Stroke Flashcards
1
Q
This is the leading cause of disability in the US, and the #5 cause of death in the US.
A
Stroke
2
Q
What % of strokes are preventable?
A
80%
3
Q
How do we prevent strokes?
A
- Eat healthy
- Quit smoking/drinking
- More physical activity
- Keep up w/ health
4
Q
What are the 2 types of cerebrovascular accidents (strokes)?
A
Ischemic (80-85%)
Hemorrhage (15%)
5
Q
What causes an ischemic stroke from an embolus(37%) ?
A
- Mitral stenosis
- Endocarditis
- MI
- Patent foramen Ovale
- CHF
- AFib
6
Q
What causes an ischemic stroke from a thrombus (63%)?
A
- Arterial stenosis
- Sickle Cell
- Protein C
- Hyperhomocysteinemia
7
Q
What are the 2 types of hemorrhagic strokes? What %?
A
- Intracerebral (63%)
2. Subarachnoid (37%)
8
Q
Who has 2x the risk of having a first-ever stroke?
A
black males
9
Q
This is known as a stroke that occurs in small blood vessels in the brain; found in pts with diabetes or HTN
A
Lacunar infarct (can only occur in thrombotic strokes)
10
Q
Whath % of embolic strokes occur in ppl with atrial fibrillation?
A
15%
11
Q
Recurrent strokes occur in what % of victims within 5 years after first stroke.
A
25%
12
Q
What % of pts have a second stroke within 2 years of their first one? 30 days after?
A
35% - 2 years
3% - 30 days
13
Q
Subarachnoid hemorrhage is due to ? Intracerebral is due to?
A
SA = ruptured aneurysm Intra = HTN
14
Q
What is the highest level of a stroke center? 2nd level?
A
- Advanced comprehensive SC
2. Advanced primary SC
15
Q
How long do you have from suspected stroke to save the brain?
A
1 hour
16
Q
What is the 1st test performed for an acute stroke at the ER? Why?
A
CT scan - want to rule out hemorrhagic stroke
17
Q
What are the causes of stroke in patients under 50?
A
- Blood dyscrasia disorder (sickle cell/hypercoagulable)
- Patent foramen ovale
- Orla contraceptives
- Drug use (cocaine)
NOT GCA
18
Q
If the brain has no flow, how long can it last? < 30% flow? 30-40% flow? Collateral/residual flow?
A
no flow = 10 mins
< 30% = 1 hr
30-40% = 1 - 3 hrs
col/res = up to 6 hrs
19
Q
What is the first line of tx for an acute ISCHEMIC stroke?
A
tPA
20
Q
What is the time window from the onset of stroke symptoms?
A
4.5 hours
21
Q
What % of patients are at risk for a hemorrhagic stroke?
A
5.2%
22
Q
Who is excluded from the 4.5 hr window? These ppl must be given tPA in 3 hrs
A
- Over 80
- Blood thinners
- Hx of stroke
- DM
23
Q
tPA is effective in what % of pts?
A
25-33%
24
Q
What’s the 2nd line of treatment for an acute ischemic stroke? Only used if tPA was attempted. When must it be used?
A
The stent retriever
- must be used w/in 6 hours of stroke
- only used in ICA and MCA (large vessles)
25
What are the 4 advantages of stent retrievers?
1. reduced disability
2. Improved neurological function
3. Shortened recovery time
4. Increased rate at which stroke survivors regained function
26
This is a neurologic deficit that resolves in 24 hours; 80% resolves in 1 hour; 10% of patients have a stroke in 90 days.
Transient Ischemic Attack
27
What are the top 2 risks for stroke?
1. elevated blood pressure
2. irregular pulse
- afib/atrial flutter
28
The brain receives what % of cardiac output?
20%
29
This is retrograde blood flow in the vertebral artery; associated w/ proximal ipsilateral subclavian artery stenosis; Patient may feel lightheaded when attempting to move that arm.
Subclavian steal syndrome
30
If a stroke is in the anterior circulation, what's possibly effected? Usually unilateral
1. Carotid artery
2. ACA
3. MCA
31
If a stroke is in the posterior circulation, what's possibly effected? Usually bilateral.
1. Vertebro-basilar
| 2. Posterior cerebral artery
32
This is a defect in language processing caused by dysfunction of the dominant cerebral hemisphere
Aphasia
33
This is responsible for articulating sounds to form words. Damage here causes expressive aphasia = inability to express/produce speech.
