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Anthony's PMR > Stroke and Movement Disorders > Flashcards

Stroke and Movement Disorders Flashcards

1
Q

What is the definition of a stroke?

A

Interruption of blood supply to an area of the brain, causing signs and symptoms of intracranial neurologic compromise.

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2
Q

What is a TIA?

A

Transient interruption of blood supply to an area of the brain causing symptoms lasting for under 24 hours

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3
Q

What % of strokes are ischemic and hemorrhagic?

A

85% ischemic

15% hemorrhagic

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4
Q

What is the most important nonmodifabile risk factor for strokes?

A

Age

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5
Q

What is the most important modifable risk factor for strokes?

A

HTN

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6
Q

What are some major risk factors for stroke?

A

HTN, smoking T2DM, HLD, CAD/CHF, Afib, carotid stenosis

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7
Q

What are the three types of ischemic strokes?

A
  1. embolic- sudden onset deficits
  2. thrombosis- gradual onset deficits, MC type of ischemic stroke
  3. lacunar (putamen, thalamus, internal capsule), variable onset, related to HTN
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8
Q

What is the most common type of ischemic stroke?

A

Thrombotic

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9
Q

Where is the classic location for SAH?

A

Berry aneurysm bursts at the anterior communicating artery (next most common Pcomm)

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10
Q

What is the classic presentation for SAH?

A

Sudden onset during exertion

“Worst headache of my life”

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11
Q

How does a posterior communicating artery aneurysm present?

A

CN III compression –> blown pupil, ptosis, down and out

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12
Q

What is the Hunt and Hess Scale?

A 
Used to grade SAH
1 = roughly asymptomatic
2 = headache, neck stiffness
3 = headache, neck stiffness, confused
4 = completely unintelligible as if they are very drunk
5 = coma

higher score = increased acute mortality, but generally more favorable functional prognosis if they survive the acute period.

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13
Q

When do SAH occur vs intracerebral hemorrhages?

A 
SAH = exertion
intracerebral = at rest
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14
Q

What is the most common site of an intracerebral hemorrhage?

A

Putamen (contralateral hemiplegia)

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15
Q

What is the goal BP in ischemic strokes?

A

SBP <220

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16
Q

What is the goal BP in hemorrhagic strokes?

A

SBP <180

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17
Q

What is the goal ICP in the setting of a stroke?

A

Keep ICP < 20 mmHg
(Remember we want CPP to be >60mmHg)
CPP = MAP - ICP

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18
Q

What techniques can be used to lower ICP in patients with strokes?

A 
Forced hyperventilation
IV mannitol
Elevate HOB
Hypothermia
(last resort) Neurosurgical Burr hole decompression
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19
Q

What are the considerations for tPA? (timeline, age, additional labs and imaging?)

A

Presenting within 3 hours of stroke onset
Adult (not elderly)
Negative CT head for blood
SBP <185
INR <1.7
Platelets <100k
Stroke territory involves <1/3 MCA territory

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20
Q

What are considerations for SAH and intracerebral hemorrhage management? (blood pressure, ICP, medications, treatment)

A

Keep SBP <180
Stool soft –> docusate, miralax
Keep ICP <20
Nimodipine x21 days to prevent secondary intracranial vasospasm due to blood irritating vessels
Perform clipping/coiling of aneurysm or removing the AVM

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21
Q

How long does an infarction typically take to show up on a CTH? What color is blood on CT? What color is infarction?

A

1-2 days usually
Blood = white
Infarction = dark area
(Opposite of T2 MRI)

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22
Q

What color is blood on T2 MRI? What color is infarction?

A

Blood = dark
Infarction = bright white on T2 MRI (T2 = H2O)
(Opposite of CT)

23
Q

What is the purpose of getting an echo for a stroke workup?

A

Look for:
Cardiac embolus source
Wall motion abnormalities
PFO

24
Q

What is the purpose of getting an LP in the setting of possibles troke?

A

Helpful when CT head is not informative but you still suspect SAH

Xanthochromia (blood breakdown products) can be detected indicating SAH

25
Q

What is the purpose of carotid artery US in the setting of possible stroke?

