Stroke Flashcards
What is a subarachnoid hemorrhage SAH)?
Blood enters the subarachnoid space
What causes an SAH?
Trauma
Intracranial aneurysm rupture
Arteriovenous malformations
What are the types of ischemic strokes?
Non-cardioembolic (local thrombus formation)
Cardioembolic (cardiogenic embolism)
What is a non-cardioembolic strokes d/t?
Plaques
What is a cardioembolic stroke d/t?
Stasis of blood in the atria/ventricles
What is a hemorrhagic stroke?
Blood in the brain parenchyma
Increased ICP
What are the RFs for ischemic stroke?
Age >55 Race > AA, pacific islanders, Hisp Men FH stroke/TIA Smoking Obesity HTN DM AFib Dyslipidemia
What are the most common causes of hemorrhagic stroke?
Trauma Uncontrolled HTN Antithrombotic therapy Aneurysm Arteriovenous malformations
What are the warning signs of a stroke?
Sudden numbness/weakness of the face/arm/leg Sudden confusion Trouble speaking/understanding Sudden trouble seeing in one or both eyes Sudden trouble walking Dizziness Loss of balance or coordination Sudden, severe HA with no known cause
What is the gold standard for diagnostic tests for stroke?
Non-contrast enhanced CT/MRI
How do we treat fever in strokes?
Antipyretics
How do we treat hyperglycemia?
Maintain glucose 140-180
Manage with IV insulin
When is HTN treatment recommended in stroke/
> 220/120
What antihypertensives are used in stroke?
Nicardipine
Labetalol
Hydralazine
What BP are required for t-PA?
<185/110
Within how many hours can alteplase be administered?
4.5 hours
Best results w/in 60 min - 180 min
What is the t-PA dose?
0.9 mg/kg over 1 hr with 10% given over 1 minute
What is the exclusion criteria for 3-4.5 hour use of t-PA?
> 80 yo
On oral anticoags
NIH stroke scale > 25
Hx of stroke AND dm
What is the treatment of hemorrhagic stroke?
Supportive care
BP control (MAP < 130)
Management of ICP
How do we control BP in hemorrhagic stroke?
Nicardipine
Labetalol
Esmolol
How do we manage ICP?
Mannitol
Who receives nimodipine?
Most subarachnoid hemorrhage patients
What is the dose of nimodipine?
60mg PO q4h x 21 days
What are the High intensity statins?
Atorv. 40-80
Rosuv 20-40
What are alternatives to statins?
Zetia
PCSK9 inhibitor
What does the CHA2DS2-VASc score stand for?
CHF HTN 2Age 75+ DN 2Stroke/TIA/thromboembolism Vascular dz Age up to 74 Female
What is the treatment with a chadsvasc of 0?
No therapy or ASA
What is the treatment with a chadsvasc of 1?
OAC or ASA
What is the treatment with a chadsvasc of 2+?
OAC