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NEURO CLERKSHIP > Stroke > Flashcards

Stroke Flashcards

(43 cards)

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1
Q

What is the 4th leading cause of death in the US?

A

Stroke

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2
Q

What is the Leading cause of serious long-term disability in the US?

A

Stroke

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3
Q

How many people have a stroke/year?

A

800,000

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4
Q

What are the 90 day and lifelong costs of a stroke to the patient?

A

$15,000 and $140,000

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5
Q

What is the most common type of stroke?

A

Ischemic (87%)

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6
Q

What is an ischemic stroke?

A

Blocked blood flow to the brain due to either a thrombus (more common) or embolus

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7
Q

What is a hemorrhagic stroke?

A

Bleeding into the brain

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8
Q

What are the main causes of hemorrhagic stroke?

A
  1. Intracerebral Hemorrhage

2. Subarachnoid Hemorrhage

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9
Q

From where are foam cells derived?

A

Smooth Muscle Cells

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10
Q

What is released by Th1 Cells to induce macrophage activity in the formation of an atheroma?

A

IFNgamma

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11
Q

What is the most common site of plaque formation leading to cerebral embolism?

A

Internal Carotid

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12
Q

What are the uncontrollable risk factors for developing a stroke?

A
  1. Age > 65 (risk doubles every 10yrs after 55)
  2. African American
  3. Family Hx
    Previous MI, Stroke or TIA
  4. Female (increased risk only at old age)
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13
Q

What is the risk of a stroke following a TIA at 1 month?

A

4-8%

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14
Q

What is the risk of a stroke following a TIA at 1 year?

A

12-13%

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15
Q

What is the risk of a stroke following a TIA at 5 years?

A

24-29%

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16
Q

What are controllable risk factors for a stroke?

A
  1. HTN
  2. DM
  3. Tobacco (risk is 2x non-smokers)
  4. Atrial Fibrillation (risk is 5x)
  5. Previous stroke/TIA
  6. Carotid artery disease
  7. Blood diseases (SS, erythrocytosis)
  8. High Cholesterol
  9. Physical inactivity/obesity
  10. Alcohol/drug use
  11. Infection
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17
Q

What are genetic risks for a stroke?

A
  1. Hypercoagulable states (Factor V Leiden and Prothrombin G20210A)
  2. Increased Serum Apolipoprotein E4
  3. Increased Homocysteine
  4. Fabry’s disease, homocystinuria, Ehler’s Danlos and Pseudoxanthoma elasticum
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18
Q

Symptoms suggesting stroke

Study These Flashcards
A

Sudden onset of…

  1. Vision loss, double or blurred vision
  2. Slurred speech or difficulty speaking/understanding language
  3. Difficulties swallowing
  4. Unilateral weakness or numbness
  5. Difficulties with balance or vertigo
  6. HA w/ decline in consciousness
19
Q

Describe the process of what to do if a patient has a stroke

Study These Flashcards
A
  1. If outside hospital- call 911, supportive care until EMS then pt taken to stroke center
  2. If at hospital- call Stroke Alert, supportive care even after arrival of stroke team, transport pt to necessary area for workup
20
Q

What is the initial stroke team evaluation?

Study These Flashcards
A
  1. Thorough Hx- including last known normal
  2. NIH Stroke Score
  3. CBC, CMP, troponin, Coags and FSBS
  4. Vitals
  5. 2 peripheral IVs (18 gauge in antecubital fossas for CTA and contrast bolusing)
21
Q

What is the best form of acute neuroimaging for a stroke; what are other choices?

Study These Flashcards
A

Best- CT Brain Attack Protocol

  1. Fast MRI
  2. CVA
  3. Carotid US
  4. Transcranial Doppler
22
Q

Describe the acute stroke CT protocol

Study These Flashcards
A
  1. Plain Head CT- r/o hemorrhage, edema w/ tumors
  2. CTA w/ contrast- evaluate vascular occlusions and stenosis
  3. CTP- evaluate infarcted “core” regions and potentially salvageable “penumbra” regions
23
Q

What does Cerebral Blood Volume assess?

Study These Flashcards
A

Blood volume throughout brain;
Core- decreased CBV
Peneumbra- normal CBV

24
Q

What does Mean Transit Time assess?

Study These Flashcards
A

The amount of time it takes blood to get to specific regions of the brain; increased in regions distal to the occlusion
MTT is prolonged in both core and penumbra

25
What are the approved Tx for an acute stroke?
1. tPA- if within 3 hrs and meet criteria | 2. 325mg Aspirin (in pts who do not get tPA + in 24hrs after tPA if no hemorrhage per CT/MRI)
26
What is the Lazarus effect and what did it show?
It evaluates improvement within 24hrs of a stoke- study showed no difference b/w tPA and 325mg Aspirin
27
When does tPA show a benefit?
When looking at improvement from baseline neurological deficit at 90 days
28
What are the indications to give tPA?
1. Ischemic stroke within 3 hours 2. Deficit on NIHSS exam 3. CT r/o hemorrhage 4. Pt > 18y/o
29
What are the absolute contraindications to giving tPA?
1. Seizure at onset of stroke 2. Hx of Head Tauma or Stoke in past 3 months 3. Major Surgery within 14 days 4. Hx of Intracranial Hemorrhage 5. BP > 185/110 despite meds 6. SX of subarachnoid hemorrhage even if CT -- 7. GI or urinary hemorrhage within 21 days 8. Arterial Puncture within 7 days in non-compressable spot 9. Heparin within last 48hrs or elevated PTT/*PT (INR > 1.7) 10. Platelet count 400
30
What are the relative contraindications to giving tPA?
1. Stroke with NIHSS > 22 | 2. CT shows large MCA stroke with effacement or blurring of gray-white JXN
31
How is tPA dosed?
IV- .9mg/kg up to a max dose of 90mg; 10% boluses over 1min, 90% given over next hour IA- dosing based on situation; can be combined with IV
32
What are possible adverse reactions to tPA?
1. Local bleeding 2. Anaphylaxis/angioedema 3. Worsening neuro exam 4. Cushing's Triad
33
What is Cushing's Triad?
HTN + Bradycardia + Irregular Respirations
34
What are other stroke Tx options other than tPA?
1. Aspirin 325mg 2. IIb/IIIa inhibitors 3. Catheters and stents
35
What are complications post-stroke?
1. Aspiration Pneumonia 2. DVT/PE 3. Decubitus Ulcers 4. Seizures 5. UTI 6. Constipation 7. Depression
36
Origins of an anterior and posterior circulation stroke
Anterior- Internal Carotid | Posterior- Vertebrobasilar
37
Non-specific stroke symptoms include
Hemiparesis, Hemianesthesia, Visual Field Deficit, Slurred Speech and Ataxia
38
What are some symptoms specific to an Anterior Circulation stroke?
Gaze preference, aphasia and neglect (if non-dominant)
39
What are some symptoms specific to a Posterior Circulation stroke?
Diplopia, Vertigo, Dysconjugate Gaze and "crossed track" findings
40
A stroke to the dominant hemisphere will cause
Aphasia
41
The thalamus receives its blood supply from
PCA
42
A stroke to the non-dominant hemisphere will cause
Neglect
43
What is lipohyalinosis?
A small vessel disease of the brain resulting in a narrowed lumen

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