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Stroke Flashcards

1
Q

Stroke is the most common neurologic disorder

A

TRUE

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2
Q

Stroke classification percentages

A

Infarct 80%
Atherothrombotic 55
Embolic 20
Lacunar 25

Bleed 20%
HTN 60
SAH 40

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3
Q

Symptoms maximal at onset

A

Bleed

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4
Q

Progressive symptoms

A

Infarct

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5
Q

Depressed sensorium

A

Bleed

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6
Q

Headache, vomiting

A

Bleed

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7
Q

SBP >= 220

A

Bleed

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8
Q

Seizures

A

Bleed

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9
Q

Plain cranial CT scan is useful in early infarcts

A

FALSE

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10
Q

Plain cranial CT 100% Sn in identifying hemorrhage

A

TRUE

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11
Q

Modality of choice for early infarct and brainstem lesions

A

MRI

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12
Q

Diffusion weighted imaging

A

Detects areas of restricted diffusion of water
Bright in acute ischemic stroke
DIfferentiates old from new

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13
Q

Tests to order ASAP

A 
Plain cranial CT
CBC
Blood sugar
ECg
PT PTT
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14
Q

Left (dominant hemisphere)

A

Left gaze preference
Right visual field deficit
Right hemiparesis
Right hemisensory loss

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15
Q

Brainstem

A 
N/V
Diplopia, gaze palsy
Dysarthria, phagia
Vertigo tinnitus
Hemiparesis quadriplegia
Sensory loss in half or all 4 limbs
Decr sensorium
Hiccups, abnormal respiration
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16
Q

Where is the lesion? Symptoms:
truncal/gait ataxia
neck stiffness

A

cerebellum

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17
Q

Where is the lesion? Symptoms:

Arm> leg weakness

A

MCA (think MCDO hand gesture)

MCA supplies lateral part of temporal and parietal lobe. Homunculus - arm sa lateral part

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18
Q

LMCA cognitive symp

A

aphasia

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19
Q

RMCA cognitive symp

A

neglect, topographical difficulty, apraxia, construction impairment

(lesion at posterior parietal cortex- imp in planning, spatial reasonging, attention)

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20
Q

Leg> arm weakness

A

ACA

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21
Q

cognitive, muteness, preservation, abulia, disinhibition

A

ACA

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22
Q

Heminaopia

A

PCA (occipital lobe)

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23
Q

Memory loss/ Confusion

A

PCA (hippocampus, amygdala)

