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Neurology > Stroke & TIA > Flashcards

Stroke & TIA Flashcards

1
Q

Define Stroke

A

Alteration of cerebral blood flow

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2
Q

Types of Stroke

A

Ischemic

Hemorrhagic

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3
Q

Reasons for Ischemic Stroke

A

Thrombosis
Embolism
Systemic hypoperfusion

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4
Q

Types of Hemorrhagic Stroke

A

Intracerebral hemorrhage

Subarachnoid hemorrhage

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5
Q

Internal carotid give way to which vessels?

A

Anterior cerebral artery

Middle cerebral artery

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6
Q

Posterior cerebral artery originates from which vessels?

A

Vertebral

Basilar

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7
Q

Etiologies of Ischemic Stroke

A 
A-fib
Atrial septal defect
Ventricular septal defect
Endocarditis
Cardiac tumor
Valvular disorder
Atherosclerotic plaques
Vasculitis
Prothrombotic State
Cerebral Hemorrhage
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8
Q

Etiology: A-fib

A

Embolization of intracardiac thrombi
Anticoagulation decreases risk by 70%
Aspirin decreases risk by 20-25%

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9
Q

Etiology: Atrial Septal Defect

A

Only if associated with a R to L shunt

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10
Q

Etiology: Ventricular Septal Defect

A

Only if associated with a R to L shunt

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11
Q

Etiology: MI

A

Most common after an anterior wall infarction

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12
Q

Etiology: Endocarditis

A

Emboli from vegetations

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13
Q

Etiology: Cardiac Tumor

A

Obstruction of blood flow
Can lead to arrhythmias
Embolization of tumor fragments

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14
Q

Etiologies: Valvular Disorders

A

Rheumatic MS: most commonly associated with stroke
Mitral valve prolapse: fibrinous deposits on valve
Prosthetic valve: require lifelong anticoagulation
Repaired valves: require anticoagulation short term

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15
Q

Percent of all strokes are hemorrhagic

A

20%

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16
Q

Causes of Spontaneous Intracerebral Hemorrhage

A

Poorly controlled HTN
Bleeding disorders
Amyloid angiopathy

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17
Q

Causes of subarachnoid hemorrhage

A 
Trauma
Spontaneous subarachnoid
Abnormal vascular composition
Illicit drug use
Intracranial arterial dissections
No identifiable cause
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18
Q

Intracranial Aneurysm

A

Located in Circle of Willis (most common)

Size and location determine risk of rupture

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19
Q

Arteriovenous Malformations

A

Abnormal connection
Venous side develop high pressures
Associated with risk of seizure

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20
Q

Types of Ischemic Stroke

A

Anterior circulation
Posterior circulation
Lacunar

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21
Q

Intracerebral Hemorrhage

A

Arterial bleeding directly into the brain
Accumulation over minutes to hours
Symptoms increase over time

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22
Q

Major causes of intracerebral hemorrhage

A 
HTN
Trauma
Bleeding disorder
Amyloid angiopathy
Illicit drug use
Arteriovenous malformations
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23
Q

Goal of treatment of intracerebral hemorrhage

A

Contain and limit the bleeding to prevent herniation

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24
Q

Major causes of Subarachnoid Hemorrhage

A

Ruptured aneurysm

Atriovenous malformation

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25
Q

What is a Subarachnoid Hemorrhage?

A

Bleeding into the CSF and the space surrounding the brain

Increases ICP

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26
Q

Treatment for Subarachnoid Hemorrhage

A

Identification of source of bleeding

Prevent brain damage

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27
Q

Ischemic Stroke: Anterior Circulation

A

Most are middle cerebral artery occlusions due to direct flow from internal carotid

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28
Q

Ischemic Stroke: Posterior Circulation

A

Have terrible outcomes

Affects occipital lobes, cerebellum, and brainstem

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29
Q

Ischemic Stroke: Lacunar Infarcts

A

Lesions that occur in the penetrating arterioles off of the MCA
“Punched out hypodense areas”
Less morbidity/mortality

30
Q

Stroke Risk Factors

A 
HTN
DM
Hyperlipidemia
Cigarette Smoking
Cardiac Disease
Elevated blood homocysteine levels
AIDS
Recreational drug abuse
Alcoholism
Family hx of stroke
Overweight
Ischemic heart disease
PVD
Sedentary lifestyle
Men >45 & Women >55
Oral contraceptives +smoking
Hypercoagulopathy
Polycythemia
Prior Stroke
Sleep Apnea
Bleeding disorders
31
Q

Stroke Symptoms

A

Facial droop
Arm droop
Speech difficulty
Time to call 911

32
Q

Define Aphasia

A

Acquired communication disorder

Input or output disorder

33
Q

4 Types of Aphasia

A

Global
Anomic
Broca’s
Wernicke’s

34
Q

Global Aphasia

A 
Most severe
INPUT AND OUTPUT
Few recognizable words
Understands minimal spoken speech
Can't read or write
35
Q

Anomic Aphasia

A 
Person who are left with a persistent inability to supply words for the things that they want to talk about
OUTPUT DISORDER
Understands speech
Reads adequately
Poor writing ability
36
Q

Broca’s Aphasia (Expressive)

A

Supplied by left MCA
OUTPUT DISORDER
Speech output severely reduced
Reading/writing affected

37
Q

Wernicke’s Aphasia (Receptive)

A 
Supplied by left MCA
Meaningless speech
iNPUT DISORDER
Comprehension poor
Writing/reading affected
38
Q

Define Dysarthria

A

Problem with the muscles that produce speech

39
Q

Define Dysconjugate Gaze

A

Failure of the eyes to turn together in the same direction

40
Q

Apraxia

A

Difficulty with the motor planning to perform tasks or movements when asked
Patient may not know where to start

