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Neuro II > Strokes > Flashcards

Strokes Flashcards

1
Q

What is the definition of stroke?

A

inadequate blood flow to the brain resulting in cell death

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2
Q

What is a TIA?

A

brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with complete resolution of symptoms, typically lasting less than 1 hour, and without evidence of infarction

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3
Q

What is the risk factor for stroke 2 days after TIA?

A

10%

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4
Q

What are the clinical symptoms of stroke?

A
  • Sudden
    • confusion, trouble speaking or understanding
    • numbness or weakness of the face, arm, or leg especially on one side of the body
    • trouble seeing out of one or both eyes
    • trouble walking, dizziness, loss of balance or coordination
    • severe headache with no known cause or no prior history of headache
    • neglect
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5
Q

What would you be looking for in a CT that indicates stroke?

A

hypodensity

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6
Q

When looking at a stroke on MRI, what two sets should you look at together?

A

ADC & DWI

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7
Q

Why do we see brightness with stroke on a DWI MRI?

A

loss of perfusion → increased edema →influx of fluid/protons that light up

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8
Q

Identify the type of aphasia indicative of leach level of the flow chart

A
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9
Q

What areas of language do we want to test when assessing stroke?

A

naming, fluency, comprehensive, repetition, prosed/singing, reading, writing

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10
Q

What are the 2 types of stroke? Which is more common?

A
  • Hemorrhagic: blood leaking out into the brain
  • Ischemic: loss of blood flow (85%)
    • thrombolic - clot develops in that specific area (usually d/t plaque build up)
    • embolic- clot forms somewhere else & shoots up to the brain (MC cardioembolic stroke)
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11
Q

Identify the characteristics of ischemic strokes relative to the following variable:

Acute / Hyperacute?

Headache?

Consciousness?

Herniation?

Territory?

A
  • Acute / Hyperacute?
    • acute or hyperacute
  • Headache?
    • moderate / no headache
  • Consciousness?
    • relatively preserved
  • Herniation?
    • rare / later
  • Territory?
    • clear vascular territory
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12
Q

Identify the characteristics of hemorrhagic strokes relative to the following variable:

Acute / Hyperacute?

Headache?

Consciousness?

Herniation?

Territory?

A
  • Acute / Hyperacute?
    • hyperacute
  • Headache?
    • severe
  • Consciousness?
    • usually impaired if large
  • Herniation?
    • early signs of herniation
  • Territory?
    • no obvious territory
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13
Q

Identify the arterial territory of the brain indicated in the provided image

A
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14
Q

What percent of all strokes are cardiothromboembolic?

A

20-30%

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15
Q

What are the major risk factors/etiologies for cardiothromboembolic stroke?

A

atrial fibrillation (x5)

acute MI w/ left ventricular thrombus

mechanical valve (mitral > aortic)

infective endocarditis

DVT → patent foramen ovale

intrapulmonary shunt

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16
Q

Ischemic stroke often occurs in what small-vessel diseases?

This most commonly affects which specific vessels?

A

hypertension / diabetes

subcortical/basal ganglia/brainstem area

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17
Q

Ischemic stroke often occurs in what large-vessel diseases?

This most commonly affects which specific vessels?

A

hyperlipidemia, hypovolemia

PCA, MCA, ACA, carotids

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18
Q

Other than vessel diseases, what are the other general etiological causes of ischemic stroke?

A
  • hypercoagulatin
  • genetic/vasculitic
  • genetic/metabolic
  • infectious
  • cryptogenic
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19
Q

What type of stroke is shown on the provided DWI image?

A

watershed stroke - string of pearls sign

between MCA & ACA territory, but all in one hemisphere

20
Q

This watershed stroke suggests what etiological cause?

A

ipsilateral carotid stenosis & hypovolemic state

loss of blood pressure → loss of perfusion → w/ stenosis lose have stroke in area between MCA & ACA territory

21
Q

What type of stroke is shown on the provided DWI image?

A

punctate

small, round infarcts cortically & in both hemispheres

22
Q

The punctate stroke shown in the provide image is suggestive of what etiological cause?

A

cardioembolic etiology

23
Q

What territory is impacted in the provided DWI/

A

MCA superior division territory

24
Q

The provided DWI image is indicative of what etiological cause of stroke?

