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SCRN > Stroke > Flashcards

Stroke Flashcards

1
Q

Ratio of cerebral infarcts to cerebral hemorrhages

A

4:1

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2
Q

What is the term to describe an occlusion in an artery causing death of tissue?

A

Ischemia

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3
Q

What types of brain bleeding are usually caused by trauma?

A

Subdural or epidural bleeds

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4
Q

What types of strokes can resolve quickly and may reoccur in minutes or hours?

A

TIA

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5
Q

What are 2 characteristics of ischemic strokes?

A

Abrupt onset

Symptoms will usually fit the distribution of a single vascular territory.

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6
Q

What are some signs of a Parenchymal hemorrhage?

A

Early decrease in LOC
N/V
HA
Accelerated hypertension

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7
Q

Symptoms of subarachnoid hemorrhages

A 
Bursting very sever HA
Worst HA of my life
Stiff neck
Decreased consciousness
N/V
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8
Q

S/S of middle cerebral artery strokes

A

Contralateral loss of strength and decreased sensation in the face, arm, and to a lesser extent leg
Aphasia for dominate hemisphere
Neglect if non-dominate

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9
Q

S/S of anterior cerebral artery stroke

A

Contralateral loss of strength and sensation in the leg and to a lesser extent the arm

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10
Q

S/S of a posterior cerebral stroke

A

Contralateral visual field deficit

Possibly confusion and aphasia if dominate hemisphere

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11
Q

S/S of penetrating (lacunar syndrome)

A

Contralateral weakness or sensory loss (usually not both) in face, arm, and leg.
No dysphasia, neglect, or visual loss.
Possibly ataxia, dysarthria.

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12
Q

S/S of vertebral (or posterior inferior cerebellar)

A

Truncal ataxia, dysarthria, dysphagia, ipsilateral sensory and contralateral sensory loss below the neck.

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13
Q

S/S of basilar artery stroke

A

Various combinations of limb ataxia, dysarthria, dysphagia, facial and limb weakness and sensory loss (may be bilateral) pupillary asymmetry, disconjugate gaze, visual field loss, decreased responsiveness.

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14
Q

Contralateral

A

On the opposite side

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15
Q

Aphagia

A

Loss if the ability to understand or express speech

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16
Q

What is neglect?

A

Lack of awareness on one side of the body contralateral to the area of stroke

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17
Q

Truncal ataxia

A

Inability to sit or stand unsupported

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18
Q

Dysarthria

A

Difficulty of speech d/t problems of lips and tongue to form the words.
Usually there is no problems with understanding or word finding

