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Neurology 2 > Stroke TIA > Flashcards

Stroke TIA Flashcards

1
Q

Causes of Stroke

A

Brain ischemia:

  • thrombosis
  • embolism
  • systemic hypoperfusion

Brain hemorrhage:

  • intracerebral hemorrhage
  • subarachnoid hemorrhage (Intracranial aneurysm, AV malformation)
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2
Q

Anterior Circulation of the brain stems from what artery? Posterior?

A

Anterior circulation of the brain stems from the internal carotid while the posterior circulation stems from vertebral-basilar artery

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3
Q

What is the most common type of stroke? What artery is usually affected?

A

Ischemic stroke is most common type, the MCA is usually the artery affected.

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4
Q

Common Cardiac causes of stroke?

A
  • ASD/VSD/PFO
  • afib
  • MI (anterior wall infarct or left ventricular wall mural thrombi)
  • endocarditis
  • Valvular disorders: Rhematic valvular stenosis is MC
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5
Q

Causes of Spontaneous Intracerebral hemorrhage?

A
  • poorly controlled HTN
  • bleeding disorders
  • amyloid angiopathy (amyloid deposition leading to weakening of the cerebral blood vessels)
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6
Q

Causes of SAH?

A
  • trauma
  • spontaneous related to AVM or aneurysm rupture*
  • abnormal vascular composition (amyloid/dissection)
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7
Q

Intracranial Aneurysm

  • most commonly located where?
  • sx
  • what size carries a high risk of rupture?
A
  • most commonly found in circle of willis
  • usually asymptomatic until rupture
  • size over 1cm
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8
Q

Arteriovenous Malformation

-what is this?

A

abnormal arterial to venous connection; tangle of artery and veins

-venous side developes pressure as high as arterial which leads to rupture.

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9
Q

What are the stroke subtypes?

A

Hemorrhagic:

  • intracerebral hemorrhage
  • subarachnoid hemorrhage

Ischemic:
-anterior, posterior, lacunar circulation

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10
Q

Intracerebral Hemorrhage:

  • what is this?
  • sx onset
  • sx
A

WHat: arterial bleeding directly into the brain parenchyma; pressure on the brain is life threatening

-sx worsen as the hematoma grows

Sx:

  • HA
  • vomiting
  • LOC with large hematoma
  • vary depending on location and size of bleed, similar to ischemic
  • may be preceeded by heavy exertion or sex
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11
Q

Subarachnoid Hemorrhage:

  • what is this?
  • sx
A

-bleeding into the CSF and the space surrounding the brain, this increased the ICP producing sx. Blood within the CSF induces vasoconstriction which can be intense and severe leads to ischemia.

Sx:

  • abrupt HA, thunderclap
  • vomiting, NO focal neurological signs
  • knees may buckle. loss of memory
  • may be preceeded by heavy exertion or sex
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12
Q

Ischemic Stroke:

-2/3 of all ischemic strokes affect which brain circulation?

A

-MCA and ACA

MCA is most commonly involved d/t the direct flow from the internal carotid and its large size.

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13
Q

Posterior Stroke Outcomes

A

-terrible, basilar artery occlusion = 90% mortality

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14
Q

Ischemic Stroke: Lacunar infarcts

  • which artery do these branch from?
  • what can you expect to see on CT?
  • What are some risk factors for development of these strokes?
A

Lacunar infarcts branch from the MCA

CT: punched out hypodense areas

Uncontrolled HTN and DM

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15
Q

What is the most common type of stroke?

Most common culprit vessel in ischemic stroke?

Anterior strokes occur from occlusion of what vessel?

Posterior strokes occur from occlusion of what vessel?

HTN may cause what specific types of strokes?

A

Ischemic

MCA

Internal Carotid

Vertebral Artery

Intracerebral hemorrhages or lacunar infarcts

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16
Q

Risk factors of Stroke

A

HTN

DM

Hyperlipidemia

Smoking

Cardiac dz

AIDS

Drug abuse

ETOH

FHx

Obesity

PVD

Sedentary

Oral contraceptives

Age 45M 55W

Sleep apnea

17
Q

Define:

  • aphasia types
  • -global
  • -anomic
  • -brocas
  • -wernickes
A

Global:
-cannot speak, understand speech, read or write

Anomic:

  • can understand what youre saying and can read
  • difficulty writing and speaking (word finding)

Brocas:
“expressive aphasia”
-cannot read, write, or speak (short utterances, aware of their garbled speech)
-comprehension intact

Wernickes:
“receptive aphasia”
-fluent but meaningless spont. speech - jargon of real words and non-words
-unaware of their language errors
-poor comprehension, reading, and writing

18
Q

Define:

  • dysarthria
  • dysconjugate gaze
  • apraxia
  • dystaxia
  • agnosia
A

Dysarthria: problem with muscles that produce speech

Dysconjugate gaze: both eyes track together

Apraxia: difficulty with motor planning to perform tasks or movements when asked (2 step instruction)

dystaxia: lack of muscle coordination
agnosia: inability to process sensory info, loss of ability to recognize objects, persons, sounds, shapes, or smells.

