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Clinical Medicine 2 > Stroke > Flashcards

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

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2
Q

What % of strokes are preventable?

A

80%

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3
Q

How do we prevent strokes?

A
  1. Eat healthy
  2. Quit smoking/drinking
  3. More physical activity
  4. Keep up w/ health
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4
Q

What are the 2 types of cerebrovascular accidents (strokes)?

A

Ischemic (80-85%)

Hemorrhage (15%)

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5
Q

What causes an ischemic stroke from an embolus(37%) ?

A
  1. Mitral stenosis
  2. Endocarditis
  3. MI
  4. Patent foramen Ovale
  5. CHF
  6. AFib
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6
Q

What causes an ischemic stroke from a thrombus (63%)?

A
  1. Arterial stenosis
  2. Sickle Cell
  3. Protein C
  4. Hyperhomocysteinemia
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7
Q

What are the 2 types of hemorrhagic strokes? What %?

A
  1. Intracerebral (63%)

2. Subarachnoid (37%)

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8
Q

Who has 2x the risk of having a first-ever stroke?

A

black males

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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)

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10
Q

Whath % of embolic strokes occur in ppl with atrial fibrillation?

A

15%

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11
Q

Recurrent strokes occur in what % of victims within 5 years after first stroke.

A

25%

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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

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13
Q

Subarachnoid hemorrhage is due to ? Intracerebral is due to?

A 
SA = ruptured aneurysm
Intra = HTN
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14
Q

What is the highest level of a stroke center? 2nd level?

A
  1. Advanced comprehensive SC

2. Advanced primary SC

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15
Q

How long do you have from suspected stroke to save the brain?

A

1 hour

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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

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17
Q

What are the causes of stroke in patients under 50?

A
  1. Blood dyscrasia disorder (sickle cell/hypercoagulable)
  2. Patent foramen ovale
  3. Orla contraceptives
  4. Drug use (cocaine)
    NOT GCA
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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

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19
Q

What is the first line of tx for an acute ISCHEMIC stroke?

A

tPA

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20
Q

What is the time window from the onset of stroke symptoms?

A

4.5 hours

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21
Q

What % of patients are at risk for a hemorrhagic stroke?

A

5.2%

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22
Q

Who is excluded from the 4.5 hr window? These ppl must be given tPA in 3 hrs

A
  1. Over 80
  2. Blood thinners
  3. Hx of stroke
  4. DM
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23
Q

tPA is effective in what % of pts?

A

25-33%

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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)
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25
Q

What are the 4 advantages of stent retrievers?

A
  1. reduced disability
  2. Improved neurological function
  3. Shortened recovery time
  4. Increased rate at which stroke survivors regained function
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26
Q

This is a neurologic deficit that resolves in 24 hours; 80% resolves in 1 hour; 10% of patients have a stroke in 90 days.

A

Transient Ischemic Attack

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27
Q

What are the top 2 risks for stroke?

A
  1. elevated blood pressure
  2. irregular pulse
    - afib/atrial flutter
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28
Q

The brain receives what % of cardiac output?

A

20%

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29
Q

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.

A

Subclavian steal syndrome

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30
Q

If a stroke is in the anterior circulation, what’s possibly effected? Usually unilateral

A
  1. Carotid artery
  2. ACA
  3. MCA
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31
Q

If a stroke is in the posterior circulation, what’s possibly effected? Usually bilateral.

A
  1. Vertebro-basilar

2. Posterior cerebral artery

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32
Q

This is a defect in language processing caused by dysfunction of the dominant cerebral hemisphere

A

Aphasia

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33
Q

This is responsible for articulating sounds to form words. Damage here causes expressive aphasia = inability to express/produce speech.

A

Broca’s area

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34
Q

This is responsible for understanding/comprehending words. Damage here causes receptive aphasia; pt doesn’t understand what you’re saying

A

Wernike’s area

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35
Q

Damage to the occipital lobe causes what ocular issue?

A

Homonymous hemianopia

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36
Q

Damage to cerebellum causes what ocular issue?

A

Ataxia, Nystagmus

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37
Q

Damage to the brainstem causes what ocular issue?

A
  1. diplopoia, skew deviation, INO, nystagmus
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38
Q

Damage to the cerebrum causes what ocular issue?

A

Supranuclear gaze palsy

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39
Q

What % of pts will have a stroke after a TIA? What % of them will have it within 48 hours?