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19
Q

Dysphagia

A

Difficulty or discomfort with swallowing

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20
Q

Ipsilateral

A

Symptoms occurring on the same side of the body as the stroke

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21
Q

What can cause the symptom of disconjugate gaze

A

Stokes affecting the brainstem frontal lobes, or cerebrum

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22
Q

Disconjugate gaze

A

Unpaired movement of the eyes

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23
Q

ACA

A

Anterior Cerebral Artery

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24
Q

ACE

A

Angiotensin Converting Enzyme

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25
Q

ARR

A

Absolute Risk Reduction

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26
Q

AVM

A

Arteriovenous Malformation

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27
Q

CBV

A

Cerebral Blood Volume

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28
Q

CEA

A

Carotid Endarterectomy

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29
Q

CPP

A

Cerebral Perfusion Pressure

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30
Q

CT

A

Computed Tomography

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31
Q

CTP

A

CT Perfusion

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32
Q

CUS

A

Carotid Ultrasound

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33
Q

DSA

A

Digital Subtraction Angiography

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34
Q

DWI

A

Diffusion-weighted Imaging

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35
Q

EEG

A

Electroencephalogram

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36
Q

HIT

A

Heparin Induced Thrombocytopenia

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37
Q

HITTS

A

Heparin Induced Thrombocytopenia with Thrombotic Syndrome

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38
Q

ICA

A

Internal Carotid Artery

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39
Q

INR

A

International Normalized Ratio

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40
Q

IVH

A

Intraventricular Hemorrhage

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41
Q

LDL

A

Low Density Lipoprotien

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42
Q

LMN

A

Lower Motor Neuron

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43
Q

MCA

A

Middle Cerebral Artery

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44
Q

MRA

A

Magnetic Resonance Imaging

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45
Q

mRS

A

Modified Rankin Scale

46
Q

NIHSS

A

National institutes of Health Stroke Scale

47
Q

NINDS

A

National Institute Of Neurological Disorders

48
Q

NNH

A

Number needed to harm

49
Q

NNT

A

Number needed to treat

50
Q

NPO

A

Nil per os

Nil by mouth

51
Q

PCA

A

Posterior Cerebral Artery

52
Q

PCC

A

Prothrombin complex concentrate

53
Q

PEG

A

Percutaneous endoscopic gastrostomy

54
Q

PWI

A

Perfusion weighted imaging

55
Q

RRR

A

Relative risk reduction

56
Q

SAH

A

Subarachnoid hemorrhage

57
Q

TCD

A

Transcranial doppler ultrasound

58
Q

TEE

A

Transesophageal echocardiogram

59
Q

tPA

A

Tissue plasminogen activator

60
Q

TTE

A

Transthoracic echocardiogram

61
Q

Name the stroke mimics

A 
Seizure
Migraine
Syncope
Hypoglycemia 
Metabolic encephalopathy
Drug overdose
CNS tumor
Herpes simplex encephalitis
Subdural hematoma 
Peripheral compression neuropathy
Bell’s palsy (peripheral 7th nerve palsy)
Benign paroxysmal positional vertigo 
Conversion disorder
62
Q

Conversion disorder

A

The development of stroke like symptoms such as weakness, numbness, or trouble talking which are manifestations of stress or a psychiatric illness

63
Q

When can you see ischemic changes on a head CT?

A

Between 3-24 hrs

64
Q

What tests should be obtained but should not delay tPA?

Why?

A

CBC
Platelet ct
PT/INR
PTT

tPA should not be delayed unless there is clinical suspicion of a bleeding abnormality or thrombocytopenia
Or
The pt has received heparin or Coumadin
Or
The use of anticoagulants is not known
65
Q

Definition of ischemic stroke

A

Death of brain tissue due to interruption of blood flow to a region of the brain, caused by occlusion of a cerebral or cervical artery, or less likely, a cerebral vein

66
Q

What are the 4 components of ischemic stroke care?

A
  1. Acute therapy and optimization of neurological status
  2. Etiological work up for secondary prevention
  3. Prevention of neurological deterioration or medical complications
  4. Recovery and rehabilitation
67
Q

What is the best way to maintain brain perfussion

A

HOB flat if there are no airway concerns.
Maintain euvolemia
Support BP

68
Q

Define euvolemia

A

The proper amount of blood in the body

Synonym: normovolemic

69
Q

WhT is the upper limit BP parameter to consider treating HTN

A

220/120

70
Q

What is the dose for labetalol?

A

10-20 mg IV

71
Q

What is the dose of cardene?

A

5mg/hr as initial dose then titration by 2.5mg/hr every 5 minutes to a max of 15mg/hr

72
Q

Meds used to treat HTN should do what?

A

Should be short acting

Short half light

73
Q

What is the reduction goal of BP?

A

10-15%

74
Q

What are the 2 halves of the brain connected by

A

Corpus callosum

75
Q

What is the max dose of labetalol when treating HTN during tPA infusion?

A

300 mg

76
Q

When treating ischemic strokes caused by a fib how is anticoagulation used?

A

As a secondary prevention treatment

77
Q

Anticoagulation meds

A

Weight based Heparin -without a bolus dose.

Lovenox 1mg/kg SQ q12

78
Q

Which stroke patients have the highest risk of reoccurrence?

