Stroke And Seizure

Question 1

Ischemic Stroke

Answer 1

Ischemic (80-90%) atrial fibrillation increases risk by up to 5 - 17X
•5-10% In hospital mortality
•Ischemic stroke can undergo hemorrhagic transformation.

Question 2

Hemorrhagic Stroke

Answer 2

Hemorrhagic (10-20%)
•50-60% In hospital mortality rate, 1 in 5 independent living after 6 months.
•ICH 8-11%
•AVM
•Subarachnoid Hemorrhage
Only 10% of stroke patients have a complete recovery

Question 3

Thrombotic Stroke

Answer 3

Most common cause of stroke

• Atherosclerosis of the large vessels in the brain causes progressive narrowing and platelet clumping
• Blood clots develop within the brain artery itself (i.e., cerebral thrombosis)

Question 4

Embolic Stroke

Answer 4

•Clots arise elsewhere in the body and then migrate to the brain (i.e., cerebral embolism)

Often from A-Fib

Question 5

Expressive (broca’s) aphasia

Answer 5

Expressive (Broca’s)
•Difficult to initiate speech
•Able to understand speech but cannot form words

Question 6

Receptive (Wernicke) aphasia

Answer 6

• Difficulty understanding speech
• May talk excessively
• Unable to read written words
• Speech maybe difficult to interpret

Question 7

TIA

Answer 7

Transient Ischemic Attack

•A brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms that typically last less than 24 hrs and without evidence of acute infarction.

Treat with same urgency as completed stroke

Question 8

Status Epilepticus

Answer 8

Status epilepticus
•Reocurring seizures without a meaningful return of consciousness lasting >5mins. Two or more seizures without coming out of the Postictal phase.

Question 9

Post-ictal phase

Answer 9

•Time period is variable among individuals. Maybe confused and combative. Temporary focal paralysis maybe present after a seizure. (minutes to hours)

Question 10

Cerebral Blood Flow (CBF)

Answer 10

• Normal CBF 40-60 ml/100 g brain
• Decrease to 15 ml/100 g brain creates electrical silent areas that are viable
• May be salvageble from 2 - 4.5 hours, 6 hours usually irreversible

Question 11

Normal Cerebral Blood Flow

Answer 11

40-60 / 100g of brain

Question 12

Anterior Cerebral Artery

Answer 12

Involves lower extremities

Question 13

Middle Cerebral Artery

Answer 13

• Cognitive function (perception, attention, memory)
• Speech
• Face and upper extremity deficit
• Neglect

Question 14

Posterior Cerebral Artery

Answer 14

Visual deficits
•Balance
•Vertigo

Question 15

Stroke Mimics

Answer 15

• Stroke Mimics 20%
• Migraine
• Seizure (Todd’s Paralysis)
• Tumour
• Labrynthitis
• Bells Palsy
• Vertigo
• Hypoglycemia
• Psychological (conversion disorder)
• Narcolepsy – Cataplexy
• Venous Sinus Thrombosis

Question 16

Subarachnoid Hemorrhage

Answer 16

A type of hemorrhagic stroke that bleeds into the spaces surrounding the brain

Question 17

Intracerebral Hemorrhage

Answer 17

A type of hemorrhagic stroke that bleeds into the brain tissue

Question 18

Cushings Triad

Answer 18

Hypertension (widening pulse pressure)

Bradycardia

Abnormal breathing patterns

With possible blown pupils

Question 19

Seizure Causes

Answer 19

Degenerative Diseases (CNS, Old CVA, MS)
•Infections (Meningitis,encephalitis)
•Metabolic (Hypoglycemia)
•Neoplasm (Brain Tumor)
•Eclampsia
•Toxins
•Withdrawl (Alcohol, medication)