Stroke Flashcards
What are the 5 uncontrollable risk factors for stroke?
- Age
- 3/4 65+ yoa
- 2x risk/ decade after 55 - AA race
- Family Hx
- Previous MI, stroke, TIA
- Sex (women more than men after 65 yoa)
What are the Treatable/ Controllable Risk factors for Stroke? (6)
- HTN (1/3 adults has HTN)
- DM (26.9% adults over 65)
- Tobacco Abuse (smokers 2x nonsmoker for ischemic stroke)
- Afib (independent risk factor; ^ risk 5x)
- Previous TIA or stroke
- Carotid or other artery disease
List 4 genetic risk factors for stroke?
- Hypercoagulable state (i.e. factor 5 leiden, prothrombin G202)
- ^ ApoE4
- ^ Homocysteine
- Fabry’s, homocystinuria, EDS, pseudoxanthoma elasticum
6 Symptoms of stroke:
- Vision changes
- Speech changes; difficulty understanding language
- Swallowing problems
- Unilateral weakness/ numbness
- Vestibular sx
- Severe HA with progressive decrease in consciousness
What is the time of onset for a stroke?
Last known normal
What labs are run in the initial stroke evaluation?
- CBC, CMP
- Troponin,
- Coags
- FSBS (finger stick blood sug.)
What are the 5 most important initial elements to stroke evaluation?
- Onset (last known normal)
- NIHSS
- Labs
- Vitals
- 2 peripheral IVs
What is the NIHSS?
What is the scale range?
Standardized evaluation to assess disability and neuro status change in stroke patients (0-42 scale)
What are 5 Neuroimaging modalities used to assess acute stroke?
- CT (Brain attack protocol)
- Fast Brain MRI
- Conventional Angiogram
- Carotid US
- Transcranial doppler
What are the following used to evaluate:
- Plain head ST
- CTA
- CTP
- Intracerebral Hemorrhage; edema asstd w underlying tumor
- Vascular occlusion/ stenosis
- Infarcted core brain tissue + penumbra (ID blood volume throughout brain)
Define Penumbra: What causes it? CBV? MTT? Treatment?
- Caused by vessel occlusion
- CBV PRESERVED
- MTT prolonged
- Recanalizaiton MAY offer benefits
Define Core infarct: What causes it? CBV? MTT? Treatment?
- Caused by vessel occlusion
- DECREASED CBV
- MTT prolonged
- Recanlaization = MORE RISK than benefit
What is the gold standard treatment for acute stroke; what is the time frame within which it must be administered?
rtPA
- Must give within 3 hrs of stroke associated near deficit onset
What can be given to patients if they are not candidates for rtPA?
Aspirin 325mg
- Give to patients that do not get tPA, or 24 hrs after getting rtPA if there is no hemorrhage on 24 hr CT/MRI
What is the Lazarus Effect?
Rapid improvement within first 24 hrs upon administration of rtPA; not seen in NINDS trial
Describe results of NINDS trial:
Patients who got pa within 90 min had better improvement from baseline at 90 days than patients given only Aspirin
What 4 statements must be true in order to give rtPA?
- Ischemic stroke within 3 hrs
- Measurable deficit on NIH stroke scale
- Plain head CT without hemorrhage/ non stroke cause of deficit
- Patient 18+ yoa
Absolute contraindications to rtPA: (8)
- Minor or rapidly improving sx
- Seizure w. stroke onset
- Another stroke/ head trauma within 3 mos
- Major surgery within 14 days
- Hx intracranial hemorrhage
- BP= 185+ / 110+ (with IV meds)
- Aggressive tx necessary to lower patient BP
What are 2 relative CI to rtPA?
- Large stroke with NIH scale 22+
2. CT shows large MCA infarct (sulcal effacement/ blurring of gray-white jxn in greater than 1/3 MCA territory)
What is the management protocol to follow rtPA administration?
First 2 hrs: Q15 min vitals + near checks
Every 6 hrs: Q30 min vitals + near checks
At 24 hrs: Q1 hr vitals + neuro checks
IMAGING:
**24 hr post tPA head CT or MRI to evaluate bleeding
**STAT CT for and decline in euro status
What is Cushing’s triad?
- HTN
- Bradycardia
- Irregular respirations
**can occur with rtPA administration
Describe 7 types of Intra-arterial therapy for stroke:
- rtPA
- IIb/IIIa inhibitors
- MERCI cash
- PENUMBRA cath
- Wingspan stent
- NeuroFlo cash
- Ekos cath
What are 8 common post stroke complications?
- aspiration +/- pneumonia
- DVT
- PE
- Decubitus ulcer
- Seizure
- UTI
- Constipation
- Depression
Describe three findings associated with anterior circulation stroke:
- Gaze preference change
- Aphasia
- Neglect
Describe 4 findings associated with posterior circulation stroke:
- Vertigo
- Diplopia
- Crossed Track findings
- Dyscongugate Gaze
What are findings common to both anterior and posterior circulations strokes? (5)
- Hemiparesis
- Hemianesthesia
- Visual field deficit
- Slurred speech
- Ataxia
Dominant hemisphere strokes wil result in…
APHASIA
+ Hemiparesis, Hemianestheia, Dysarthria, Gaze preference, Visual field deficit
Non dominant hemisphere strokes will result in…
NEGLECT
+ Hemiparesis, Hemianestheia, Dysarthria, Gaze preference, Visual field deficit
What are 5 possible etiologies for large artery strokes?
- Cardioembolism
- Artery-artery embolism
- Large artery stenosis (ICAD)
- Paradoxical embolus
- Cryptogenic (idiopathic)
What are 3 possible etiologies for small artery stroke?
- Lipohyalinosis*** (secondary to vascular risk factors)
- ICAD
