Stroke

Question 1

Types of Stroke

Answer 1

• Ischemic

- Hemorrhagic

Question 2

Transient ischemic attack

Answer 2

• Transient episode, symptoms last < 24 hrs

- focal ischemia, without acute infarction

Question 3

Subarachnoid hemorrhage (SAH)

Answer 3

• Bleeding between the arachnoid and pia mater (CSF filled space)
• Commonly-rupture of a cerebral aneurysm
• “Worst headache of one’s life”
• Stiff neck

Question 4

Types of ischemic strokes?

Answer 4

thrombolic, embolic, and watershed

Question 5

Stroke-Clinical Manifestations

Answer 5

• Face, Arm, Speech, Time
• Motor/Sensory changes
• Communications
• Personality/Affect
• Intellectual function
• Spatial-perceptual alterations
• Elimination

Question 6

Common quick check of stroke manifestations?

Answer 6

(FAST)
Face - doopage, asymmetrical
Arm - weakness
Speech - slurred
Time - tx quickly

Question 7

Stroke risk factors?

Answer 7

HTN, a-fib, MI, high cholesterol, smoking

Question 8

Medical tx for a patient with a hx of TIA?

Answer 8

• Antiplatelet drugs (Aspirin, Ticlopidine, Clopidigrel)
• Warfarin (atrial fib)
• Surgical Intervention
  
  • Carotid endarterectomy

Question 9

are around stroke site with limited blood flow that can saved with quick tx?

Answer 9

penumbra

Question 10

What is the tx focus for ischemic stroke?

Answer 10

clot busters and to prevent new clot formation

Question 11

What is the tx focus for hemorrhagic stroke?

Answer 11

manage symptoms and complications (anti-HTN, anti-convulsants)

Question 12

Ischemic stroke medications?

Answer 12

• Aspirin
• platelet inhibitors and anticoagulants
• tPA

Question 13

How long after a stroke should aspirin be given?

Answer 13

within 24 - 48 hrs

Question 14

How long after a stroke should tPA be given?

Answer 14

• within 3 - 4.5 hrs

- interarterial within 6 hrs of onset

Question 15

Surgical interventions for ischemic stroke?

Answer 15

clot retrieval (MERCI or suction)

Question 16

Surgical interventions for Hemorrhagic stroke?

Answer 16

Clipping and Coiling

Question 17

Subarachnoid Hemorrhage Treatment?

Answer 17

• Prevent rebleed
  
  • Clipping
  • Coiling
• Manage ICP
• Treat cerebral vasospasm
  
  • Nimodipine
• Manage HTN and Seizures

Question 18

What drug is given to treat cerebral vasospasm during a subarachnoid hemorrhage?

Answer 18

Nimodipine- dihydorpyridine CCB relaxes vascular smooth muscle causing vasodilation

Question 19

What is homonymous hemianopia?

Answer 19

blindness in same half of of each visual field

Question 20

Medical term for drooping eyelid(s)?

Answer 20

ptosis

Question 21

Manifestations of Right-brain stroke?

Answer 21

• left hemiplegia
• Difficulty in judging position, distance, and movement
• Impulsive, impatient, and deny problems related to stroke
• short attention span
• Respond best to directions given verbally

Question 22

Manifestations of Left brain stroke?

Answer 22

• Right hemiplegia
• Slower in organization and performance of tasks
• Impaired spatial discrimination
• Impaired speech/language aphasias
• Have fearful, anxious response to stroke
• Respond well to nonverbal cues