A

Helpful looking for carotid stenosis

26
Q

What is secondary prevention for strokes?

A

Preventing strokes after at least one has occurred

27
Q

What anticoagulation, antiplatelet therapy would you use for the following:
Cardioembolic stroke

A

Warfarin (goal INR 2-3)
OR
NoAC (rivaroxaban, apixaban, dabigatran)

28
Q

What anticoagulation, antiplatelet therapy would you use for the following:
Thrombotic stroke

A

ASA 81mg

29
Q

What anticoagulation, antiplatelet therapy would you use for the following:
Carotid stenosis

A

ASA + dipyridamole

30
Q

If carotid stenosis >70% and symptomatic, what would be the next step in managment?

A

Carotid endarterectomy (CEA)

31
Q

Prognostically, when will most of the recovery of a stroke occur?

A

Within the first 3-6 months

Motor, speech, swallow, bowel, bladder

32
Q

Anterior cerebral artery primarily supplies which muscles?

A 
Leg muscles
(also executive function)
33
Q

Middle cerebral artery primarily supplies which muscles?

A

Face and upper extremity muscles

also language and spatial perception

34
Q

Anterior cerebral artery primarily supplies the brain to perform which cortical functions?

A

Executive functions

35
Q

Middle cerebral artery primarily supplies the brain to perform which cortical functions?

A

Language and spatial perception

36
Q

Posterior cerebral artery primarily supplies which areas of the brain?

A

Cerebellar and visual cortices

37
Q

Walk through the flow of CSF from the choroid plexus to the subarchanoid space.

A 
Choroid plexus 
Lateral ventricles
Foramina of Monro
Third ventricle
Cerebral aqueduct
Fourth ventricle
Foramen of Magendie
Foramina of Luschka
Subarachnoid space
38
Q

What are the 4 midline structures in the rule of 4s?

A

Midline startswith M

  1. Motor pathway
  2. Medial lemniscus
  3. Medial longitudinal fasciculus
  4. Motor nuclei
39
Q

What are the 4 side structures in the rule of 4s?

A

Side starts with S

  1. Spinothalamic pathway
  2. Spinocerebellar pathway
  3. Sensory nucleus of CN V
  4. Sympathetic
40
Q

Which cranial nerve nuclei are NOT in the brainstem?

A

CN I and II

41
Q

Which cranial nerve nuclei are located in the midline?

A

CN III, IV, VI, XII (divisible by 12)

42
Q

What are the classic symptoms of an ACA stroke?

A
  1. Contralateral leg weakness and numbness (distal > proximal)
  2. Incontinence
  3. If bilateral: B/l symptoms and executive function with personality deficits
43
Q

What are the classic symptoms of an MCA stroke?

A
  1. Contralateral face, arm, hand weakness and numbness
  2. Aphasia (dominant)
  3. Contralateral hemineglect (nondominant)
44
Q

MCA stroke of the superior division of dominant MCA presents with which classic cortical deficit?

A

Broca aphasia (expressive aphasia)

45
Q

MCA stroke of the inferior division of dominant MCA presents with which classic cortical deficit?

A

Wernicke aphasia (receptive aphasia)

46
Q

MCA stroke of the inferior division of nondominant MCA presents with which classic cortical deficit?

A

Contralateral Hemineglect

47
Q

Which type of aphasia?

Fluent, comprehension intact, repetition intact, cannot name things

A

Anomia

48
Q

Which type of aphasia?

Nonfluent, comprehension intact, cannot repeat

A

Broca’s Aphasia

49
Q

Which type of aphasia?

Nonfluent, comprehension intact, repetition intact

A

Transcortical motor aphasia

50
Q

Which type of aphasia?

Fluent, cannot comprehend, cannot repeat

A

Wernicke’s Aphasia

51
Q

Which type of aphasia?

Fluent, cannot comprehend, repetition intact

A

Transcortical sensory aphasia

52
Q

Which type of aphasia?

Nonfluent, cannot comprehend, repetition intact

A

Mixed transcortical aphasia

53
Q

Which type of aphasia?

Fluent, comprehension intact, cannot repeat

A

Conduction aphasia

Anthony's PMR (2 decks)

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