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Neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

How common is stroke?

A
  • most common cause disability

- 4th leading COD

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2
Q

Lifetime cost of ischemic stroke

A

$140k

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3
Q

MC type of stroke

A

87% are ischemic, usually cerebral thrombus

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4
Q

Two types of ischemic stroke

A
  • thrombotic

- embolic

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5
Q

Two types of hemorrhagic stroke

A
  • SAH (in skull around brain)

- intracerebral (in brain)

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6
Q

Four layers of vessel

A

lumen –> endothelium –> SM –> adventitia

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7
Q

Unmodifiable risk factors for stroke: (5)

A
  • 65+ years old
  • african americans
  • previous
  • female
  • family hx
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8
Q

Preventable risk factors for stroke: (7)

A
  • HTN
  • DM
  • Tobacco
  • Afib, carotid disease
  • previous
  • obesity, inactivity
  • hypercholesterolemia
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9
Q

Secondary blood disorders contributing to stroke risk:

A
  • high RBCs

- sickle cell anemia

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10
Q

Genetic risk factors for stroke: (5)

A
  • FV Leiden,prothrombin
  • ^ApoE4, homocysteine
  • Fabrys
  • ED
  • Pseudoxanthoma elasticum
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11
Q

Acute Neuroimaging during stroke alert:

A

1) CT
2) fast brain MRI
3) conventional angio
4) carotid US
5) transcranial dopplers

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12
Q

CTP evaluates for? How?

A
  • core/penumbra

- penumbra has preserved blood volume (CBV)

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13
Q

Define MTT:

A
  • mean transit time

- increased in areas of brain distal to vessel occlusions (penumbra + core)

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14
Q

Define CBV:

A
  • cerebral blood volume

- preserved in penumbra, decreased in core

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15
Q

Compare recanalization of vessels in penumbra v core:

A
  • May be beneficial in penumbra

- risk for more ADRs than benefit in core

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16
Q

Timing for tPA administration

A
  • FDA: 3 hours

- ASA: 3-4.5 hours

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17
Q

ASA dose for stroke pts:

Who recieves ASA?

A
  • 325 mg
  • do not recieve tPA
  • 24 hours after tPA if no hemorrhage present
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18
Q

When are benefits of tPA seen?

A

-tPA better than ASA at 90 days out, 24 improvement no different

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19
Q

In addition to 3 hr window + CT free of hemorrhage, what must be true of pt to consider tPA?

A
  • measurable deficit on NIH stroke scale

- patient 18+ years old

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20
Q

What “conditions” are absolute CIs to tPA? (5)

A
  • stroke/ trauma within 3 months
  • GI/GU hemorrhage within 21 days
  • surgery within 2 weeks
  • artery puncture within 1 wk
  • history of ICH
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21
Q

What blood pressures are absolute contraindications to tPA?

A

-185/110 after efforts to manage

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22
Q

What symptoms are absolute contraindications to TPA?

A

-sx suggestive of SAH even with clear CT scan

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23
Q

What bleding conditions are abs contraindications to TPA?

A
  • heparin + elevated PTT w/in last 48 hours
  • PT higher than 15 s
  • INR higher than 1.7
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24
Q

Platelet count CI in TPA?

A

-less than 100k uL

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25
Q

What glucose is abs CI in TPA?

A
  • less than 50

- higher than 400

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26
Q

Four “relative” CI to TPA?

A
  • large/MCA stroke
  • sx are minor or rapidly improving
  • seizure at onset of stroke
  • aggressive tx needed to meet BP goals
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27
Q

FDA approved method of TPA administration

A

systemic IV dosing

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28
Q

Cushings triad

A
  • HTN
  • brady
  • irregular respirations
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29
Q

Three symptoms specific of Anterior circulation stroke

A
  • gaze preference
  • aphasia
  • neglect
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30
Q

Four symptoms specific for posterior circulation stroke

A
  • vertigo
  • diplopia
  • crossed track findings
  • dysconjugate gaze
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31
Q

Four symptoms that may be seen in either anterior or posterior stroke

A
  • hemiparesis, anesthesia
  • visual field deficit
  • slurred speech
  • ataxia
32
Q

Symptom specific to dominant hemispheric strokes:

A

1) dominant: aphasia

2) nondominant: neglect, apraxia

33
Q

Cause of akinetic mutism

A

Bilateral ACA strokes

34
Q

Cause of Antons Syndrome + What is antons syndrome

A
  • bilateral PCA strokes

- cortical blindness

35
Q

mesial temporal lobe infarct affects what structures?

A

-limbic

36
Q

MC Cause of AMS assc with stroke

A

-Aphasias

37
Q

How common is symptomatic ICH following IV TPA?

