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MBB > Stroke > Flashcards

Stroke Flashcards

1
Q

What do you if think a patient has stroke?

A

FOCUSED history -Time of onset (last known well) -Basic risk factors ( HTN, HDL,DM,TOB, CAD, hx cardiac surgery) -taking antithrombotics

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2
Q

Patient presents with right sided facial drop, right sided arm weakness and difficulty speaking, but able to understand commands. What part of the brain is effected? What is the next step?

A

*Left sided MCA occluded or hemorrhage-broca aphasia *Need non- contrasted head CT STAT - if non-hemorrhagic, give tPA and get STAT CT angiogram if onset less than 4.5hrs

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3
Q

tPA how does it work? Risks?

A

-Bind to fibrin and dissolve clot NNT = 7 -Risk: ICH (intracranial bleed) 6.4%

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4
Q

Patient has an mca occlusion what interventional treatment can you do after obtain CT angiogram?

A

Endovascular therapy (mechanical thrombectomy within 6hrs) after tPA

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5
Q

Ischemic stroke etiology

A

-Large arteriosclerosis *-cardioembolism* -small vessel occlusion -other determined etiology (dissection) -undetermined

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6
Q

After thrombotic stroke event what should the patient take?

A

Aspirin daily (antithrombotic) Risk factor modification -diet to decrease HTN -stop alcohol -exercise -stop smoking

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7
Q

When give dual antiplatlet therapy? Aspirin + extended release dipyridamole

A

-post small vessel occlusion -intercranial atherosclerosis

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8
Q

What give someone with a-fib to prevent strokes?

A

Warfarin 68% efficacy (anticoagulation) ASA 20% efficacy

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9
Q

40 yr old patient with history of uncontrolled HTN, develops sudden HA with gait instability, weakness and altered mental status. Last known well 4hr. BP 220/120 left lower sided facial droop, no movement LUE or LLE. Right side moves against gravity. Decrease consciousness. Diagnosis and treatment?

A

Hemorrhagic stroke - stop bleeding –reverse anticoagulation

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10
Q

Layers of meninges?

A

DAP Dura Arachnoid Pia

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11
Q

36 yr old patient hits left side head while skiing. Brief LOC and then responsive, within 20 minutes got slurred speech and appeared confused. Half hour later LOC. Diagnosis? Work up?

A

-Head CT without contrast -Epidural hematoma (lucid interval after trauma) -middle meningeal artery rupture -cannot cross midline

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12
Q

Family brings elderly patient to ER with mentation problems and disorientation. Questionable minor ball several months ago. Work up? What could this be?

A

-subdural hematoma -tearing bridging veins (build up over time) CT noncontrast head -can cross midline

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13
Q

Middle aged patient complains about sudden onset of worst headache of their life 10 out of 10. What is your differential? What do you want to do?

A

Non-contrast CT head -Subarachnoid hemorrhage -causes: congenital aneurysms, septic aneurysms, arterial venous malformation

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14
Q

Intracerebral hemorrhage causes?

A

Cerebral amyloid angiopathy, germinal matrix hemorrhage (prenatal)

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15
Q

How tell difference between adult brain and baby brain grossly?

A

Baby brain smooth

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16
Q

Grey matter vs white matter vulnerability

A

Grey: Neurons > oligodendrocytes >astrocytes > vessels White: oligodendrocytes>astrocytes> vessels

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17
Q
A
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18
Q
A
19
Q

Infant and adult brain vulnerability?

A

-CA1 (Sommer’s sector) of hippocampus -purkinje cells of cerebellum

20
Q

1 day post stroke micro findings histology?

A

Red neurons (coagulative)

21
Q

1 day-2 weeks post stroke finding micro and macro

A

Micro: transient neutrophils, massive macrophages Macro: adematous liquefactive

22
Q

Beyond 2 weeks post stroke micro and macro changes?

A

Micro: rim of Astrogliosis

Macro: progressive cavitation

23
Q

Diagnosis

A

Epidural Hemorrage

24
Q

Diagnosis?

