Stroke

Question 1

What causes lateral medullary infarction?

Answer 1

PICA occlusion

Question 2

What occurs w/ lateral medullary infarction?

Answer 2

• loss of pain temp over ipsi face and contra body (spinal trigem, spinothalamic)
• ipsi bulbar muscle weakness (nucleus ambiguus)
• vertigo/nystagmus (vestibular nuclei)
• Horner syndrome (ascending sympathetic fibers)

Question 3

How do midbrain strokes present?

Answer 3

• ipsi oculomotor nerve palsy
• ataxia (damage to superior cerebellar peduncle)
• contralateral hemiparesis (cerebral peduncle)

Question 4

What is a common site of hypertensive intraparencyhymal brain hem? what happens?

Answer 4

• putamen

- internal capsule usually involved -> contralat hemiparesis, sensory loss, conjugate gaze palsy toward side of lesion

Question 5

Normal CSF values:

• cell count
• glucose
• pressure
• proteins

Answer 5

• cell ct (0-5)
• glucose ~40-70 (2/3 serum(
• pressure 70-180 mmH20
• protein <40

Question 6

What is the MCC of spontaneous lobar/cortical hem (occipital, parietal) in adults >60?

Answer 6

cerebral amyloid angiopathy

Question 7

MCC of intraparenchymal brain hem in kids?

Answer 7

brain AVM

Question 8

inclusion criteria for tpa

Answer 8

• ischemic stroke w/ measurable neurodeficits

- symptom onset <3-4.5 hours before tx

Question 9

Strict tpa exclusion criteria

Answer 9

• hemorrhage or multilobar infarct of >33% of cerebral hemisphere on CT
• stroke/head trauma in past 3 months
• hx of ICH, neoplasm, or AVM
• recent intracranial/spinal sx
• active bleeding or arterial puncture in past 7 days at noncompressible site
• BP >185/110
• platelets <100K or glucose <50
• anticoag use w/ INR >1.7, PT >15 sec or increased PTT

Question 10

relative exclusion criteria for tpa?

Answer 10

• minor or rapidly improving neurodeficits
• major sx/trauma in past 14 days
• MI in past 3 months
• GU/GI bleed w/in 21 days
• seizure at stroke onset
• pregnancy

Question 11

Within what window can ASA reduce clot propagation/risk of stroke recurrence?

Answer 11

48 hrs

**but not as good as tpa; hold ASA for 24 hrs post tpa

Question 12

What is the goal bp prior to admin of tpa?

Answer 12

<= 185/110

Question 13

localization of pure motor hemiparesis

Answer 13

lacunar stroke in posterior limb of the internal capsule

Question 14

What else is assoc w/ lateral medullary syndrome?

Answer 14

aka Wallenburg (vertigo, ipsi ataxia)
- vertebral artery dissection

Question 15

common cause of partial ipsi Horners (ptosis and miosis WITHOUT anhidrosis)

Answer 15

carotid dissection

Question 16

localization of resting tremor

Answer 16

PD: prog less of DA neurons in BG, interrupts connection from BG -> thalamus -> motor cortex

Question 17

Antiplatelet antithromobotic tx for ischemic stroke: presents w/in 3.5-4 hrs of onset, and no CI

Answer 17

IV TPA

Question 18

ischemic stroke tx if stroke w/ no prior antiplatelet therapy and outside time window?

Answer 18

ASA (asap! w/in 24 hours and continue indefinitely)

Question 19

stroke tx on ASA tx?

Answer 19

ASA + dipyridamole OR clopidogrel

Question 20

stroke tx if on ASA and intracranial large artery atherosclerosis?

Answer 20

ASA + clopidogrel

Question 21

stroke tx with evidence of afib?

Answer 21

long term anticoag (warfarin, dabigatran, rivaroxaban)

Question 22

What else do you see with ACA stroke other than legs>arms?

Answer 22

• abulia (lack of will or initiative)

- dyspraxia, emotional disturbances, urinary incontinence