19
Q

Sx of Anterior Circulation Stroke (ACA and MCA)

Sx of ACA occclusion

Sx of MCA occlusion

A

ACA and MCA

  • face-hand-arm-leg contralateral hemiparesis
  • aphasia
  • dysarthria

ACA sx:

  • leg weakness and sensory loss; contralateral side affected
  • prox arm weakness and sensory loss; contralateral side affected
  • urinary incontinence

MCA:

  • contralateral hemiplegia in the face*-arm-leg
  • homonymous hemianopsia
  • if on the left side= aphasia (wernickes or brocas)
  • if on the right side = confusion, spatial disorientation, emotional neglect
  • apraxia
20
Q

Posterior Circulation Stroke Sx

A

sx depend upon which brain structure is affected;

  • Midbrain = CN III, IV
  • Pons = V, VI, VII, VIII
  • Medulla = IX, X, XI, XII
  • vertigo
  • diplopia, dysconjugate gaze, homonymous hemianopsia
  • sensory deficits= ipsilateral face & contralateral limbs
  • dysarthria
  • ataxia
21
Q

When sx are not all on the same side of the body this is a tip off that they are having what kind of stroke?

A

-posterior stroke

22
Q

What are the 5 D’s of posterior stroke?

A
  • Dizziness
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Dystaxia
23
Q

Lacunar Stroke Sx

A

-pure motor loss (weakness) OR pure sensory loss

24
Q

NIH Stroke Scale scores and severities..

A 
0 = no stroke 
1-4 = minor 
5-15 = moderate 
16-20 = moderate to severe
21-42 = severe
25
Q

Stroke Evaluation

  • labs
  • imaging
A

Labs:

  • lipid profile
  • blood sugar
  • CBC
  • CMP
  • PT/PTT
  • Cardiac biomarkers (R/O cardiac ischemia)

Imaging:

  • ACUTE: non-contrast CT
  • later; MRI +/- MRA
  • ekg
  • ultrasound carotids
  • echo
26
Q

Acute Stroke treatment

  • window of opportunity for tx
  • time frame that a pt must be evaluated and recieve tx once they are at the hospital

-Acute tx of ischemic stroke & hemorrhagic

A
  • 3-4.5hrs
  • 60minutes

Ischemic:

  • Fibrinolytic: clot buster = tPA given within 3-4.5hrs
  • ASA
  • Heparin/Lovenox
  • PCI

Hemorrhagic: correct cause of hemorrhage

27
Q

Inclusion criteria for

thrombolytics? Exclusion?

A

Inclusion:
ischemic stroke, onset of sx less than 4.5hrs ago, greater than 18yo

Exclusion:

  • stroke or head trauma in previous 3 mo
  • previous intracranial hemorrhage
  • intracranial neoplasm
  • av malformation/aneurysm
  • recent intracranial or intraspinal surgery
  • arterial puncture at a non-compressible site
  • SBP greater than 185mmHg or 110DBP
  • glucose less than 50
  • active internal bleeding or diathesis
  • INR greater than 1.7
  • Heparin use within 48hrs and elevated PTT
28
Q

Relative exclusion of Thrombolytics for tx 3-4.5hrs from sx onset.

A
  • greater than 80yrs
  • oral anticoagulation use
  • very severe stroke
  • previous ischemic stroke and DM
29
Q

Discharge medications post stroke

A
  • aspirin
  • statin (unless hemorrhagic)
  • anticoagulaton
  • Plavix
  • Antihypertensive
  • control blood sugar if DM
30
Q

After stroke, if sx last longer than 2-3mo complete recovery from aphasia is likely or unlikely?

What are some residual effects of strokes?

A

unlikely.

Residual:

  • emotional lability
  • difficulty recognizing familiar objects
  • difficulty planning
  • loss of awareness
  • dysphagia
31
Q

What are some complications of stroke?

A
  • bowel/bladder dysfunction
  • pressure ulcers
  • malnutrition/dehydration
  • recurrent strokes
  • VTE
  • Dysphagia
  • aspiration pna
  • seizures
32
Q

TIA

  • what is this?
  • types
  • work up
  • tx
A

What: stroke like event lasting less than 24hrs (usually 20minutes) that occurs secondary to cerebral ischemia

Types:

  • amarosis fugax
  • low flow
  • ebolic
  • thrombotic

Work up:

  • CT or MRI
  • Carotid ultrasound
  • eval for source of emboli or thrombus

Tx:

  • admit if seen within 72hrs of sx
  • treat risk factors (same as stroke)

Neurology 2 (8 decks)

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