A

Subdural Hemorrage

25
Q

What could have caused this and where is this located

A

DM or HTN could have caused, weakening of small vasculature in the basal ganglia caused this hemorrage.

26
Q

What is this?

A

germinal matrix hemorrage (prenatal)

27
Q

What is this?

A

1 day post stroke- red neurons

28
Q

What is this?

A

1 day- 2 weeks post stroke

-transient neutrophils, massive macrophages

29
Q

What is this?

A

More than 2 weeks post stroke

rim of astrogliosis

30
Q

How old is this this stroke?

A

1 day-2 weeks. Right side is macrophages

31
Q

How old is this stroke?

A

1 day old

32
Q

How old is this stroke?

A

greater than 2 weeks (cavatation)

33
Q

This is a 28 year-old female who has 5 days of left leg numbness.Four years agoshe hadblurry visionin the right eye for2 weeks.One year agoshe hadnumbnessof theright facefor4 weeks. There are no motor abnormalities. Fatigue is present.

The exam confirms decreased pinprick in the left leg and a mild right afferent pupillary defect (optic nerve finding).

Diagnosis?

A

MS

34
Q

Diagnosis

A

MS (disease CNS)

Dawson Fingers

35
Q

MS signs

A
  • optic neuritis (blurry vision, painful eye movement, color desaturation)
  • weakness, spasticity
  • sensory
  • ataxia, tremor
  • cognitive
  • Lhermitte’s sign
  • fatigue
  • heat and exercise intolerance
  • Bladder
  • sexual dysfunction
36
Q

How test for MS?

A

MRI

CSF (oligoclonal bands)

Evoked potential (longer time to get sensory information to brain using CNS)

37
Q

58 year-old hypertensive man was admitted to the hospital for sudden onset of dizziness, vomiting, dysarthria, and numbness.

The exam revealed pinprick sensory loss on the right face and left body, but proprioception was fine; nystagmus to the left; miosis, ptosis and decreased facial sweating on the right; ataxia of the right arm/leg; hoarseness; and the soft palate moved to the left when saying “aaah”.

A

Right face sensory loss and left body loss= brainstem problem

Wallenberg Syndrome

(stroke of posterior lateral medulla, blood supply PICA and vertebral)

38
Q

loss of pinprick sensation means damage to what part of pathway?

A

spinothalamic

39
Q

loss of proprioception means damage to what part of pathway?

A

posterior columns

40
Q

53 year-old female who has 1 day of bilateral leg weakness, urinary retention and numbness from the waist down. One week ago she had a cold.

The exam confirms decreased pinprick at T8 and below, reduced proprioception in the feet, bilateral leg weakness, absent leg reflexes, upgoing toes, and reduced rectal tone.

A

Transverse myelitis (whole spine cord damage)

41
Q

This is a 21 year-old male s/p an MVA today. He is on a stretcher with severe mid back pain. He has trouble with feeling in both legs and moving the right one.

The exam confirms decreased pinprick and temperature in the left leg, decreased proprioception and vibration in the right leg, and weakness with upgoing toe in the right leg.

A

Brown Sequard Syndrome

loss pinprick left leg= spinothalamic damage right side

decrease proprioception right side= damage posterior columns right side

right sided weakness = cortico spinal tract damage right side

42
Q

This is a 72 year-old female who had surgery to repair an aortic aneurysm 2 days ago. Now that she is waking up it is clear she can’t move her legs.

The exam confirms paraplegia, and decreased pinprick in both legs while proprioception and vibration are intact. There is a sensory level at T10

A

Anterior Spinal Artery Syndrome

43
Q

This is a 42 year-old male who has 3 weeks of progressive bilateral leg and arm numbness, and gait trouble.

The exam confirms decreased proprioception and vibration in the LE, and spastic weakness in the legs with increased reflexes and upgoing toes. Pinprick is normal.

A

B12 deficiency

44
Q

Nerve conduction studies: Axon damage vs. demyelinating damage

A

Axon damage (90%): DM

  • amplitude decreased
  • CV normal

Demyelinating damage (10%): GBS

  • amplitude normal
  • CV decreased

MBB (21 decks)

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