A
  • 10-15% will have a stroke 3 months later

- 50% occur after 48 hrs

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40
Q

What needs to be done within the first 1-2 days of a TIA?

A
  1. MRI with DWI
  2. CT scan
  3. EKG
  4. Lab test - CBC, Coagulation, Lipid profile
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41
Q

What is the risk of a recurrent TIA or stroke after retinal TIA at 3 years?

A

24%

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42
Q

T/F: Patients wait longer to treat retinal TIAs than cerebral TIAs?

A

True.

- 48.5 days vs. 15.2 days

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43
Q

What is the mortality rate of Ocular ischemic syndrome? What’s the most common symptom?

A

40%

- progressive vision loss

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44
Q

If a patient is symptomatic w/ 70%+ stenosis, carotide endarterectomy is?

A

recommended

45
Q

If a patient is symptomatic w/ 50-70% stenosis, carotide endarterectomy is?

A

Indicated

- there’s a 2.1% risk of stroke and death

46
Q

If a patient is asymptomatic w/ carotid stenosis, carotide endarterectomy is?

A

controversial = dont

47
Q

If a patient comes in with a PAINFUL horners, what don’t you do?

A

don’t put in apraclonidine, it takes too long to work

48
Q

If a patient has a painful (eye, head, neck) horner’s, what disease do you think they have?

A

Carotid artery dissection

49
Q

What % of ischemic strokes in young people are caused by Carotid dissection?

A

10-25%

Most common reason for stroke in young population

50
Q

Homonymous Hemianopia can improve as edema resolves. What % have some amount of recovery at 6 months?

A

84%

51
Q

How long do patients need to recover from an homonymous hemianopia?

A

1 year

52
Q

When you see bilateral altitudinal defects (right + left HH), in the setting of normal optic nerves and retina: where does the lesion localize?

A

the occipital lobe

53
Q

Elevated levels of homocysteine causes what?

A

atherosclerosis

54
Q

What can cause homocysteine?

A
  1. Vit B12 or folate deficiency
  2. Genetic cause
  3. Renal disease
55
Q

Homocysteine levels above 14umol increase one’s risk of?

A

Alzheimer’s (by 150%)

56
Q

If someone has an irregular pulse, what are you concerned about?

A

afib

57
Q

Stroke risk from afib averages what % a year?

A

5%

58
Q

As we age the risk o f stroke due to afib increases by ___% for 50-59 and ___% for 80-89 years old.

A

1.5%

30%

59
Q

When a patient is on ____ they have a higher chance of surviving a stroke.

A

Warfarin

60
Q

What are the ocular manifestations of anterior circulation ischemia.

A
  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
Q

What are the ocular manifestations of posterior circulation ischemia.

A
  1. INO
  2. Skew deviation
  3. Homo. Hemianopia
  4. Disorders of Visal cortex
62
Q

This allows the associated of cortices beneath calcarine fissue + adjacent temporal regions. Aids in visual object recognition, reading, color vision

A

Ventromedial pathway - helps understand “what it is”

63
Q

This allows the association of cortices above calcarine fissures + in adjacent parietal, TPO regions

A

Dorsolateral pathway - helps understand “where it is”

64
Q

What two issues are associated with dorsolateral pathway lesions?

A
  1. Balint’s syndrome

2. Akinetopsia

65
Q

This is an acquired disorder of color perception involving all or part of the visual field.

A

Central Achromatopsia - patient will report they see gray

66
Q

What other findings are found with achromatopsia?

A
  1. Superior VF defects

2. Alexia (inability to see or read words)

67
Q

This is the inability to recognize objects that are seen.

A

Visual agnosia

68
Q

This is when the image of the object is in some way distorted and can’t be recognized

A

Aperceptive agnosia

69
Q

This is when the image is clear, but connections to associatoin visual cortex are impaired, not allowing recognition

A

Associative agnosia (but if they touch it, they know what it is.)

70
Q

This is the inability to recognize a familiar or their own face.

A

Prosopagnosia

71
Q

This is known as not being able to read, but can write

A

alexia without agraphia

72
Q

T/F: Patients with alexia can read numbers and spell words

A

True

73
Q

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.

A

Alexia with agraphia

74
Q

This is known as motion blindness; retina is normal. What area of the visual cortex is it associated with?

A

Akinetopsia

V5

75
Q

Balint’s syndrome is characterized by what 3 things?