Broca's area
34
This is responsible for understanding/comprehending words. Damage here causes receptive aphasia; pt doesn't understand what you're saying
Wernike's area
35
Damage to the occipital lobe causes what ocular issue?
Homonymous hemianopia
36
Damage to cerebellum causes what ocular issue?
Ataxia, Nystagmus
37
Damage to the brainstem causes what ocular issue?
1. diplopoia, skew deviation, INO, nystagmus
38
Damage to the cerebrum causes what ocular issue?
Supranuclear gaze palsy
39
What % of pts will have a stroke after a TIA? What % of them will have it within 48 hours?
- 10-15% will have a stroke 3 months later
| - 50% occur after 48 hrs
40
What needs to be done within the first 1-2 days of a TIA?
1. MRI with DWI
2. CT scan
3. EKG
4. Lab test - CBC, Coagulation, Lipid profile
41
What is the risk of a recurrent TIA or stroke after retinal TIA at 3 years?
24%
42
T/F: Patients wait longer to treat retinal TIAs than cerebral TIAs?
True.
| - 48.5 days vs. 15.2 days
43
What is the mortality rate of Ocular ischemic syndrome? What's the most common symptom?
40%
| - progressive vision loss
44
If a patient is symptomatic w/ 70%+ stenosis, carotide endarterectomy is?
recommended
45
If a patient is symptomatic w/ 50-70% stenosis, carotide endarterectomy is?
Indicated
| - there's a 2.1% risk of stroke and death
46
If a patient is asymptomatic w/ carotid stenosis, carotide endarterectomy is?
controversial = dont
47
If a patient comes in with a PAINFUL horners, what don't you do?
don't put in apraclonidine, it takes too long to work
48
If a patient has a painful (eye, head, neck) horner's, what disease do you think they have?
Carotid artery dissection
49
What % of ischemic strokes in young people are caused by Carotid dissection?
10-25%
| Most common reason for stroke in young population
50
Homonymous Hemianopia can improve as edema resolves. What % have some amount of recovery at 6 months?
84%
51
How long do patients need to recover from an homonymous hemianopia?
1 year
52
When you see bilateral altitudinal defects (right + left HH), in the setting of normal optic nerves and retina: where does the lesion localize?
the occipital lobe
53
Elevated levels of homocysteine causes what?
atherosclerosis
54
What can cause homocysteine?
1. Vit B12 or folate deficiency
2. Genetic cause
3. Renal disease
55
Homocysteine levels above 14umol increase one's risk of?
Alzheimer’s (by 150%)
56
If someone has an irregular pulse, what are you concerned about?
afib
57
Stroke risk from afib averages what % a year?
5%
58
As we age the risk o f stroke due to afib increases by ___% for 50-59 and ___% for 80-89 years old.
1.5%
| 30%
59
When a patient is on ____ they have a higher chance of surviving a stroke.
Warfarin
60
What are the ocular manifestations of anterior circulation ischemia.
1. Amaurosis Fugax, CRAO/BRAO
2. Ocular ischemic syndrome
3. carotid artery dissection
4. Visual field neglect (infarct of MCA)
5. Supranuclear gaze palsy/preference
61
What are the ocular manifestations of posterior circulation ischemia.
1. INO
2. Skew deviation
3. Homo. Hemianopia
4. Disorders of Visal cortex
62
This allows the associated of cortices beneath calcarine fissue + adjacent temporal regions. Aids in visual object recognition, reading, color vision
Ventromedial pathway - helps understand "what it is"
63
This allows the association of cortices above calcarine fissures + in adjacent parietal, TPO regions
Dorsolateral pathway - helps understand "where it is"
64
What two issues are associated with dorsolateral pathway lesions?
1. Balint's syndrome
| 2. Akinetopsia
65
This is an acquired disorder of color perception involving all or part of the visual field.
Central Achromatopsia - patient will report they see gray
66
What other findings are found with achromatopsia?
1. Superior VF defects
| 2. Alexia (inability to see or read words)
67
This is the inability to recognize objects that are seen.
Visual agnosia
68
This is when the image of the object is in some way distorted and can't be recognized
Aperceptive agnosia
69
This is when the image is clear, but connections to associatoin visual cortex are impaired, not allowing recognition
Associative agnosia (but if they touch it, they know what it is.)
70
This is the inability to recognize a familiar or their own face.
