritation with photophobia and retinal hemorrhages
40
Two diagnostic modalities of subarachnoid hemorrhage
1. ) Noncontrast CT | 2. ) Lumbar puncture if CT scan is negative - shows blood and xanthochromia - gold standard
41
After diagnosis of subarachnoid hemorrhage, what test should be ordered to confirm diagnosis
Cerebral angiogram
42
Complications of subarachnoid hemorrhage
1. ) Rerupture 2. ) Vasospasm 3. ) Communicating hydrocephalus 4. ) Seizures 5. ) SIADH
43
Surgical treatment options of subarachnoid hemorrhage
Berry aneurysms treated surgically
44
Medical treatment of subarachnoid hemorrhage
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
What is a heat stroke and what is required to make the diagnosis
Thermoregulatory problem - hyperthermia > 40.5C
46
How do patients with heat stroke present clinically
Acute confusion, tachycardia, coagulopathic bleed, hypotension
47
What is a complication of heat stroke
Rhabdomyolosis
48
What is wallenberg's syndrome and what area of the brain does it affect
Occlusion of PICA or vertebral artery, affecting lateral medulla
49
What are the symptoms of wallenberg syndrome, and what is spared?
1. ) Pain/temp loss over ipsilateral face/contralateral body 2. ) Vestibulocereballar impairment 3. ) Horners syndrome Spared: Motor function
50
What is the diagnostic modality of choice for wallenberg syndrome
MRI
51
What is the difference in symptoms between intracerebral hemorrhage of cerebellum, thalamus, and pons
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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