strokes & tia's

Question 1

stroke risk factors

Answer 1

HTN
Hyperlipidemia
tobacco abuse
DM
Race
Oral contraceptives
Age
Gender: males
sickle cell anemia
hx of TIA
A fib

Question 2

Ischemic stroke

Answer 2

thrombotic
atherosclerosis - damage to vessel wall, plaque forms, reduces blood flow to area, plaque could rupture

hypercoagulable state - CA, birth control pills, pts with COVID

Question 3

penumbra

Answer 3

ischemic area that is still viable

goal is to salvage the penumbra within 3 hours

Question 4

hemorrhagic stroke

Answer 4

bleeding within the brain parenchyma

associated with long standing, severe HTN

aneurysm

Question 5

intracranial hemorrhage

Answer 5

epidural

• skull fxs
• arterial
• injury is usually less severe

subdural

• bridging veins
• brain moves within skull, vessels don’t
• rapid decline - severe injury
• can be slow, 2-10 days later

subarachnoid

• rupture of cerebral aneurysm
• arterio-venous malformation (AVM)

Question 6

presentation of hemorrhagic strokes

Answer 6

age 30-60 years
high morbidity and mortality rates
serious disabilities

"worst HA of my life"
rapid change in LOC
irritation of the meninges
 - nuchal rigidity (similar to meningitis)
 - photophobia
blood in the CSF

Question 7

B
E

F
A
S
T

Answer 7

balance
eyes

face
arm
speech
time to call 911

time is tissue, 3 hrs is key

Question 8

stroke diagnostics

Answer 8

CT scan

• w/o contrast to exclude hemorrhage
• better than MRI in acute phase, faster

Question 9

atelplase

Answer 9

tissue plasminogen activator

MOA: promotes conversion of plasminogen to plasmin

Uses: acute MI, PE, ischemic stroke

given IV, monitor BP and HR

Question 10

atelplase

AEs

Answer 10

increased risk of intracranial bleeding
goal is to restore blood flow as quickly as possible
with reperfusion, may develop dysrhythmias

antidote: aminocaproic acid (Amicar)

Question 11

penumbra procedure

Answer 11

go in and try to remove the clot

Question 12

consequences of strokes (CVAs)

Answer 12

aphasia - inability to speak or comprehend
dysphasia - impairment of speech
dysarthria - imperfect speech sounds
expressive aphasia - comprehend but can’t express
receptive “ - can’t comprehend but can communicate

depression
memory problems
behavioral problems
 - increased emotional response
 - may overestimate own abilities
 - slow rx times
 - hesitant and cautious
 - may be apathetic, confused, disoriented

Question 13

transient ischemic attack (TIA)

Answer 13

acute, focal cerebral insufficiency lasting < 24 hr
usually < 60 minutes
no residual effects

Question 14

TIA

Answer 14

males have them more than females
increases risk for stroke
- highest risk within 1 month of TIA

Question 15

TIA presentation (dependent on vessel)

Answer 15

carotid area

• weakness, heaviness in contralateral arm, leg, or face
• numbness
• dysphagia
• ipsilateral monocular visual loss

vertebrobasilar area

• dim or blurry vision
• vertigo
• dysphasia
• ataxia (uncoordinated)
• motor or sensory changes
  
  • ipsilateral face
  • contralateral body