Stroke / Cerebrovascular Dz Flashcards
What are some risk factors which contribute to Cerebrovascular Dz?
HTN MOST IMPORTANT Atherosclerosis Hyperlipidemia DM Hx of CVA, TIA, CHF, or MI Men > women Lifestyle
Asymptomatic generally; but a wooshing sound is heard upon auscultation of the carotids. What studies should you order to work this PT up?
What would you Dx this as in your note?
Carotid Stenosis –> Bruits
Doppler ultrasound
Carotid duplex
Cerebral angiography
You suspect an aneurysm in your 55 y.o. PT, what kind would you most likely suspect?
What studies would you order?
Saccular aneurysm MC (round “berry” blood containing aneurysm)
Fusiform aneurysm: Ballooning of vessel
MRA and Carotid Angiogram
CT
Cerebral angiography
A PT has intermittent neurologic deficit or weakness. You decide to order what studies and Rx what medication as you work this PT up for what?
Transient Ischemic Attack
Aspirin Clopidogrel (Plavix)
MRI/MRA or CT Carotid Duplex Echo ADMIT CBC, glucose, Lipids, EKG, CXR, echo
If there were an occlusion of the anterior cerebral artery; how would the PT present clinically?
Leg > arm weakness and paresthesia
Urinary incontinence
Emotional lability, confusion, amnesia
Baseline personality changes
If there were an occlusion of the cerebellar arteries; what signs and symptoms might develop with the PT clinically?
Vertigo Nausea, Vomiting Nystagmus Ipsilateral limb ataxia Contralateral spinothalamic sensory loss (limbs) Superficial Px Elevated temp
When you suspect an ischemic stroke; what imaging studies might you consider ordering for your PT?
What labs would you order?
CT w/out contrast MRI MRA Angiography (hemorrhagic stroke) EKG CXR
Blood glucose (finger stick IMMEDIATELY as they arrive) Troponin PT/PTT CBC with diff Chem 7 Lipid panel U/A
When is tPA contraindicated for Stroke PTs?
Recent surgery, GI bleed, MI, or prior ICH
BP >185/110
Platelets <100,000
Glucose <50 or >400
