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PAEP Neurology > Stroke & hemorrhages > Flashcards

Stroke & hemorrhages Flashcards

1
Q

def stroke

A

Sudden onset of neuro deficits of a vascular etiology that persists for >24h w/ infarction of CNS tissue (confirmed by neuroimaging)

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2
Q

def ischemic stroke

A

stroke dt insufficient blood supply

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3
Q

causes of ischemic stroke

A
  • embolic ➔ afib
  • thromboembolic
  • HTN/DM ➔ lacunar
  • global hypoperfusion
  • arterial thrombosis ➔ atherosclerosis
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4
Q

RF for ischemic stroke

A
  • increased age
  • HTN
  • DM
  • increased lipids
  • smoking
  • increase alcohol
  • drugs ➔ polypharm
  • anticoags and antiplatelets
  • sickle cell disease
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5
Q

def hemorrhagic stroke

A

cerebral infarction dt hemorrhage

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6
Q

types of hemorrhage that could cause a hemorrhagic stroke

A

intracerebral hemorrhage: bleeding within the brain parenchyma

subarachnoid hemorrhage: in the subarachnoid space

intraventricular hemorrhage: bleeding within the ventricles

subdural hematoma: crescent along the borders of the brain and skull

epidural hematoma: doming

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7
Q

RF for intracranial hemorrhage

A
  • increased age
  • htn
  • cerebral amyloid angiopathy
  • smoking
  • alcohol
  • drugs ➔ polypharm
  • anticoags and antiplatelets
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8
Q

RF for subarachnoid hemorrhage

A
  • smoking
  • htn
  • alcohol
  • age
  • personal hx of aneurysm or SAH
  • fhx of intracranial aneurysm
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9
Q

stroke mimics

A
  • drug intoxication
  • Infections
  • Migraines – complex migraines
  • Metabolic
  • Seizures
  • Tumours
  • Hypoglycemia
  • Stroke spares the forehead vs bell’s palsy involved the forehead (can move the eyebrows)
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10
Q

causes of hemorrhagic stroke

A
  • nontraumatic (spon) intracerebral hemorrhage ➔ commonly from HTN emergency
  • nontraumatic (spon) ➔ ruptured aneurysm
  • traumatic SAH
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11
Q

general patho of an ischemic stroke

A

Insufficient blood flow to focal area of brain → central core of tissue → irreversible damage (area of infarction) → surrounding area (penumbra) does not have immediate cell death (has potential for recovery if there is early re-perfusion)

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12
Q

general patho for hemorrhagic stroke

A

hematoma ➔ mass effect and perihematoma edema ➔ increase ICP ➔ decreases cerebral perfusion and causes ischemic injury

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13
Q

what does BE FAST stand for for stroke?

A

B - balance loss
E - eyesight changes

F - facial drooping
A - arm numbness
S - slurred speach
T - time

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14
Q

s/s to suspect stroke

A

BE FAST

  • sudden numbness
  • confusion
  • trouble seeing
  • severe headache
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15
Q

most common type of ischemic stroke and s/s

A

Middle cerebral artery

CHANGes

C - contralateral hemiparesis and sensory loss
H - homonymous hemianopia
A - aphasia
N - neglect
G - gaze preference towards the side of the lesion

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16
Q

how to tx an ischemic stroke?

A

within 4.5h ➔ TPA ➔ BP we want <180

otherwise permissive HTN ➔ only lower if >220/120 ➔ IV labetalol

consider endovascular thrombectomy (EVT) if it has been <24h and there is still salvageable tissue (penumbra) via CT w/ perfusion

if TPA not an option ➔ dual anti-platelet therapy w/ ASA + plavix

consider anticoagulation (DOAC or warfarin) if there is some level of afib

consider HTN control ➔ labetalol

17
Q

how to tx a hemorrhagic stroke?

A

refer to neurosurgery ➔ hematoma evacuation of decompressive craniotomy

blood pressure control ➔ can use IV mannitol to decrease ICP or elevate the head of the bed

reverse any anticoags

18
Q

how to ix a suspected stoke?

A
  1. non-contrast CT/MRI
  2. POC glucose
  3. wanna get a contrast CT or a CT angio
  4. NIH stroke scale

consider carotid dopplers

19
Q

what general non-stroke specific things can you do when managing them?

A

manage the HTN ➔ permissive ➔ goal <220/120; labetalol

manage sugars ➔ ensure not hypoglycemic

refer to a stroke centre later for secondary prevention

refer to SLP, PT, OT for rehabilitation and decrease disablity

20
Q

what can we do to prevent another stroke?

A
  1. antiplatelet therapy – ASA
  2. cardiovascular risk factor management ➔ wt loss, statins
  3. DM control ➔ metformin
  4. control HTN ➔ diuretics, ACEi, ARBi
  5. smoking cessations
  6. increase exercise
21
Q

s/s of anterior cerebral artery ischemic stroke

A

lower limbs paralysis + sensory loss ➔ unable to perform coordinated leg movements

cognitive deficits ➔ apathy, confusion, slowed mental state

22
Q

s/s of middle cerebral artery ischemic stroke

A

the classic stroke s/s
- upper limb weakness/numbness
- facial droop
- wernickes and brocas aphasia
- vision changes

23
Q

s/s of posterior cerebral artery ischemic stroke

A

4 deadly D/s
- Diplopia/ocular
- dizziness
- dysphagia
- dysarthria

24
Q

what is a TIA?

A

Transient ischemic attack: brief, reversible episode of focal neurologic dysfunction w/out acute infarction (normal imaging)

25
Q

what should a TIA tell you about stroke risk?

A

Considered to be a warning of an impending ischemic stroke → highest risk of ischemic stroke within 24h

26
Q

what is amaurosis fugax?

A

transient monocular vision loss ➔ retinal vein or artery occlusion

27
Q

RF for TIA

A

HTN, DM, age, smoking, obesity, alcoholism, stress, prev hx of stroke/TIA

28
Q

what ix do you do for a TIA?

A

CT angiogram – CTA
- can get a carotid doppler, but the CTA includes the carotids
- helps to assess the extent of blockage in arteries/chance for ischemic stroke

29
Q

what tx can we offer for TIA?

A

could offer stenting or carotid endarterectomy – removal of the fatty deposits/plaques that result in the narrowing

30
Q

what prevention meds do we go on for TIA to not become a stroke?

A

DAPT - asa and plavix

PAEP Neurology (18 decks)

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