Strokes

Question 1

TPA

Answer 1

fibrinolytic enzyme

Question 2

Aminocaproic Acid

Answer 2

blocks conversion of plasminogen to plasmin (TPA + bleeding)

Question 3

Can you give TPA if patient is on warfarin

Answer 3

NO

Question 4

Bell’s palsy

Answer 4

involves forehead

Question 5

Stroke spares

Answer 5

forehead

Question 6

Global stroke

Answer 6

low cardiac output

Question 7

Most common cause of embolic stroke

Answer 7

A-FIB - a-fib patients must be on blood thinners

Question 8

Focal

Answer 8

occluded artery

Question 9

Ischemic stroke risk factors

Answer 9

diabetes, HTN, smoking, FHx, A-fib, high cholesterol, TIA or MI, CHF, drugs

Question 10

Watershed event

Answer 10

hypotension, decreased BF between 2 areas fed by different arteries

Question 11

Cerebral perfusion pressure is driven by

Answer 11

Pco2

Question 12

Autoregulation

Answer 12

body maintains constant CBF even if it must sacrifice other organs

Question 13

Chronic HTN - autoregulation

Answer 13

body adjusts to HTN and sets a new range, more tolerant to higher BPs, do not drop BP quickly with meds

Question 14

penumbra

Answer 14

transition zone between normal tissue and infarcted tissue. Able to save this area with treatment! Ischemic but viable

Question 15

ischemic areas can become

Answer 15

infarcts (dead)

Question 16

Decreasing BP following a stroke will

Answer 16

kill the penumbra

Question 17

Patient doesn’t die from stroke, they can die from

Answer 17

cerebral edema (3-5d post stroke) herniation

Question 18

Cytotoxic cerebral edema

Answer 18

intracellularly from halt of mitochondrial metabolism and lactic acidosis

Question 19

Vasogenic cerebral edema

Answer 19

interstitially from damage to endothelial cells of blood brain barrier -> disrupting blood brain barrier -> allowing macromolecules (e.g., plasma proteins) to enter interstitial space.

Question 20

Ischemic stroke caused 2/3 by

Answer 20

cerebral atherosclerosis

Question 21

Ischemic stroke caused 1/3 by

Answer 21

cardiogenic emboli (A-FIB)

Question 22

Causes of stroke in young patients

Answer 22

dissection, drugs, endocarditis, clotting deficiency, SLE, PFO

Question 23

A-FIB HUGE cause of

Answer 23

CVA (prescribe warfarin) INR of 2-3 (not 1 like normal)

Question 24

TIA

Answer 24

Transient neurological deficit (mini stroke), lasts <1h

Question 25

Conduction aphasia

Answer 25

Poor repetition, Fluent speech, Intact comprehension, Lesion: arcuate fasciculus, Cant repeat phrases such as “no ifs ands or buts”

Question 26

CT do not reveal stroke until

Answer 26

several hours later

Question 27

Todd’s paralysis

Answer 27

one-sided paralysis or weakness after a seizure) goes away after ~1hr

Question 28

Complicated migraine

Answer 28

weakness, focal neuro deficit, difficult to distinguish between complicated migraines and actual neuro effect)

Question 29

Stroke Treatment

Answer 29

LOW dose heparin for DVT prophylaxis, early therapy, BP and glucose control, ANTIPLATELET therapy

Question 30

Stroke Treatment - Thrombolysis

Answer 30

< 3 h of ONSET = TPA, no ASA or anticoagulant for 24 hours

Question 31

Treatment for cerebral edema

Answer 31

Intubation, mannitol, burr hole

Question 32

BP of _____ requires lowering

Answer 32

>220/>120

Question 33

Mycotic aneurysms

Answer 33

Result from septic embolism Most often occur in more distal vessels, and at cortical surface Most significant complication is SAH

Question 34

Charcot-Bouchard

Answer 34

chronic htn, small vessels (e.g., basal ganglia, thalmus), Microaneurysms

Question 35

Cerebral AVM-arteriovenous malformations

Answer 35

HA, seizures, tinnitus, blurry vision, or hemorrhage

Question 36

MCA Stroke

Answer 36

pathoneumonic sign: hyperdense sign

Question 37

SAH complication

Answer 37

vasospasm and rebreeding as blood is broken down (nicaridine)

Question 38

Main cause of intraparenchymal hemorrhage

Answer 38

chronic HTN