41
Q

Define Dystaxia

A

Lack of muscle coordination

42
Q

Define Agnosia

A

Inability to process sensory information

Loss of ability to recognize objects, persons, sounds, shapes, or smells

43
Q

Symptoms of Subarachnoid Hemorrhage

A 
Symptoms begin abruptly
Sudden increase in ICP
"Thunderclap" headache
No focal neurologic signs
Signs of meningeal irritation
Symptoms preceded by heavy physical exertion or sex
44
Q

Symptoms of Intracerebral Hemorrhage

A

Symptoms slower in onset
Symptoms worsen as hematoma enlarges
Headache/vomiting
Symptoms preceded by heavy physical exertion or sex
Symptoms will vary depending on location/size of bleed

45
Q

Stroke Symptoms

A

Brain damage one side, deficits on contralateral side

46
Q

General Symptoms of Anterior Circulation Stroke

A

Face-hand-arm-leg contralateral hemiparesis
Aphasia
Dysarthria

47
Q

Anterior Cerebral Artery Occlusion may cause:

A

Contralateral leg weakness/sensory loss
Contralateral arm weakness/sensory loss
Urinary incontinence

48
Q

Middle Cerebral Artery Occlusion May Cause:

A

Contralateral hemiplegia
Homonymous hemianopsia
Apraxia

49
Q

Left Dominant Hemisphere MCA Occlusion

A

Aphasia
Wernicke’s (receptive)
Broca’s (expressive)

50
Q

Nondominant Right Hemisphere MCA Occlusion

A

Confusion
Spatial Disorientation
Sensory Neglect
Emotional Neglect

51
Q

Posterior Circulation Stroke Symptoms

A

Vertigo
Diplopia, dysconjugate gaze, ocular palsy, hemonymous hemianopsia
Sensorimotor- IPSILATERAL face and CONTRALATERAL limbs
Dysarthria
Ataxia

52
Q

5 D’s of Posterior Stroke Symptoms

A 
Dizziness
Diplopia
Dysarthria
Dysphagia
Dystaxia
53
Q

Lacunar Stroke Symptoms

A

Pure motor or sensory loss
Sensorimotor stroke
Ataxic hemiparesis

54
Q

Acute Evaluation of Stroke

A

Timing of onset
Assessment of risk factors
Look for stroke sources

55
Q

Blood Work for Evaluation of Stroke

A 
Lipid Profile
CBC
CMP
PT/PTT
Cardiac biomarkers
56
Q

Diagnostic Work Up for Evaluation of Stroke

A 
Noncontrast CT
EKG
Ultrasound of carotids
Echo
MRI or MRA
57
Q

Key Window for Treating Stroke

A

3-4.5 hours

58
Q

Medical Tool Bag for Strokes

A

ASA
Heparin or Lovenox
Fibrinolytics
Percutaneous Intracerebral Intervention

59
Q

Treatment of Stroke

A

Continuous monitoring

Medical support as needed

60
Q

Tissue Plasminogen Activator (tPA)

A

Clot busting drug
Dissolve clot in ischemic stroke
ONLY FOR ISCHEMIC STROKES

61
Q

Inclusion Criteria for tPA

A

Ischemic Stroke

Onset of symptoms 18

62
Q

Exclusion Criteria for tPA

A

Significant stroke/head trauma in previous 3 months
Previous intracranial hemorrhage
Intracranial neoplasm, arteriovenous malformation, or aneurysm
Recent intracranial or intraspinal surgery
Arterial puncture 1.7 or PT >15 secs
Heparin use within 48 hours
Current use of direct thrombin inhibitor

63
Q

Relative Exclusion Criteria for tPA

A

Minor/isolated neurologic signs
TIA
Major surgery/trauma

64
Q

Discharge Medications for Stroke

A 
Aspirin
Statin
Anticoagulation?
Plavix?
Antihypertensives
Blood sugar control in DM
65
Q

Residual Effects of Strokes

A

Emotional Lability
Difficulty recognizing, understanding familiar objects
Difficulty planning/carrying out simple tasks
Loss of awareness
Dysphagia and aspiration

66
Q

Medical Complications of Stroke

A 
Bladder dysfunction
Bowel dysfunction
Pressure ulcers
Malnutrition
Dehydration
Falls/injuries
Recurrent strokes
Venous thromboembolism
Dysphagia
Aspiration pneumonia
Seizures
Spasticity
67
Q

Define TIA

A

Stroke like event lasting less than 24 hours that occurs secondary to cerebral ischemia

68
Q

Etiology for TIA

A 
A-fib
Atrial septal defect
Ventricular septal defect
Endocarditis
Cardiac tumor
Valvular disorder
Atherosclerotic plaques
Vasculitis
Prothrombotic State
Cerebral Hemorrhage
69
Q

Risk Factors for TIA

A 
HTN
DM
Hyperlipidemia
Cigarette Smoking
Cardiac Disease
Elevated blood homocysteine levels
AIDS
Recreational drug abuse
Alcoholism
Family hx of stroke
Overweight
Ischemic heart disease
PVD
Sedentary lifestyle
Men >45 & Women >55
Oral contraceptives +smoking
Hypercoagulopathy
Polycythemia
Prior Stroke
Sleep Apnea
Bleeding disorders
70
Q

TIA Subtypes

A

Amarosis fugax
Low Flow
Embolic
Thrombotic

71
Q

TIA Work Up

A

CT or MRI
Carotid ultrasound
Evaluation for source of embolic/thrombus

72
Q

TIA Treatment

A

Consider hospital admission (

Neurology (10 decks)

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