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Neuro B4 - WLB > Stroke - J. Prunuske > Flashcards

Stroke - J. Prunuske Flashcards

1
Q

What is the basic definition of a stroke according to Dr. Prunuske?

A

Sudden onset of focal CNS deficit due to a vascular cause.

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2
Q

What are the two types of strokes?

A

Hemorrhagic & Ischemic

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3
Q

What causes a hemorrhagic stroke?

A

Weakened vessel wall ruptures, causing bleeding in the brain.

  • Large vessel
    • Anterior usually Common Carotid
      • (could also be MCA and ACA)
    • Posterior usually Vertebral artery
      • (could also be basilar artery)
  • Small vessel
    • Penetrating arteries (lacunar stroke)
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4
Q

What causes an Ischemic Stroke?

A

Obstruction blocks blood flow to part of the brain.

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5
Q

What condition induces endothelial damage (which leads to clot formation) and causes an increased risk of bleeding in Small Vessel (Lacunar) Ischemic Strokes?

A

Hypertension

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6
Q

What is intracerebral hemorrhage?

A

Bleeding into the brain tissue

(causes hemorrhagic strokes)

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7
Q

In an intracerebral hemorrhage, what part of the brain is affected if the patient presents with contralateral hemiparesis, gaze paresis, and aphasia or hemineglect?

A

Putamen

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8
Q

In an intracerebral hemorrhage, what part of the brain is affected if the patient presents with contralateral hemianesthesia?

A

Thalamus

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9
Q

In an intracerebral hemorrhage, what part of the brain is affected if the patient presents with vomiting, ataxia, nystagmus, facial paralysis, ipsilateral gaze palsies, and decreased LOC?

A

Cerebellum

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10
Q

In an intracerebral hemorrhage, what part of the brain is affected if the patient presents with quadriplegia, pinpoint pupils, autonomic instability, and/or coma?

A

Pons

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11
Q

What imaging study is used to diagnose an intracerebral hemorrhage?

A

Noncontrast Head CT

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12
Q

How do you manage intracranial hemorrhage?

A
  • Surgical removal of clots in supratentorial hemorrhage (may improve outcomes)
  • Stop or reverse anticoagulants
  • Lowering BP
    • no change in death/disability
    • may contribute to improved function in survivors
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13
Q

What are common symptoms in a patient presenting with Subarachnoid Hemorrhage?

A
  • Thunderclap headache
  • Nausea or Vomiting
  • Focal neurologic deficits
  • Altered level/LOC
  • Headache (possibly only symptom)
  • Sentinel headaches
  • Nuchal rigidity
  • Photophobia
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14
Q

What tests help diagnose a subarachnoid hemorrhage?

A
  • Noncontrast Head CT
  • LP if head CT is negative and you still have a high suspicion for SAH
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15
Q

How do you manage a subarachnoid hemorrhage?

A
  • Medicinal
    • Nimodipine
      • Ca2+ channel blocker
      • preferentially affects CNS
      • dilates small vessels to increase collateral circulation & preserve cerebral perfusion
  • Surgical
    • clipping berry aneurysm
    • endovascular coil to fill aneurysm
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16
Q

What two common factors have no association with subarachnoid hemorrhages?

A
  • Recurrent headaches
  • Recent use of NSAIDs
17
Q

When a stroke occurs in this area it results in contralateral motor and sensory deficits. What area is it?

A

Anterior

(ACA)

18
Q

When a stroke occurs in this area it results in speech deficits, facial weakness, visual field deficits, and arm movement deficits. What area is affected?

A

Middle

(MCA)

19
Q

When a stroke occurs in this area it results in vision deficits with macular sparing, cerebellar dysfunction, vertigo, and sometimes cranial nerve palsies. What area is affected?

A

Posterior

(Vertebral artery, Basilar artery)

20
Q

When a stroke occurs in this particular area it results in respiratory failure and LOC. What area is affected?

A

Blood flow to the brainstem

(Basilar Artery)

21
Q

When a stroke occurs in this specific area it causes vertigo, vomiting, and nystagmus. What is the affected area?

A

Cerebellum

(Vertebral Artery)

22
Q

When a stroke occurs in this area it results in weird deficits that do not make sense. What area is affected?

A

Lenticulostriate

(Internal capsule, Caudate nucleus, Putamen, Globus pallidus)

23
Q

What are useful labs/tests to order when diagnosing a stroke?

A
  • Blood tests
    • CBC, BMP, Hepatic panel, Lipid profile, INR
  • EKG, Telemetry
  • Carotid Doppler
  • Echo
24
Q

What is the MOA of TPA?

A

catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown

25
Q

What are the contraindications for administering TPA?

A
  • Intracranial hemorrhage or concern for SAH
  • Greater than 3 hrs after onset of symptoms in older/sicker patient (4hrs in younger/healthier)
  • Rapidly resolving symptoms
  • BP > 185/110 mmHg
  • MI, Stroke, head injury within past 3 months
  • GI bleed within past 3 weeks
  • Major surgery within past 2 weeks
  • Active bleeding/acute trauma (e.g. fracture)
  • On anticoagulation therapy

Neuro B4 - WLB (17 decks)

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