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Neuro Clerkship > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the 5 uncontrollable risk factors for stroke?

A
  1. Age
    - 3/4 65+ yoa
    - 2x risk/ decade after 55
  2. AA race
  3. Family Hx
  4. Previous MI, stroke, TIA
  5. Sex (women more than men after 65 yoa)
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2
Q

What are the Treatable/ Controllable Risk factors for Stroke? (6)

A
  1. HTN (1/3 adults has HTN)
  2. DM (26.9% adults over 65)
  3. Tobacco Abuse (smokers 2x nonsmoker for ischemic stroke)
  4. Afib (independent risk factor; ^ risk 5x)
  5. Previous TIA or stroke
  6. Carotid or other artery disease
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3
Q

List 4 genetic risk factors for stroke?

A
  1. Hypercoagulable state (i.e. factor 5 leiden, prothrombin G202)
  2. ^ ApoE4
  3. ^ Homocysteine
  4. Fabry’s, homocystinuria, EDS, pseudoxanthoma elasticum
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4
Q

6 Symptoms of stroke:

A
  • Vision changes
  • Speech changes; difficulty understanding language
  • Swallowing problems
  • Unilateral weakness/ numbness
  • Vestibular sx
  • Severe HA with progressive decrease in consciousness
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5
Q

What is the time of onset for a stroke?

A

Last known normal

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6
Q

What labs are run in the initial stroke evaluation?

A
  • CBC, CMP
  • Troponin,
  • Coags
  • FSBS (finger stick blood sug.)
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7
Q

What are the 5 most important initial elements to stroke evaluation?

A
  • Onset (last known normal)
  • NIHSS
  • Labs
  • Vitals
  • 2 peripheral IVs
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8
Q

What is the NIHSS?

What is the scale range?

A

Standardized evaluation to assess disability and neuro status change in stroke patients (0-42 scale)

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9
Q

What are 5 Neuroimaging modalities used to assess acute stroke?

A
  1. CT (Brain attack protocol)
  2. Fast Brain MRI
  3. Conventional Angiogram
  4. Carotid US
  5. Transcranial doppler
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10
Q

What are the following used to evaluate:

  1. Plain head ST
  2. CTA
  3. CTP
A
  1. Intracerebral Hemorrhage; edema asstd w underlying tumor
  2. Vascular occlusion/ stenosis
  3. Infarcted core brain tissue + penumbra (ID blood volume throughout brain)
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11
Q 
Define Penumbra: 
What causes it? 
CBV? 
MTT? 
Treatment?
A
  • Caused by vessel occlusion
  • CBV PRESERVED
  • MTT prolonged
  • Recanalizaiton MAY offer benefits
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12
Q 
Define Core infarct: 
What causes it? 
CBV? 
MTT? 
Treatment?
A
  • Caused by vessel occlusion
  • DECREASED CBV
  • MTT prolonged
  • Recanlaization = MORE RISK than benefit
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13
Q

What is the gold standard treatment for acute stroke; what is the time frame within which it must be administered?

A

rtPA

- Must give within 3 hrs of stroke associated near deficit onset

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14
Q

What can be given to patients if they are not candidates for rtPA?

A

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

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15
Q

What is the Lazarus Effect?

A

Rapid improvement within first 24 hrs upon administration of rtPA; not seen in NINDS trial

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16
Q

Describe results of NINDS trial:

A

Patients who got pa within 90 min had better improvement from baseline at 90 days than patients given only Aspirin

17
Q

What 4 statements must be true in order to give rtPA?

A
  1. Ischemic stroke within 3 hrs
  2. Measurable deficit on NIH stroke scale
  3. Plain head CT without hemorrhage/ non stroke cause of deficit
  4. Patient 18+ yoa
18
Q

Absolute contraindications to rtPA: (8)

A
  1. Minor or rapidly improving sx
  2. Seizure w. stroke onset
  3. Another stroke/ head trauma within 3 mos
  4. Major surgery within 14 days
  5. Hx intracranial hemorrhage
  6. BP= 185+ / 110+ (with IV meds)
  7. Aggressive tx necessary to lower patient BP
19
Q

What are 2 relative CI to rtPA?

A
  1. 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)

20
Q

What is the management protocol to follow rtPA administration?

A

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

21
Q

What is Cushing’s triad?

A
  • HTN
  • Bradycardia
  • Irregular respirations

**can occur with rtPA administration

22
Q

Describe 7 types of Intra-arterial therapy for stroke:

A
  1. rtPA
  2. IIb/IIIa inhibitors
  3. MERCI cash
  4. PENUMBRA cath
  5. Wingspan stent
  6. NeuroFlo cash
  7. Ekos cath
23
Q

What are 8 common post stroke complications?

A
  1. aspiration +/- pneumonia
  2. DVT
  3. PE
  4. Decubitus ulcer
  5. Seizure
  6. UTI
  7. Constipation
  8. Depression
24
Q

Describe three findings associated with anterior circulation stroke:

A
  • Gaze preference change
  • Aphasia
  • Neglect
25
Q

Describe 4 findings associated with posterior circulation stroke:

A
  • Vertigo
  • Diplopia
  • Crossed Track findings
  • Dyscongugate Gaze
26
Q

What are findings common to both anterior and posterior circulations strokes? (5)

A
  • Hemiparesis
  • Hemianesthesia
  • Visual field deficit
  • Slurred speech
  • Ataxia
27
Q

Dominant hemisphere strokes wil result in…

A

APHASIA

+ Hemiparesis, Hemianestheia, Dysarthria, Gaze preference, Visual field deficit

28
Q

Non dominant hemisphere strokes will result in…

A

NEGLECT

+ Hemiparesis, Hemianestheia, Dysarthria, Gaze preference, Visual field deficit

29
Q

What are 5 possible etiologies for large artery strokes?

A
  • Cardioembolism
  • Artery-artery embolism
  • Large artery stenosis (ICAD)
  • Paradoxical embolus
  • Cryptogenic (idiopathic)
30
Q

What are 3 possible etiologies for small artery stroke?

A
  • Lipohyalinosis*** (secondary to vascular risk factors)

- ICAD

Neuro Clerkship (13 decks)

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