Stroke Flashcards
Ischemic Stroke
Loss of blood supply/perfusion to an area of the brain
Can be the result of hypoperfusion/hypotension
AKA “blockage stroke”
Medical Risk Factors for Stroke
Hypertension Atrial Fibrilation Hyperlipidemia/Hypercholerestemia Diabetes Carotid Stenosis
Behavior Risk Factors
Cigarette smoking
Physical Inactivity
Illicit Drugs
Heavy Alcohol Consumption
What are the three subtypes of ischemic strokes?
Large Artery Atherosclerosis
Cardioembolism
Lacunar Infarctions (Small Vessel)
What is the significance of getting a Head CT for an ischemic stroke?
You want to rule out a hemorrhagic stroke. CT are good for viewing blood, but are not good at determining blockages.
What diagnostic method is sensitive and specific for detecting an ischemic stroke?
Diffusion Weighted Imaging MRI
What is a TIA
Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction.
Where in the arteries is atherosclerosis most commonly found?
In the bifurcations because there is a lot of turbulent flow.
A 68-year old patient comes into the ER with CC of right-side facial weakness and slurred speech. You order a CT scan first, which shows no sign of a hemorrhagic stroke. What would you do next and how long do you have to act?
Order for the patient to have tPa and you have 3 hrs from the onset of the stroke. Giving tPa increases the likelihood of recovery at 90 days.
What is the purpose of tPa?
It helps to break up clots and fibrin products
A 72-year old patient comes in with stroke symptoms. You are doing your H&P and learn that he suffers from thrombocytopenia. Can he receive tPa?
NO. This is one of the exclusion criteria
What is the most common cause of intraparenchymal hemorrage (IPH)?
HYPERTENSION
What is an intraparenchymal hemorrhage (IPH)?
Bleeding into the parenchyma of the brain which may extend into the ventricular system.
Where does IPH most commonly occur?
Basal ganglia, pons, cerebellum, thalamus
Clinical presentation of IPH?
- Rapidly progressive focal neurological deficits
- Vomiting, systolic BP >200 mmHg, severe headache, depressed mental status (not specific though)
- Hard to distinguish from ischemic strokes
Definition of Subarachnoid Hemorrhage?
Bleeding into the space between the arachnoid membrane and and the pia mater surrounding the brain.
Common cause of subarachnoid hemorrhage?
Trauma
Common cause of non-traumatic subarachnoid hemorrhage?
Rupture of cerebral aneurysm
What are the symptoms of subarachnoid hemorrhage?
“Worst headache of my life”
Nausea/vomiting, depressed mental status, meningeal irritation/neck stiffness
What are the signs of subarachnoid hemorrhage?
The patient is often hypertensive and drowsy and exam is NON-FOCAL
What is the common site of cerebral aneurysm?
Anterior communication artery
The patient you are seeing has a CT scan that comes back negative. You highly suspect a cerebral aneurysm based on your exam findings. What do you do next?
Lumbar puncture
Gold standard for diagnosing cerebral aneurysm?
Conventional Cerebral Angiogram
After doing that lumbar puncture, you see that they are positive for subarachnoid hemorrhage (not due to trauma). What are two surgical options that you do for this patient
Coiling (endovascular approach)
Clipping (surgical approach)
This complication of SAH occurs in 25% of patients and results in ischemic stroke. What is it?
Vasospasm
What drug is given to reduce the morbidity and possible mortality associated with vasospasm?
Prophylactic Nimodipine
