Stroke Guidlines TIA and AF Flashcards

(38 cards)

1
Q

A patient came in with 4/5 weakness of the UE and slurring of speech. GCS 15 comfortable.
Based on stroke definition this patient has what stroke severity?

A

Mild

Mild stroke any or combi of the following

  1. Mild pure motor weakness 3-4/5
  2. Pure sensory deficit
  3. Slurred but intelligible speech
  4. Vertigo with incoordination
  5. Visual field deficits

NIHSS score 0-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is moderate stroke defined?

A

Significant motor/sensory/ language/ visual defect *and/or

Disoriented, drowsy, light stupor with purposeful response to painful stimuli

NIHSS 6-21

*** basically a patient that is not GCS 15 but not in deep coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you define severe stroke?

A

Depp stupor or coma

NIHSS >22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NIHSS score for

Mild stroke

Moderate stroke

Severe stroke

A

0-5

6-21

> 22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Based on the local Philippines guideline what is the time frame for resolution of clinical symptoms of TIA?

A

Last less than an hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk of having stroke after a TIA is highest within what time frame?

A

Within 48 hours 25-50% will have stroke

10-15 % will have stroke within 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 66 yo, diabetic female patient claimed that he had left sided weakness 2 days ago but resolved spontaneously. Should you hospitalize the patient or advise opd monitoring?

A

Yes

ABCD2 score is >/= to 3

A age > 60 = 1
B BP > 140/90 = 1
C Clinical feat 
-> unilat weakness = 2
-> language disturbance w/o weakness = 1
D diabtes = 1
D duration
-> >60 min = 2
-> 10-59 = 1
-> <10 = 0

Patient score 2+ 1+ 1 = 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the imaging modality of choice for suspected TIA patients?

A

MRI icluding DWI if not avialble CT scan should be done

  • patients with TIA should ideally have neuroimaging within 24 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

First choice antiplatelet for TIA

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

True or false aspirin and clopidgrel combination is recommended for stroke prevention?

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

For patients who are candidates for Carotid endarterectomy when is the best time to perform the procedure after a TIA event?

A

Within 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Leading cause of embolic stroke?

A

AF

Accounts for 15% of all strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CHA2DS2VASc score means?

A
C - CHF
H - Hypertension
A - Age > 75 (2)
D - Diabetes
S - Stroke/ TIA (2)
V - Vascular disease
A- Age 65-74
Sc- Sex (Female)

All have one point except the 2s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management for INR >9 without significant bleeding?

A

Hold drug
Give vitamin K one dose oral 2.5-5 mg
Repeat INR daily
Resume warfarin once INR is <3 but decrease dose by 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CHA2DS2VASc score to start anticoagulation?

A

2 or greater

CHADS2 score of > 2 start warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Target INR for high risk patients such as those with prosthetic valves?

17
Q

Calss IB indication drug alternative for warfarin?

18
Q

For TIA and ischemic stroke patients precipitous drop in bp is avoided. How much is the safe range for lowering BP?

A

Not >15% of baselin MAP

19
Q

For TIA patients with non-cardioembolic cause ASA is given for how long in the early phase?

A

14 days at 160-325 mg/day

20
Q

You treat with BP lowering medications for ischemic stroke patients if MAP is?

21
Q

When is O2 support given for ischemic stroke patients?

A

O2 saturation < 95%

22
Q

Further workup using CT with contrast, Ct angiogram, MRA or CTA is warranted for what group of patients?

A
< 45 yo
Normotensive
Lobar ICH
Uncertain cause of ICH
Suspected AVM
23
Q

For mild stroke how soon can rehab be initiated?

A

72 hrs post stroke once clinically stable

24
Q

For severe Hemorrhagic stroke supportive management with 20% mannitol is warranted. How much is the dose?

A

0.5-1 g/kg q 4-6 x 3-7 days

25
Hypotension should be avoided in stroke patients. Permissive hypertension is allowed for?
1st 7 days
26
What is the recommended IV fluid for stroke patients?
Isotonic solution such as PNSS
27
Patient is for rTPA. BP was 180/90. This is a contraindication for rTPA True or false?
False SBP >185 DBP >110 At the time of treatment
28
Normal range for ICP? CPP?
ICP 5-10 mmHg Cerebral perfusion pressure - 70-100 mmHg
29
In acute ischemic stroke treatment BP is important. When is it warranted to treat with BP lowering medications?
SBP >220 DBP > 120 MAP >130 Treat SBP 185-220 or DBP 105-120 only if with compeling indication like AMI, Aortic disection, CHF, etc.
30
For ICH ischemic penumbra is not present so a more aggressive BP lowering is safe. What are the critical values to consider in ICH? MAP SBP
Maintain MAP 110 Treat MAP if > 130 Treat SBP if > 180
31
SAH has a propensity for delayed cerebral ischemia. What are the critical values to consider? MAP SBP
MAP 130-140 SBP 180-200
32
What is the dose of IV rtpa?
0.9 mg/kg max of 90 mg | Give 10% as bolus the remainder over 60 minutes
33
What is the golden window for RtPA?
0-3 hours May be effective upto 4.5-6 hours
34
A patient who presents with hemianopsia withoit macular sparing and memory loss/ confusion most likely haa?
PCA stroke syndrome
35
CT scan was done 30 minutes after a patient presented with acute stroke. On imaging it was noted that 1/2 of the teritory supplied by the MCA was affected. This is an idication for RtPA. True or false?
False Indications for rTPA 1. Clinical dx of stroke 2. Onset of symptoms = to 4.5 hours 3. CT scan showing < 1/3 of MCA teritory 4. >/= 18 years old 5. Consent given
36
CBG was taken prior to rTPA and it showed 57 mg/DL. This is a contraindication for the therapy? True or false?
``` False Contraindication if CBG < 50 or > 400 Other notable CI - plt < 100 - hct < 25% - heparin in the past 48 hrs - deranged bleeding parameters - rapidly improving sx - prior cvd/ head injury in the past 3 months - prior ICH - major surgery in the past 14 days - minor stroke symptoms - GI bleed in the past 3 weeks - recent MI - coma ```
37
Rapid correction of warfarin induced coagulopathy can be achieved using what blood component?
Prothrombin complex concentrates PCCs can reverse effects of oral factor Xa inhibitors
38
Medication given for pxs taking Dabigatran who presents with serious bleeding
Idarucizumab