Prosopagnosia
71
This is known as not being able to read, but can write
alexia without agraphia
72
T/F: Patients with alexia can read numbers and spell words
True
73
This is known as not being able to read, write, spell, recognize a word, interpret word pictures + cannot evoke the images of words to write them down.
Alexia with agraphia
74
This is known as motion blindness; retina is normal. What area of the visual cortex is it associated with?
Akinetopsia
| V5
75
Balint's syndrome is characterized by what 3 things?
1. Optic Ataxia (defective hand control)
2. Ocular apraxia (bad gaze control)
3. Simultanagonosia
76
What is the core abnormality of Balint's syndrome?
Simultanagnosia
77
This is the inability to perceive parts of a visual scene as a whole.
Simultanagnosia
78
This is known as the inability to reach for or point to objects by use of visual guidance; can point or reach using proprioceptive or auditory cues
Optic Ataxia (can't touch dr's finger but can touch own finger)
79
This is known as difficulty directing gae toward objects in peripheral vision through saccades
Ocular apraxia
80
What is Balint's syndrome often associated with?
1. Inferior quadrant VF defects
2. Aphasia
3. Hemi-neglect
81
Visual field neglect is often accompanied by what 2 things?
- hemiparesis + hemisensory loss
82
This is known as not having knowledge of a visual field loss.
Anosagnosia
83
What are the 3 differnt types of dementias?
1. Alzheimer's disease
2. Lewy Body disease
3. Multi-infarct/Mini stroke
84
What % of dementia is alzheimers? Lewy body?
40%
| 20%
85
What % of strokes occur after 65?
75%
86
Afib increases risk of stroke by how many times? (pelino?
4-5 times
87
Retinal emboli and TIA has a ___ % risk of stroke/year
8%
88
Amaurosis fugax has what % risk of a stroke/year
2%
89
AF is an indicator for what 2 diseases?
1. Coronary disease
| 2. Cerebrovascular
90
What are the 1st and 2nd leading cause of death in ocular ischemic syndrome?
1. Ischemic heart disease
| 2. Stroke
91
Arterial dissection is responsible for less than 2% of stroke cases, but up to ___% of all strokes in young and middle aged people.
25%
92
What % of cerebral infarctions are caused by migraines in people under the age of 45?
25%
93
T/F: A women's risk jumps by 25-75% when vision loss is experienced just prior or during an attack.
true
94
What % of sickle cell patients will suffer strokes before their 20th bday?
5-10%
90% will experience a recurrence
95
A heroin and cocaine abuser will have what types of stroke?
Ischemic
96
Where is the main location to get venous sinus thrombosis?
1. Superior sagittal sinus
2. transverse sinus
3. sigmoid sinus
97
What are the 4 emergency treatments for a stroke patient?
1. tPA
2. Meds to protect from ischemia
3. Life support systems (ventilators)
4. Corticosteroids and IV fluids
98
What % of stroke patients have a foramen ovale?
20%
99
CRP of ___mg/L or higher can triple your risk of heart disease.
3. 0mg/L
| - 0.5mg/L - no heart attacks
100
If an INO lesion is in the pons, is convergence affected?
No
100
If an INO lesion is in the midbrain, is convergence affected?
Yes. Pt will have an INO with the inability to converge
100
What are the 3 findings in a patient with a skew deviation and dorsal midbrain syndrome?
1. Eyelid retraction
2. Upgrade paresis
3. LND
100
One in a half syndrome is the combination of what 2 things?
Gaze palsy + INO
100
If a patient had a lesion at the top of the basilar artery, what ocular issue will they have?
Upgaze paralysis
100
Frontal eye fields control what? Where will the eyes point (in terms of the lesion) ? What side will the hemiparesis be found?
- Control contralateral saccades
- eyes will point toward lesion
- hemiparesis on opposite side (eyes point away from paralyzed side)
100
Parieto-occipital-temporal area control what?
Control ipsilateral pursuit and contralateral eye movements
100
What 2 areas can in lesioned in a supranuclear haze palsy (cerebrum)?
- FEF
| - POT area
100
A conjugate gaze palsy due to lesion of CN VI or PPRF cause what 3 things?
1. Eyes point away from lesion
| 2. Contralateral hemiparesis (eyes point towards paralyzed side)
100
What 2 ways can drugs cause strokes?
1. Increase blood pressure (hemorrhagic)
| 2. Narrow blood vessels (ischemic)
