Strokes

Question 1

asx at rest, but arm claudication
and CNS sx with exercise

pathyophys? how to dx? treatment?

Answer 1

Subclavian steal syndorme

due to stenoic subclavian artery (can also present like TIA)

Dx with arteriogram

Tx with bypass surgery

Question 2

TIA vs Stroke

Answer 2

TIA has focal neuro symptoms fors < 24 hrs while stroke has them for > 24 hrs

Question 3

when should you consult surg for carotid endarterectomy

Answer 3

> /= 70% stenosis

Question 4

brief paralytic spells resulting in pt dropping

to knees w/o LOC

Answer 4

drop attack (type of TIA)

Question 5

rapid retrograde memory loss +
confusion but preservation of
self-identity

**lasts < 24 hrs

Answer 5

Transient global ishemia = TIA in temporal lobes or thalamus

Question 6

temporary unilateral loss of vision

Answer 6

Amaurosis fugax

TIA in retinal artery

Question 7

presentation of carotid TIA

Answer 7

abrupt contralateral sx

Question 8

presentation of vertebrobasillar TIA

Answer 8

ipsilateral CN palsy + contralateral hemiplegia

Question 9

how to dx stroke?

Answer 9

Head CT w/o contrast (stroke in dark areas)

Question 10

general Tx for stroke:

Tx for afib related stroke?
lacunar?
anterior circle strokes?

Answer 10

TPA if 3 hrs or TPA CI

afib= heparin/warfarin
lacunar= control HTN
ant cir = carotid artery duplex with consult to surg if > 70% stenosis

Question 11

Where is stroke?

contralateral leg hemiparesis, incontinence

Answer 11

ACA

Question 12

Where is stroke?

contralateral face/arm hemiparesis

Answer 12

MCA

Question 13

Where is the stroke?

homonymous hemianopia

Answer 13

PCA

Question 14

Where is the stroke?
ipsilateral CN palsy
contralateral hemiplegia

Answer 14

Vertebrobasilar

Question 15

headache, nausea, vomiting,

vertigo, nystagmus

Answer 15

cerebellar infarction

Question 16

pure motor or sensory stroke, clumsy

hand-dysarthria syndrome

Answer 16

lacunar stroke

Question 17

focal neuro sx + sudden headache + vomiting

dx? management?

Answer 17

think ICH (inc pressure)

head CT w/o contrast (white areas)

Tx intubate and hyperventilate, slowly lower BP, control inc ICP w/ mannitol, admit to ICU

Question 18

“worst headache of my life”

Dx? management?

Answer 18

SAH (think berry aneuysm)

Dx head CT w/o contrast (white areas), do an LP if not sure (blood, xanthrochromia)

Tx bed rest in dark/quiet room, analgesics for headache, nifedipine for vasospasm ppx, consult neurosurg to clip berry aneurysm

Question 19

stroke in young pt, think?

Answer 19

cocaine abuse