Stroke - Rockroth

Question 1

List some risk factors for stroke.

Answer 1

1. age
2. HTN
3. diabetes
4. hypercholesterolemia
5. smoking
6. A-fib or mechanical valve
7. asymptomatic carotid artery stenosis
8. migraine
9. patent foramen ovale
10. prior stroke or TIA

Question 2

What is the most potent risk factor for stroke?

Answer 2

Age. After the age of 40 the risk doubles for each decade.

Question 3

What is the second largest risk factor for stroke?

Answer 3

Prior stroke or TIA.

Question 4

Why is a patent foramen oval a stroke risk?

Answer 4

It allows emboli to go to the left side of the heart and bypass the lungs.

Question 5

Where do emboli from the heart or carotid artery tend to go?

Answer 5

The middle cerebral artery.

Question 6

Hypertension is a major risk factor for what?

Answer 6

All major stroke types.

Question 7

What is a major prevention strategy for preventing primary strokes?

Answer 7

Treatment of underlying conditions that contribute to stroke risk such as treatment of HTN, diabetes, smoking cessation etc..

Question 8

Chronic anticoagulation is reserved for what types of patients in stroke prevention?

Answer 8

Patients with A-fib or mechanical valves. Warfarin is often given.

Question 9

Why is smoking a risk factor for stroke?

Answer 9

Smoking contributes to buildup of atherosclerotic plaques and it makes you more pro-thrombotic.

Question 10

Smoking cessation does what for the risk of stroke?

Answer 10

It lowers the risk by making the person less likely to clot and you can also get regression of atherosclerotic plaques over time.

Question 11

What is the amount of risk increase for asymptomatic carotid artery stenosis?

Answer 11

2% per year. This could be cut in half with treatment by endarterectomy but since the risk is only 2% to begin with surgery is not usually indicated.

Question 12

Risk of stroke is increased with what condition?

Answer 12

Migraines, but in this population (age group of 15-45) stroke risk is fairly low so although migraines increases it - it is still a low risk.

Question 13

Does migraine with aura increase the risk of stroke over migraine alone?

Answer 13

Yes. Especially in women.

Question 14

Are patent foramen ovale’s normally treated even though they increase risk for stroke?

Answer 14

Not usually indicated as it is questionable if they really do increase risk of stroke.

Question 15

Statins are given to reduce hypercholesteremia which also does what?

Answer 15

Lowers the risk of all types of strokes. Statins also give reduction of risk in patients who have had a TIA but don’t have hypercholesteremia.

Question 16

Although it is not yet standard of care, it has been found that giving intravenous tPA to a select population at stroke onset does what?

Answer 16

Increases the chances of a good prognosis.

Question 17

What are some stroke preventions strategies for prevention of future stroke after a patient has already had a one?

Answer 17

1. carotid endarterectomy or angioplasty
2. antiplatelet therapy - great option
3. statins
4. chronic anticoagualiton for A-fib and mechanical valve patients

Question 18

Which patient population does better with endarterectomy as a means of secondary prevention of stroke?

Answer 18

Patients older than 65 with carotid stenosis.

Question 19

Which patient population does better with angioplasty as a means of secondary prevention of stroke?

Answer 19

Patient younger than 65 with carotid stenosis.

Question 20

What are some interventions that may be used in acute ischemic stroke?

Answer 20

1. judicious BP management
2. IV hydration
3. intravenous thrombolysis
4. intra-arterial thrombolysis
5. mechanical clot retreival
6. heroic measures such as hemispherectomy

Question 21

What are some interventions that may be used in intracerebral hemorrhage?

Answer 21

1. BP control - helps control the size and growth of the hematoma
2. heroic measures