A

6.4% of patients

38
Q

4 risk factors for ICH following tPA

A
  • older
  • previous stroke
  • small vessel ischemia
  • labile BP
39
Q

How can emboli reach the brain?

A
  • heart: afib, valve disease, PFO

- carotid stenosis

40
Q

Visual defect assc with left sided MCA stroke?

A
  • loss of the rt visual fields

- eyes look towards lesion

41
Q

Speech is controlled by the same side of the brain as:

A

handedness

right hand dominant, left brain dominant language

42
Q

3 classic ACA infarct symptoms

A
  • leg more than arm weakness
  • personality or cognitive defects
  • urinary incontinence
43
Q

Limb ataxia is assc with stroke of what artery?

A

-PCA (per master the boards, Kaplan) (per Nolte, can be anterior OR posterior circulation…)

44
Q

How soon does CT show stroke? MRI? Why is CT done acutely?

A
  • CT: 4-5 days to reach 95% sensitivity
  • MRI: 24-48 hrs
  • CT done acutely to exclude hemorrhage
45
Q

What characterizes nonhemorrhagic stroke on CT?

A

-edema without blood (may see midline shift, ventricular compression)

46
Q

If ischemic stroke patient is already taking aspirin at time of symptom onset, what is the next best anticoagulant option? (assuming pt is not tpa candidate or has already received is a day ago)

A
  • add dipyridamole

- switch to clopidogrel

47
Q

Treatment for TIA

A

aspirin +/- dipyridamole OR clopidogrel

48
Q

Treatment for hemorrhagic stroke

A
  • none

- may surgically drain only if limited to posterior fossa

49
Q

If tPA is given within 3-4.5 of sx onset, what is required?

A

-written consent, this time period is not FDA approved and is considered experimental

50
Q

In addition to being anticoagulated, every patient with a stroke should take?

A

STATINS

51
Q

LDL goal for stroke patients?

A

-70-100

52
Q

Appearance of blood on CT

A

bright white hyperdense lesion

53
Q

Treatment of thrombi throwing clots to brain:

A

-heparin –> warfarin

54
Q

Goal INR for pt with hx of embolic strokes

A

2-3

55
Q

How is afib treated to prevent stroke?

A

-heparin –> warfarin to INR of 2-3

56
Q

Workout to evaluate causes of stroke?

A
  • echo
  • EKG (telemetry, holter)
  • Carotid US
57
Q

When is carotid endarterectomy advised?

A

70%-90% stenosis

**Cannot intervene is blockage is 100% occluded.

58
Q

Endarterectomy vs carotid angioplasty and stenting: which is superior?

A

-endarterectomy, stenting is of no proven value to stroke patients

59
Q

4 risk factors to control for stroke prevention

A
  • HTN
  • keep a1c under 7
  • reduce LDL to under 100
  • smoking cessation
60
Q

Definition of TIA

A

sx resolve within 24 hours

61
Q

Two main pathways resulting in cellular death from stroke:

A
  • necrosis (energy failure, cell swelling)

- apoptosis (penumbra over days)

62
Q

PCA #1 defect

A

-contralateral visual field cut

63
Q

Signs of lacunar infarct:

A

-motor/sensory deficit WITHOUT cortical signs

64
Q

Signs of basilar artery stroke

A

crossed face and body findings + oculomotor deficits

65
Q

Signs of vertebral artery stroke

A

crossed face and body findings + lower cranial nerve deficits

66
Q

Define: anosognosia

A

unawareness of illness and its clinical manifestations

similar to insight?

67
Q

MC cause neglect (2)

A

-right MCA territory stroke (non-dominant parietal lobe, premotor cortex of frontal lobe)

68
Q

Why must be determined before diagnosing apraxia

A

-pt understands the command, is cooperative, and has learned the task

69
Q

Deficit assc with stroke of dominant occipital cortex/adjacent corpus callosum

A

agnosia: visual information disconnected from language centers
- patient cannot read own writing, has color agnosia

70
Q

Define:

  • asomatognosia

- prosopagnosia

A
  • asomatognosia: does recognize body as part of own (Mrs. Mayo)
  • prosopagnosia: cannot recognize faces
71
Q

Labs drawn during Stroke Alert (4)

A
  • CBC
  • CMP
  • PTT
  • INR
72
Q

How long should imaging take during code stroke?

A

-CT + CTA less than 10 minutes

73
Q

MRI sequence needed for for assessing stroke?

A

DWI (intense in stroke)

74
Q

TPA MOA

A

-binds fibrin, converts plasminogen to plasmin

75
Q

How common is hemorrhage in TPA administration?

A

-6-7%; 1/16

76
Q

Large artery strokes are often _____ while lacunar infarcts are _____.

A

large: embolic
lacunar: HTN related

Neuro (15 decks)

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