Stroke Diagnosis and Management (3) Flashcards
What is the first task in treating a pt presenting with acute focal neurological deficits?
Stabilize the vital signs
What should be the presumptive dx until proven otherwise in presentation of acute focal neurological deficits?
Stroke
What are three key points to obtain in the history of a patient presenting with acute focal neuro deficits?
- Time of symptom onset (last time patient felt/ observed to be normal)
- Symptom progression
- If headache is present; if so, how severe?
What two things should be focused on in the PMHx?
- Stroke risk factors
2. Medications
What are three things to ask about in the FHx?
History of:
- Vascular disease
- HTN
- Hyperlipidemia
What three things should be focused on in the social history?
Use of:
- Tobacco
- EtOH
- Illicit drugs (cocaine, amphetamines)
What are 4 things to look for in the workup of potential stroke victim during the physical exam?
- HR and rhythm
- BP in both arms
- Check for carotid bruits
- Peripheral vascular exam
- looking for any possible etiology of the stroke
What is the goal of a complete neurological exam in a possible stroke victim?
Determine the anatomical location of the stroke and the vascular territory involved
If stroke is highly likely, what is one of the first things that need to be determined?
Whether it is ischemic or hemorrhagic
What are 7 things that are part of routine laboratory evaluation of possible stroke victims?
- EKG
- CXR (evaluate heart size)
- CBC with diff
- CMP
- Lipid profile
- Clotting times
- Head CT without contrast
What is head CT without contrast very sensitive for?
Very sensitive for hemorrhagic stroke, so if negative can effectively rule them out
Why are head CT w/o contrast not very good at picking up ischemic stroke?
They can’t reliably detect evolving infarcts until 6-12 hours, so if they stroke is relatively new, it will be false negative
What imaging modality is the best tool for detecting early ischemic stroke?
Diffusion weighted MRI (DWI) –> is better than CT and MRI FLAIR at detecting early ischemic changes
What test should be done if vasculitis is suspected (like in the elderly especially)?
ESR; also FANA
What are five other additional labs that my be run, depending on clinical suspicion of stroke etiology?
- RPR
- Coag profile
- Viscosity tests
- Homocysteine levels
- Urine drug screen