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24
Q

Crossed signs,

A

CN findings

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25
Ipsilateral ataxia
PCA or vertebrobasilar system
26
Thrombolysis rule of 3s
within 3 hrs, 30% more likely to have minimal or no disability at 3 months
27
Thrombolysis risk
ICH (5%)
28
rTPA dose
0.9 mg/kg 10% as bolus, 90% as infusion for 1 hour
29
rTPA window
if IV - 3hours, if arterial 4.5 hours
30
rTPA inclusion criteria
within 3 hours, no ICH on CT scan, Screening NIH score of >= 6
31
Exclusion of rTPA
``` SBP >185, DBP >110 minor symptoms, rapidly improving SEIZURE at onset HEAD TRAUMA within 3 months GI/GU BLEEDING within 21 days ANTICOAG/HEPARIN within 2 days ELEVATED PT/PTT >1.5 Thrombocytopenia <100,000 RBS <50 or >400 mg/dl ```
32
Components of therapy
``` Antiplatelets (Aspirin, clopidogrel, cilostazol) Statin Address comorbs Medical decompression Neuroprotection 5H Rehab ```
33
Goal of BP mgt
maintain celrebral perfusion
34
CPP?
MAP-ICP Needs to be at least 70
35
Permissive HTN in Ischemic stroke to ensure perfusion
TRUE MAP 110-130 !!! SBP <=220, DBP <=110
36
Hydralazine Esmolol Labetalol Nicardipine
Nicard dose 5-15 mg/kg/hr
37
Normal CBF
50-55 ml/100 g/min
38
Contraindications to permissive HTN
``` Acute MI CHF AKI Acute Pulmo edema Aortic dissection ```
39
Embolic stroke
cardioembolic (AFib, ACS, MVP)
40
Early signs of ischemic stroke
``` Gray white differentiation is lost Insular ribbon sign Rtery: dense MCA sign Lentiform nucleus obscuration Sulci effacement ```
41
Gyral enhancement occurs D4-D7 post ictus
TRUE plus mass effect and edema
42
Acute | Subacute
4 hours - A | 3 days - SA
43
Valvular AF
Warfarin target INR 2-3
44
Nonvalvular AF
Warfarin NOACs Aspirin
45
Lacunar strokes - Percentage of ischemic
15-20%
46
Lacunar strokes involve which vessels
small oenetrating bracnhes of CW, MCA< vertebrobasilar artery
47
infarct of deep brain structures - BG, cerebral white matter, thalamus, pons and cerebellum
Lacunar strokes | 15 mm to 1.5 cm
48
RF for Lacunar strokes
DM, HTN, Polycythemia
49
Pure motor hemiplegia
posterior limb of internal capsule equal weakness of CL limbs, face, with dysarthria
50
Pure sensory
VPL VPM nuclei of thalamus numbness and tingling of LC face and limbs
51
Sensorimotor stroke
thalamocapsular CL face arm leg weakness and numbness
52
Lesion in dorsal pons
dysarthria or clumsy hand (but good strength)
53
Lesion in ventral pons
ataxic hemiparesis mild hemiparesis with more marked IL limb ataxia
54
Transient Ischemic Attack - sudden focal neuro deficit lasting less than
24 hours to an area supplied by a specific artery
55
TIA clinical symptoms last typically
less than 1 hr with no evidence of acute infarct
56
Most common cause of non traumatic ICH
HTN bleed ``` then aneurysmal rupture AV mal rupture tumor bleed cocain use - angiopathy ```
57
Hypertensive bleed most common location
``` Putamen 50% Thalamus Cerebellum Pons Lobar ```
58
% of bleed in Thalamus
15%
59
% of bleed in Cerebellum
10%
60
% of bleed in Pons
10%
61
% of bleed in Lobar hemorrhage
15%
62
Mnemonic for ICH percentages
``` Putamen TaLo si CP Thalamus Lobar si Cerebellum Pons ```
63
Symptoms of putaminal bleed/ganglionic bleed
symptoms of IC lesion, thalamic lesion PLUS hmonymous hemianopia gaze towards affected side
64
Factors for surgical mgt
``` Khothari >30 cc Cerebellar bleed more than 3 cm in diameter Midline shift Intraventricular extension Distance from the cortex ```
65
For hyprtensive bleed, no anticoag/antiplatelets! No permissive HTN
``` BP control medical decompression: mannitol or hypertonic saline Statin Neuroprotection Rehab ```
66
MC site of aneurysm - ruptured- SAH
ACom-ACA junction
67
CN III palsy
PCom
68
CN VI palsy
any
69
Bilateral leg weakness, abulia
ACom
70
Nystagmus, ataxia, dizziness
Posteriori circulation symdromes
71
** Todd's paralysis
focal weakness after a seizure
72
Hemiparesis wiht aphasia or neglect
MCA
73
Factors for Clipping
MCA aneurysm | Large parenchymal clot (>50 ml)
74
Factors for coiling
Elderly >70 yo Vasospasm Poor clinical grade Pos. circulation aneurysm (basilar)
75
Neuro VS
BP with MAP RR Temp GCS
76
MAP
SBP + 2 DBP divide by 3 maintain at 110-130
77
5H - Avoid!
``` Hypoxia Hypovolemia Hyper or Hypotension Hyper or Hypothermia Hypo/pernatremia, glycemia other metab derangements ```
78
HOLD BP lowering agents in CVD infarcts EXCEPT if:
``` SBP>220, DBP >120, MAP >130 Acute Pulmo Edema Acute Renal failure Acute MI Aortic dissection Hypertensive ENCEPHALOPATHY ```
79
Mgt of SAH
Nimodipine 60 mg q4h for 21 days Manage Inc ICp Anticonvulsants Clip or Coil
80
Clin features of incICP
HA N/V Papilledema +/- dec in sensorium
81
Neuro features of inc ICP
Cushings triad (irregular respiration, bradycardia, increased pulse pressure) Anisocoria (dilated pupil ipsilateral to lesion) Dec sensorium Cheyne stokes respiration
82
Normal Pulse Pressure
Above 40 mmHg
83
Normal CPP
60-140 mmHg
84
Hyperventilation causes
cerebral vasoconstriction de to decreased pCO2 (goal 26-30 mmHg) decreased CBF

Neurology (5 decks)

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