Stroke and TIA

Question 1

Cardiac source of stroke

Answer 1

Atrial fibrillation
ASD/VSD
Recent AMI
Endocarditis
Caradiac tumor
Valvular disorder

Question 2

Causes of Spontaneous intracerebral hemorrhage

Answer 2

Associated with poorly controlled hypertension
Commonly located in the basal ganglia
Lacunar infarcts are associated with HTN or DM
Bleeding disorders
Amyloid angiopathy

Question 3

Causes of subarachnoid hemorrhage

Answer 3

Trauma
Spontaneous SAH is usually related to a ruptured AVM or aneurysm
Abnormal vascular composition (amyloid angiopathy or dissection)
Illicit drug use such as cocaine or amphetamines
Intracranial arterial dissections
20% may have no identifiable cause

Question 4

Lacunar strokes CT

Answer 4

“punched-out hypodense areas” but sometimes no abnormalities can be seen

Question 5

Hypertension may cause what kind of strokes?

Answer 5

intracerebral hemorrhages (vessel rupture) or lacunar infarcts from small vessel occlusion

Question 6

Aphasia

Answer 6

Acquired communication disorder
Impairs ability to process language but does not affect intelligence
Impairs ability to speak and understand others
Experience difficulty reading and writing
Global-can’t produce recognizable words
Anomic- can’t think of proper word
Broca’s- decrease speech output
Wernicke’s- can’t process words

Question 7

FAST campaign

Answer 7

F Facial droop
A Arm weakness
S Speech difficulties
T Time to call 911

Question 8

Subarachnoid hemorrhage Sx.

Answer 8

Symptoms begin abruptly
Sudden increase in ICP may cause a cessation of activity (knees may buckle, loss of memory)
Sudden, severe headache “thunderclap” followed by vomiting
Usually no focal neurologic signs
Symptoms may be preceded by heavy physical exertion

Question 9

Intracerebral hemorrhage Sx.

Answer 9

Symptoms are slower in onset than SAH and increase over minutes to hours
Symptoms worsen as the hematoma enlarges
Headache and vomiting occur in about half of patients
Symptoms may be preceded by heavy physical exertion

Question 10

Anterior cerebral artery occlusion may cause:

Answer 10

Leg weakness and sensory loss
Arm (esp. proximal) weakness and sensory loss
Urinary incontinence
Contralateral side affected

Question 11

Middle cerebral artery occlusion may cause:

Answer 11

Contralateral hemiplegia in the face-arm-leg
Homonymous hemianopsia
If on the L and it is the dominant hemisphere = aphasia
Nondominant right hemisphere = confusion, spatial disorientation, sensory and emotional neglect
Apraxia

Question 12

Posterior circulation stroke symptoms

Answer 12

Structures that rely on the posterior circulation blood supply
Brainstem
Thalamus
Hippocampus
Cerebellum
Visual cortex
Temporal lobes
Occipital lobe
Sensorimotor deficits – ipsilateral face and contralateral limbs (crossed findings), drop attack

Question 13

The brainstem has 3 parts and houses cranial nerves III-XII

Answer 13

Midbrain: III, IV
Pons: V, VI, VII, VIII
Medulla: IX, X, XI, XII

Question 14

5 D’s of posterior stroke symptoms

Answer 14

Dizziness
Diplopia
Dysarthria: Difficulty speaking (loss of motor control for speech)
Dysphagia: Difficulty swallowing
Dystaxia: Difficulty controlling voluntary movement

Question 15

Lacunar stroke symptoms

Answer 15

Pure motor loss (weakness): Most common presentation in up to 2/3 of cases
Or pure sensory loss
Many other lacunar syndromes including
Sensorimotor stroke (2nd most common)
Ataxic hemiparesis

Question 16

NIH Stroke Scale

Answer 16

0- No stroke
1-4 Minor
5-15 Moderate
16-20 Moderate to severe
21-42 Severe

Question 17

Inclusion criteria for thrombolytics

Answer 17

Clinical diagnosis of ischemic stroke causing measurable neurologic deficit
Onset of symptoms <4.5 hours before beginning treatment
Age ≥18 years