A

watershed or thrombotic stroke

25
Q

What type of stroke is shown in the provided DWI image?

A

lacunar infarct

26
Q

The provided image of lacunar infarct on DWI is suggestive of what etiological cause of stroke?

A

small vessel disease

(hypertension, diabetes)

27
Q

List the components fo the cerebral vasculature affected by atherosclerotic disease from high to low:

A

high to low

  • basilar artery
  • carotid
  • cavernous sinus
  • MCA & ACA divisions
28
Q

What is carotid dissection?

A

tearing of the inner wall of an artery

blood enters the tunica media of the vessel & forms intramural hematoma

29
Q

What characteristics can increase a persons chance of having a carotid dissection?

A
  • Ehler’s Danlos Syndrom IV
  • marfan syndrome
  • autosomal dominant polycystic kidney disease
  • osteogenesis imperfecta type I
30
Q

What is the clinical presentation of a patient with carotid dissection? Treatment?

A

ipsilateral cervical pain (25%)

headache (66%)

ipsilateral Horner Syndrome (<50%)

TIA (50-95%) days/hours after dissection

Treatment: anti-platelet therapy

31
Q

Describe the stroke pathophysiology

A

mismatch of blood pressure & blood volume → brain wants to maintain constant cerebral blood flow → cerebral vasodilation to maximize blood flow (allow for optimal blood oxygen extraction) → autoregulation is overwhelmed due to the insufficient cerebral perfusion pressure → blood flow decreases → tissue hypoperfusion

32
Q

What is it called when the surrounding tissue in a stroke tries to respond to the loss in blood flow?

A

penumbra

(goal area for tissue recovery)

33
Q

How long is brain tissue viable?

A

until cell death occurs

can still be recovered even if it is not optimally metabolically function

34
Q

Every 30 minutes in delay in acute perfusion leads to what percent irreversible outcome?

A

10%

35
Q

What treatment for ischemic stroke increases the likelihood of patient independence at three months post event?

A

intravenous thrombolysis via recombinant tissue plasminogen activator (tpa) within 4.5 hrs

36
Q

Patients with what kind of stroke are a candidate for endovascular thrombectomy within what timeframe post stroke?

A

large vessel occlusion

24 hrs from onset

37
Q

What type of stroke is shown in the provided image?

A

MCA branch ischemic stroke

38
Q

Occlusion of what artery causes “locked in syndrome”?

how?

A

basilar artery involving the pons

disconnects supratentorium/midbrain from pons & medulla

39
Q

What type of movement is spared in “locked in syndrome”?

Why?

A

vertical eye movements

controlled by interstitial nucleus of MLF in the midbrain just dorsal to red nucleus

40
Q

What are the modifiable risk factors for stroke?

A
  • hypertension
  • dyslipidemia
  • diabetes
  • metabolic syndromes
  • atrial fibrillation
  • carotid stenosis
  • cigarette smoking
  • alcohol use
  • obesity
  • physical inactivity
  • obstructive sleep apnea
41
Q

What are the non-modifiable risk factors for stroke?

A
  • age
  • gender
  • race/ethnicity
  • heredity
  • Hx of TIA/prior stroke
42
Q

How long after quitting smoking is risk of stroke decreased?

Cessation of smoking after how long brings risk of stroke to that of non-smoker?

A

after 2 yrs → risk decreased

5yrs

43
Q

What medications can be given to patients to mitigate risk of stroke?

A
  • anti platelet
    • aspirin, plavix
  • anticoagulation
    • coumadin, NOACs
  • statin
44
Q

Control of what chronic conditions can help modify risk of stroke?

A
  • control of blood pressure
  • weight loss / exercise / diet
  • diabetes management
  • smoking cessation
  • CPAP for obstructive sleep apnea
45
Q

Women with what characteristic are predisposed to stroke?

A

with migraine with aura

tobacco use

supplemental estrogens

46
Q

What procedure can be performed to decrease risk of stroke? In what situations is this appropriate?

A

carotid endarterectomy

(70-99% stenosis)

symptomatic: 50-59% stenosis

Neuro II (30 decks)

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