Stroke

Question 1

What are the types of strokes?

Answer 1

1. Embolic 2. Thrombotic (involves diseased vessels) 3. Hemorrhagic (subarachnoid or parenchymal)

Question 2

ACA feeds primarily

Answer 2

Feet and legs

Question 3

MCA feeds primarily

Answer 3

Arms, hands, face, speech

Question 4

PCA feeds primarily

Answer 4

vision

Question 5

Basilar and vertebral insufficiency leads to

Answer 5

Syncope

Question 6

Basilar infarct can lead to what syndrome?

Answer 6

Locked in syndrome

Question 7

What are signs of cerebellar infarct?

Answer 7

Dysdiadokinesia; Ataxia

Question 8

Why perform a non-contrast CT of the head?

Answer 8

Answers the question, “is this a brain bleed?”

Question 9

If a hemorrhagic stroke is diagnosed on CT, what are the neurosurgical options?

Answer 9

Clip Coil Craniotomy

Question 10

While waiting for neurosurgery to consult on a hemorrhagic stroke, what is your role?

Answer 10

Reduce BP; Control bleed with FFP

Question 11

After acute management of a stoke, what studies should be ordered?

Answer 11

EKG Echo Carotid Ultrasound

Question 12

What post stroke finding requires a heparin to warfarin bridge?

Answer 12

Thrombus found on echo

Question 13

What post stroke finding does not require a heparin to warfarin bridge?

Answer 13

Atrial fibrillation

Question 14

Stroke is a clinical diagnosis. If there is a question, order what study?

Answer 14

MRI

Question 15

What is the cutoff time for tPA?

Answer 15

3 hours from symptom onset

Question 16

What is the BP cutoff for tPA?

Answer 16

<180/<105

Question 17

Who can’t you tPA

Answer 17

Anyone with current bleed, like GI bleed; Anyone with hx of intracranial bleed; Anyone with recent surgery

Question 18

Do not give what blood thinner in an acute stroke setting?

Answer 18

Heparin Warfarin

Question 19

Why allow permissive BP in the setting of acute stroke management (w/o tPA)?

Answer 19

Up to 220/110; Allowing punumbra (area around the infarct) to be perfused

Question 20

What is the management of diabetes in the setting of acute stroke?

Answer 20

Tightly control sugar, <140

Question 21

If a patient has a stroke while on aspirin, what is the management in terms of antiplatelet therapy in the long term?

Answer 21

ASA + dipyrimidole OR clopidogrel for ASA intolerance