Stroke & Syncope Flashcards
Definition of stroke?
Neurologic dysfunction secondary to cerebral infarct as evidenced by neuro-imaging or signs of permanent injury
Definition of TIA?
Transient episode of neurologic dysfunction w/o evidence of infarct, initially defined as return to baseline in <24hrs
What is penumbra?
Ischemic but not infarcted tissue, potentially viable if circulation is restored promptly
General definition of stroke/TIA?
Interruption of blood supply to an area of the brain (results in deprivation of O2 and nutrients to brain cells)
What causes an ischemic stroke?
Cerebral artery blockage
What is a thrombotic stroke (type of ischemic stroke)?
Formation of clot (thrombus) w/in a cerebral artery, usually as a result of atherosclerosis
What is an embolic stroke (type of ischemic stroke)?
Clot forms away from brain and is swept through the bloodstream/lodges in narrower brain arteries
Common causes of embolic stroke (type of ischemic stroke)?
A. fib, carotid atherosclerosis, PFO (patent foramen ovale), endocarditis
What causes a hemorrhagic stroke?
Arterial leakage or rupture secondary to HTN, AVM (arteriovenous malformations), anticoagulants, or aneurysm
Where is the leakage located in an intracerebral hemorrhage (type of hemorrhagic stroke)?
Vessel w/in the brain
Where is the leakage located in an subarachnoid hemorrhage (type of hemorrhagic stroke)?
Vessel on the surface of the brain
What causes the leakage from an aneurysm, AVM, malignancy (types of hemorrhagic stroke)?
Causes other than vessels w/in the brain or surface of the brain
S/Sx of stroke?
Confusion, dysarthria, hemiparesis, unilateral weakness (extremity, face), unilateral numbness, headache, non-orthostatic dizziness, loss of coordination, ataxia, visual field defect, carotid bruit
How to distinguish stroke from Bell’s palsy?
Which stroke is generally associated with headaches?
Hemorrhagic
diagrams –> watch lecture
Stroke patient hx?
Time of onset important (<3 hrs?, if unknown use “last known well”), prior hx of stroke/any chronic deficits, recent head injury, changes in meds (including disruption of ASA/anticoag), alcoholism, seizure d/o, migraine, recent infection, DM
What is the cincinatti stroke scale (PE)?
What is the NIH stroke scale (PE)?
What is HINTS testing (PE)?
What is a lacunar infarct?
Does an isolated lacunar infarct involve cortical sx?
Classic lacunar infarct syndromes/sx?
What is a watershed infarct?
What does a watershed infarct mostly result from?
What can a watershed infarct present with?
Tx for Watershed infarct?
Work-up for stroke?
Treatment for ischemic stroke if definitive <4.5 hrs?
Door to needle time for ischemic stroke?
What to consider for MCA occlusion with ischemic stroke?
What to do if fibrinolysis is C/I with ischemic stroke?
tPA C/Is?
Goal when treating stroke?
Treatment for hemorrhagic stroke?
What is the BJH stroke dysphagia screen?
Discharge planning for stroke?
What is a carotid/vertebral artery dissection?
Causes of carotid/vertebral artery dissection?
S/Sx of carotid/vertebral artery dissection?
Work-up for carotid/vertebral artery dissection?
Tx for carotid/vertebral artery dissection?
What is syncope?
What is pre/near syncope?
What is lightheadedness?
50% of initial incident syncope will not have _______ ________
Identifiable cause
Nature of syncope <65 y/o?
Nature of syncope >65 y/o?
Nature of syncope in children?
Hx for syncope (if witness available/per pt)?
Exam for syncope?
DDX for syncope?
What is neurally mediated syncope?
Cause of neurally mediated syncope?
How to dx neurally mediated syncope?
What is orthostatic syncope?
Cause of orthostatic syncope?
How to dx orthostatic syncope?
What is cardiovascular syncope?
Cause of cardiovascular syncope?
How to dx cardiovascular syncope?
What is POTS (postural orthostatic tachycardia syndrome)?
30% of POTS pts have syncope, with the remainder having what variety of sx?
Cause of POTS?
What is Hypovolemic POTS?
What is neuropathic POTS?
What is hyperadrenergic POTS?
What is autoimmune POTS?
What is mast cell degranulation POTS?
Hx of pts with POTS?
PE findings with POTS?
Diagnostic criteria for POTS?
What to use in syncope work up if hypovolemia suspected?
Most useful tool in work-up for syncope?
Labs for syncope workup?
What to use in syncope work up if suspicion of cardiovascular obstructive pathology?
What to use in syncope work up if trauma secondary to episode or ICB high on differential?
What to use in syncope work up to r/o seizure if suspected by hx?
What to use in work up for syncope is POTS is suspected?
Is CXR usually done in the work up for POTS?
Assess EKG for syncope for what?
What is hypertrophic cardiomyopathy?
Causes of hypertrophic cardiomyopathy?
Average age of dx for hypertrophic cardiomyopathy?
MC cause of sudden death in yound adults?
Hypertrophic cardiomyopathy
S/Sx of hypertrophic cardiomyopathy?
Work-up for hypertrophic cardiomyopathy?
Tx for hypertrophic cardiomyopathy?
EKG?
Clinical decision making tools for syncope?
Admit for syncope when?
Tx ______ _______ if possible with syncope
Tx for symptomatic bradycardia, Vfib, Vtach?
Pacemaker and/or AICD
Management of POTS?