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Guidelines > Stroke Guidlines TIA and AF > Flashcards

Stroke Guidlines TIA and AF Flashcards

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

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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

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3
Q

How do you define severe stroke?

A

Depp stupor or coma

NIHSS >22

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4
Q

NIHSS score for

Mild stroke

Moderate stroke

Severe stroke

A

0-5

6-21

> 22

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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

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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

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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

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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
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9
Q

First choice antiplatelet for TIA

A

Aspirin

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10
Q

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

A

False

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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

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12
Q

Leading cause of embolic stroke?

A

AF

Accounts for 15% of all strokes

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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

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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%

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15
Q

CHA2DS2VASc score to start anticoagulation?

A

2 or greater

CHADS2 score of > 2 start warfarin

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16
Q

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

A

INR 2.5-3.5

17
Q

Calss IB indication drug alternative for warfarin?

A

Dabigatran

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?

A

> 130 mmHg

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
Q

Hypotension should be avoided in stroke patients. Permissive hypertension is allowed for?

A

1st 7 days

26
Q

What is the recommended IV fluid for stroke patients?

A

Isotonic solution such as PNSS

27
Q

Patient is for rTPA. BP was 180/90. This is a contraindication for rTPA

True or false?

A

False

SBP >185
DBP >110

At the time of treatment

28
Q

Normal range for

ICP?

CPP?

A

ICP 5-10 mmHg

Cerebral perfusion pressure - 70-100 mmHg

29
Q

In acute ischemic stroke treatment BP is important. When is it warranted to treat with BP lowering medications?

A

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
Q

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

A

Maintain MAP 110

Treat MAP if > 130

Treat SBP if > 180

31
Q

SAH has a propensity for delayed cerebral ischemia. What are the critical values to consider?

MAP

SBP

A

MAP 130-140

SBP 180-200

32
Q

What is the dose of IV rtpa?

A

0.9 mg/kg max of 90 mg

Give 10% as bolus the remainder over 60 minutes

33
Q

What is the golden window for RtPA?

A

0-3 hours

May be effective upto 4.5-6 hours

34
Q

A patient who presents with hemianopsia withoit macular sparing and memory loss/ confusion most likely haa?

A

PCA stroke syndrome

35
Q

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?

A

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
Q

CBG was taken prior to rTPA and it showed 57 mg/DL. This is a contraindication for the therapy?
True or false?

A 
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
Q

Rapid correction of warfarin induced coagulopathy can be achieved using what blood component?

A

Prothrombin complex concentrates

PCCs can reverse effects of oral factor Xa inhibitors

38
Q

Medication given for pxs taking Dabigatran who presents with serious bleeding

A

Idarucizumab

Guidelines (5 decks)

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