Strokes

Question 1

What are the 2 types of strokes?

Answer 1

Ischemic and hemorrhagic

Question 2

What is a TIA?

Answer 2

Transient ischemic attack. The patient has symptoms lasting <1 hr but no damage to the brain.

Question 3

Why is a TIA still dangerous?

Answer 3

3-10% of people will have a stroke within the next 2 days and 9-17% of people will have one within 90 days (3 months)

Question 4

What is the difference between a stroke and TIA?

Answer 4

TIA will not show up on imaging. Hemorrhagic strokes can be seen on CT and MRI. Ischemic strokes can’t be seen on CT.

Question 5

Why is A fib; CAD, heart valves, HLD, coronary heart disease, and septal defects; PE, DVT, recent surgery, sedentary lifestyle a stroke risk factor?

Answer 5

They can all increase the risk for clots and if they break off can travel to the brain and occlude a vessel supplying oxygen to the brain.

Question 6

Taking blood thinners puts someone at risk for what type of stroke?

Answer 6

Hemorrhagic because the thinners thin the blood in order to prevent clots but also put the individual at increased risk for bleeding.

Question 7

Why is the prevalence of strokes the highest in African American populations?

Answer 7

Because they also have a higher prevalence of diseases like HTN, HLD, and cardiac diseases putting them at risk for a stroke.

Question 8

Who has a higher risk for strokes men or women?

Answer 8

Women because although more men have strokes women live longer thus increasing rates

Question 9

What are the signs of strokes?

Answer 9

Any sudden neurological symptom.

Question 10

What 3 symptoms does the Cincinnati stroke scale assess?

Answer 10

Facial droop, arm drift, and slurred speech

Question 11

What are 2 stroke scales used in the pre hospital setting?

Answer 11

Cincinnati and Los Angeles

Question 12

What is the stroke scale used in the hospital?

Answer 12

NIH

Question 13

What labs are ordered for stroke patients?

Answer 13

CBC, CMP, co-ags, type and screen, and beta HCG

Question 14

Why do we get a CMP?

Answer 14

To assess for kidney function because CT scans with contrast damage the kidneys. Also to check blood sugar if not done so already.

Question 15

Why do we get a CBC?

Answer 15

To look at the H&H and platelet levels.

Question 16

How can we assess for balance on a suspected stroke patient?

Answer 16

Ask the patient to walk or if they can reach for something

Question 17

What are some eyesight complaints associated with a stroke?

Answer 17

Blurry, black spots, seeing shadows either bilaterally or unilaterally

Question 18

What can we ask a suspected stroke patient to do to assess facial symmetry?

Answer 18

Ask them to smile, show you their teeth, or raise their eyebrows.

Question 19

What is the difference between a CT and MRI?

Answer 19

CT is faster but does not have detailed picture of the vessels in the brain.

MRI uses magnetic waves, takes longer, and is more detailed so you can see the vessels.

Question 20

What is the difference between a hemorrhagic and ischemic stroke?

Answer 20

Ischemic is when there is a blocked artery supplying oxygen to the brain a hemorrhagic stroke is when the artery breaks causing a bleed.

Question 21

Why is smoking a stroke risk factor?

Answer 21

Because the tobacco can damage the inner walls of the blood vessels, the endothelium, making it a site for atherosclerosis.

Question 22

Why is A fib and heart attack a stroke risk factor?

Answer 22

It can cause blood to stagnate thus increasing risk for blood clots

Question 23

A clot formation is worse on the L or R atrium?

Answer 23

L atrium because the clot will go to the L ventricle into the aortic valve with direct access to the brain

Question 24

If a clot forms in the R atrium where does it go?

Answer 24

Right ventricle into the lungs

Question 25

Why is a septal defect a stroke risk factor?

Answer 25

If there is a clot in the right atrium it can go into the L atrium instead of the pulmonary valve and travel to the brain.

Question 26

Why is DM and HTN a stroke risk factor?

Answer 26

Increase pressure can cause vessels to thicken and therefore becoming occluded. HTN can also cause hypertensive crisis where an artery in the brain can rupture.

Question 27

Why is a diet high in Na+ a stroke risk factor?

Answer 27

Increase Na+ will draw water into the cells causing them to swell. This is called cytotoxic edema.

Question 28

What are some treatments for an ischemic stroke?

Answer 28

TPA (tissue plasminogen activator) which activates body’s clot busting mechanism but has a time limit for usage.

Aspirin and sometime surgery to physically remove the clot.