A
  1. Optic Ataxia (defective hand control)
  2. Ocular apraxia (bad gaze control)
  3. Simultanagonosia
76
Q

What is the core abnormality of Balint’s syndrome?

A

Simultanagnosia

77
Q

This is the inability to perceive parts of a visual scene as a whole.

A

Simultanagnosia

78
Q

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

A

Optic Ataxia (can’t touch dr’s finger but can touch own finger)

79
Q

This is known as difficulty directing gae toward objects in peripheral vision through saccades

A

Ocular apraxia

80
Q

What is Balint’s syndrome often associated with?

A
  1. Inferior quadrant VF defects
  2. Aphasia
  3. Hemi-neglect
81
Q

Visual field neglect is often accompanied by what 2 things?

A
  • hemiparesis + hemisensory loss
82
Q

This is known as not having knowledge of a visual field loss.

A

Anosagnosia

83
Q

What are the 3 differnt types of dementias?

A
  1. Alzheimer’s disease
  2. Lewy Body disease
  3. Multi-infarct/Mini stroke
84
Q

What % of dementia is alzheimers? Lewy body?

A

40%

20%

85
Q

What % of strokes occur after 65?

A

75%

86
Q

Afib increases risk of stroke by how many times? (pelino?

A

4-5 times

87
Q

Retinal emboli and TIA has a ___ % risk of stroke/year

A

8%

88
Q

Amaurosis fugax has what % risk of a stroke/year

A

2%

89
Q

AF is an indicator for what 2 diseases?

A
  1. Coronary disease

2. Cerebrovascular

90
Q

What are the 1st and 2nd leading cause of death in ocular ischemic syndrome?

A
  1. Ischemic heart disease

2. Stroke

91
Q

Arterial dissection is responsible for less than 2% of stroke cases, but up to ___% of all strokes in young and middle aged people.

A

25%

92
Q

What % of cerebral infarctions are caused by migraines in people under the age of 45?

A

25%

93
Q

T/F: A women’s risk jumps by 25-75% when vision loss is experienced just prior or during an attack.

A

true

94
Q

What % of sickle cell patients will suffer strokes before their 20th bday?

A

5-10%

90% will experience a recurrence

95
Q

A heroin and cocaine abuser will have what types of stroke?

A

Ischemic

96
Q

Where is the main location to get venous sinus thrombosis?

A
  1. Superior sagittal sinus
  2. transverse sinus
  3. sigmoid sinus
97
Q

What are the 4 emergency treatments for a stroke patient?

A
  1. tPA
  2. Meds to protect from ischemia
  3. Life support systems (ventilators)
  4. Corticosteroids and IV fluids
98
Q

What % of stroke patients have a foramen ovale?

A

20%

99
Q

CRP of ___mg/L or higher can triple your risk of heart disease.

A
  1. 0mg/L

- 0.5mg/L - no heart attacks

100
Q

If an INO lesion is in the pons, is convergence affected?

A

No

100
Q

If an INO lesion is in the midbrain, is convergence affected?

A

Yes. Pt will have an INO with the inability to converge

100
Q

What are the 3 findings in a patient with a skew deviation and dorsal midbrain syndrome?

A
  1. Eyelid retraction
  2. Upgrade paresis
  3. LND
100
Q

One in a half syndrome is the combination of what 2 things?

A

Gaze palsy + INO

100
Q

If a patient had a lesion at the top of the basilar artery, what ocular issue will they have?

A

Upgaze paralysis

100
Q

Frontal eye fields control what? Where will the eyes point (in terms of the lesion) ? What side will the hemiparesis be found?

A
  • Control contralateral saccades
  • eyes will point toward lesion
  • hemiparesis on opposite side (eyes point away from paralyzed side)
100
Q

Parieto-occipital-temporal area control what?

A

Control ipsilateral pursuit and contralateral eye movements

100
Q

What 2 areas can in lesioned in a supranuclear haze palsy (cerebrum)?

A
  • FEF

- POT area

100
Q

A conjugate gaze palsy due to lesion of CN VI or PPRF cause what 3 things?

A
  1. Eyes point away from lesion

2. Contralateral hemiparesis (eyes point towards paralyzed side)

100
Q

What 2 ways can drugs cause strokes?

A
  1. Increase blood pressure (hemorrhagic)

2. Narrow blood vessels (ischemic)

Clinical Medicine 2 (12 decks)

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