A

Cardioembolic strokes - thrombus on valves, or mural thrombus.
LVO occlusive clot at risk of distal embolism.
Arterial dissections
Venous thrombosis

79
Q

One risk of anticoagulation bridging (until the INR reaches the desired level) is

A

Hemorrhagic conversion

80
Q

Hemorrhagic conversion is frequent with

A

Large strokes

81
Q

What test should you do before starting anticoagulation?

A

CT

82
Q

Glucose levels above ? can increase the stroke size and risk of brain hemorrhage?

A

150

83
Q

Why is hyperthermia bad?

A

It increases the metabolic demand and infarct size

84
Q

For secondary prevention why do we do brain imaging and vascular evaluation?

A

To find the etiology of he stroke and treat it.

85
Q

What are some risk factors of stroke that can be reversed

A 
HTN
DM
Hypercholesterolemia
Smoking
Substance abuse
86
Q

What types of strokes can be caused by large artery atherosclerosis?

A

Intracranial

Extracranial (carotid or aortic arch)

87
Q

Cardioembolic strokes can be the result of

A

A fib
Segmental wall akinesis
Paradoxical embolus

88
Q

Small vessel disease can cause what types of strokes?

A

Lacunar infarction

89
Q

What test is best for detecting internal and external arterial stenosis and excludes large aneurysms and vascular malformations

A

MRA-MR angiography

90
Q

What noninvasive test can estimate the degree of ICA (internal carotid artery) stenosis at the bifurcation

A

Carotid US

91
Q

What test is considered the gold standard for visualizing arteries

A

Digital subtraction angiography

92
Q

What are some downsides to performing DSA

A

Takes longer to obtain b/c the angiography team is needed

93
Q

DSA

A

Digital subtraction angiography

94
Q

DSA is the gold standard for

A

Determining the degree of arterial stenosis
Seeing arterial dissections
Other vascular malformations

95
Q

An ECG can detect a fib and ? that could result as a consequence of the stroke

A

Silent MI or infarction

96
Q

What can a TTE detect?

A

Wall motion abnormalities
Low ventricular ejection fraction
Valvular abnormalities
PFO

97
Q

Anterior wall akinesis carries a high risk of what

A

High embolic risks

98
Q

What is a TTE

A

Transthorasic echocardiogram

99
Q

What is TEE

A

Transesophageal echocardiogram

100
Q

Which test shows the atria better? TTE or TEE

A

TEE

101
Q

Some findings detected by a TEE carry a high risk of ischemic stroke are

A 
Left atrial appendage clot.
PFO.
PFO Associated with atrial septal aneurysm.
Aortic arch atheroma
Spontaneous echo contrast
102
Q

Coumadin is considered the best preventative treatment for what types of embolic sources

A

Cardioembolic

103
Q

What 3 types of medications should most ischemic strokes be on?

A

Antiplatelets
Statins
Ace inhibitors

104
Q

Names of antiplatelets (antithrombotics)

A

ASA 81 - 325 daily
Clopidogrel (plavix) 75 mg daily
Aggrenox/asasantin (aspirin 25mg/dipyridamole 200mg ER bid

105
Q

What dose of heparin is considered DVT prophylaxis

A

5000u SQ every 8-12 hrs
Enoxaparin (lovenox) 40 mg SQ
Dalteparin

106
Q

Name the 3 types of ischemic strokes

A

Thrombotic
Embolic
Lacunar

107
Q

What is a lacunar stroke

A

Micro clots block one or more small cerebral arteries

108
Q

Complications after vascular access for interventional procedures

A 
Hematoma
Arterial dissection
Retroperitoneal hemorrhage
Arterial thrombosis
Pseudoaneurysm
109
Q

What are s/s of arterial dissection and retroperitoneal bleed

A 
Abdominal, groom, back pain
Diaphoresis
Bradycardia
Hypotension
Shock
110
Q

What is Moyamoya disease?

A

Chronic vasoocclusive disease

Progressive narrowing of the carotid arteries and major vessels

SCRN (26 decks)

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