Stroke Diagnosis and Management (3)

Question 0

What is the first task in treating a pt presenting with acute focal neurological deficits?

Answer 0

Stabilize the vital signs

Question 1

What should be the presumptive dx until proven otherwise in presentation of acute focal neurological deficits?

Answer 1

Stroke

Question 2

What are three key points to obtain in the history of a patient presenting with acute focal neuro deficits?

Answer 2

1. Time of symptom onset (last time patient felt/ observed to be normal)
2. Symptom progression
3. If headache is present; if so, how severe?

Question 3

What two things should be focused on in the PMHx?

Answer 3

1. Stroke risk factors

2. Medications

Question 4

What are three things to ask about in the FHx?

Answer 4

History of:

1. Vascular disease
2. HTN
3. Hyperlipidemia

Question 5

What three things should be focused on in the social history?

Answer 5

Use of:

1. Tobacco
2. EtOH
3. Illicit drugs (cocaine, amphetamines)

Question 6

What are 4 things to look for in the workup of potential stroke victim during the physical exam?

Answer 6

1. HR and rhythm
2. BP in both arms
3. Check for carotid bruits
4. Peripheral vascular exam

• looking for any possible etiology of the stroke

Question 7

What is the goal of a complete neurological exam in a possible stroke victim?

Answer 7

Determine the anatomical location of the stroke and the vascular territory involved

Question 8

If stroke is highly likely, what is one of the first things that need to be determined?

Answer 8

Whether it is ischemic or hemorrhagic

Question 9

What are 7 things that are part of routine laboratory evaluation of possible stroke victims?

Answer 9

1. EKG
2. CXR (evaluate heart size)
3. CBC with diff
4. CMP
5. Lipid profile
6. Clotting times
7. Head CT without contrast

Question 10

What is head CT without contrast very sensitive for?

Answer 10

Very sensitive for hemorrhagic stroke, so if negative can effectively rule them out

Question 11

Why are head CT w/o contrast not very good at picking up ischemic stroke?

Answer 11

They can’t reliably detect evolving infarcts until 6-12 hours, so if they stroke is relatively new, it will be false negative

Question 12

What imaging modality is the best tool for detecting early ischemic stroke?

Answer 12

Diffusion weighted MRI (DWI) –> is better than CT and MRI FLAIR at detecting early ischemic changes

Question 13

What test should be done if vasculitis is suspected (like in the elderly especially)?

Answer 13

ESR; also FANA

Question 14

What are five other additional labs that my be run, depending on clinical suspicion of stroke etiology?

Answer 14

1. RPR
2. Coag profile
3. Viscosity tests
4. Homocysteine levels
5. Urine drug screen

Question 15

What is the treatment for acute stroke if patient presents less than 4.5 hours from onset of symptoms?

Answer 15

IV tPA

Question 16

How should stroke be treated if patient presents between 4.5 - 6 hours of symptom onset?

Answer 16

Intra-arterial tPA

Question 17

What is treatment for stroke if patient presents over 8 hours after onset of symptoms?

Answer 17

Retrieve the clot with intra-arterial retrieving device

Question 18

When should vascular stenting or endarterectomy be performed as part of stroke prophylaxis?

Answer 18

When stenosis is affecting over 70% of artery lumen

Question 19

What is Rx tx for atherothrombotic stroke?

Answer 19

Anti-platelet drugs (aspirin, etc.)

Question 20

What is Rx tx for cardioembolic stroke?

Answer 20

Anti-coagulants

Question 21

What are prophylactic treatments of stroke generally aimed at?

Answer 21

Aimed at control of comorbid conditions that are risk factors for stroke –> meds to control HTN, DM, hyperlipidemia; also increase physical activity and stop smoking