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NEURO CLERKSHIP > Stroke > Flashcards

Stroke Flashcards

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

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

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?

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?

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

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?

A

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

24
Q

What does Mean Transit Time assess?

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
Q

What are the approved Tx for an acute stroke?

A
  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
Q

What is the Lazarus effect and what did it show?

A

It evaluates improvement within 24hrs of a stoke- study showed no difference b/w tPA and 325mg Aspirin

27
Q

When does tPA show a benefit?

A

When looking at improvement from baseline neurological deficit at 90 days

28
Q

What are the indications to give tPA?

A
  1. Ischemic stroke within 3 hours
  2. Deficit on NIHSS exam
  3. CT r/o hemorrhage
  4. Pt > 18y/o
29
Q

What are the absolute contraindications to giving tPA?

A
  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
Q

What are the relative contraindications to giving tPA?

A
  1. Stroke with NIHSS > 22

2. CT shows large MCA stroke with effacement or blurring of gray-white JXN

31
Q

How is tPA dosed?

A

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
Q

What are possible adverse reactions to tPA?

A
  1. Local bleeding
  2. Anaphylaxis/angioedema
  3. Worsening neuro exam
  4. Cushing’s Triad
33
Q

What is Cushing’s Triad?

A

HTN + Bradycardia + Irregular Respirations

34
Q

What are other stroke Tx options other than tPA?

A
  1. Aspirin 325mg
  2. IIb/IIIa inhibitors
  3. Catheters and stents
35
Q

What are complications post-stroke?

A
  1. Aspiration Pneumonia
  2. DVT/PE
  3. Decubitus Ulcers
  4. Seizures
  5. UTI
  6. Constipation
  7. Depression
36
Q

Origins of an anterior and posterior circulation stroke

A

Anterior- Internal Carotid

Posterior- Vertebrobasilar

37
Q

Non-specific stroke symptoms include

A

Hemiparesis, Hemianesthesia, Visual Field Deficit, Slurred Speech and Ataxia

38
Q

What are some symptoms specific to an Anterior Circulation stroke?

A

Gaze preference, aphasia and neglect (if non-dominant)

39
Q

What are some symptoms specific to a Posterior Circulation stroke?

A

Diplopia, Vertigo, Dysconjugate Gaze and “crossed track” findings

40
Q

A stroke to the dominant hemisphere will cause

A

Aphasia

41
Q

The thalamus receives its blood supply from

A

PCA

42
Q

A stroke to the non-dominant hemisphere will cause

A

Neglect

43
Q

What is lipohyalinosis?

A

A small vessel disease of the brain resulting in a narrowed lumen

NEURO CLERKSHIP (10 decks)

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