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Recapping > Stroking > Flashcards

Stroking Flashcards

1
Q 
Stroke Demo
age
race
sex
comorbid conditions
A

old
AA
male
HTN, Smoking, DM, CAD/CHF, Afib, carotid stenosis

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2
Q

Embolic stroke

A

clot dislodges, sudden onset (usually afib) usually at MCA

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3
Q

Thrombotic stroke

A

systemic vascular dz
gradual onset, narrowing
most common ischemic
wake up with symptoms

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4
Q

Lacunar stroke

A

small vessels- putamen, thalamus (pure sensory stroke) internal capsule (pure motor stroke)
associated with HTN

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5
Q

Hemorrahagic

A

burst vessel HTN or berry aneurysm

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6
Q

Subarachnoid hemorrhage
common cause
common location
description

A

deep hemorrhage
berry aneurysm
AComm (ant communicating), 2nd PComm (CN3 compression, parasympathetic blown pupil before motor changes)
“worst headache of my life”

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7
Q

Hunt and Hess Scale

A

for SAH

  1. nl
  2. HA + stiff neck
  3. HA + stiff neck + confusion
  4. drunk / hemiparesis
  5. coma
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8
Q

Intracranial hemorrhage ICH

A

HTN => vessel burst
sudden onset at rest n/v/ seizures
usually at putamen
contralateral hemiplegia

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9
Q

Acute stroke management

A 
ABCs
CTH w/o contrast (r/o hemorrhagic)
ASA 325mg
BP control
if seizure IV lorazepam or phenytoin/ fosphenytoin 
Keel ICP <20mmg Hg
CPP > 60mmHg
CCP = MAP-ICP
hypervent, IV mannitol, elecate HOB, hypthermia, Burr hole
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10
Q

BP control
Ischemic
Hemorrhagic

A

SBP<220

SBP>180

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11
Q

When tPA?

criteria

A 
<3hrs 
adult
neg CTH
SBP<185
plt >100k
Stroke <1/3 MCA
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12
Q

Acute stroke special consideration for SAH/ICH

A 
Reduce strain
keep SBP<180
Stool softener
ICP <20
Nimodipine x21 days (decrease intracranial vasospasms due to blood irritation)
clip/coil aneurysm   or remove AVM
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13
Q

Imaging studies for stroke.
Initial?
Work up?
last resort?

A

CTH w/o contrast
MRI/MRA T2 (H2O- white)
TTE/TEE, carotid a. US
Lumbar - xanthochromia

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14
Q 
Chronic stroke management  2ndary prevention AC and AP
cardiac embolism
thrombotic
thrombotic from carotid
carotid >70%
A

Afib: Warfarin INR 2-3 or riveroxaban, apixaban, dabigatran.
Thrombotic stroke: ASA 81mg
Thromboembolism from carotid stenosis ASA and dipyridamole
Carotid stenosis>70% and symptomatic: carotid enarterectomy CEA

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15
Q

Territories

anterior cerebral artery (ACA)

A

frontal= executive function, personality
LEs (distal> proximal)
bowel and bladder incontinence

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16
Q

Territories

meddle cerebral artery (MCA)

A

Face and UEs
L MCA = parietal dominant language
R MCA = parietal spatial perceptions (L hemi neglect with intact language)
Superior MCA = Broca’s- expressive aphasia and UE weakness
Inferior MCA= Wernicke’s- receptive aphasia or hemineglect
usually due to cardiac emboli- afib

17
Q

Territories

posterior cerebral artery (PCA)

A

occiput: visual cortices

cerebellar

18
Q

CSF flow

A

choroid plexus (lat ventricle) - down foramen of menro to 3rd ventricle- down cerebral aqueduct to 4th ventricle- divides to lateral foramen Luschka or medial foramen Magendie- down spinal cord, loops back up

19
Q

Rule of 4 for brain stem

A
  • 4 CN nuclei per structure: Midbrain, Pons, Medulla
  • 4 Ms medial
    1. Motor (corticospinal tract)
    2. medial lemniscus (touch, vibration, proprioception)
    3. Medial longitudinal fasciculus (MLF)- common in MS pt
    4. Motor CN 3, 4, 6, 12
  • 4 S= Side (lateral)
    1. Spinothalamic tract (pain and temp) contralateral loss in body
    2. Spinocerebellar: ipsilateral cerebellar ataxia
    3. sensory nucleus of CN 5 (loss of pain and temp in face ipsi)
    4. Sympathetic pathway (ipsi Horner’s syndrome)
20
Q

3 components of aphasia

A

fluency, comprehension, repeating

21
Q

Broca- expressive aphasia
location
definition

A

L inf frontal gyrus

nonfluent, comprehends, cannot repeat

22
Q

transcortical motor aphsia

A

nonfluent, comprehend an repeat

broca’s but you can repeat

23
Q

Wernicke aphasia

A

word salad

fluent, no comprehension, cannot repeat

24
Q

Transcortical sensory

A

fluent, no comprehension, can repeat

25
Q

conduction aphasia

A

Damage to arcuate faciculus

fluent, can comprehend, cannot repeat

26
Q

anomia

A

cannot repeat

27
Q

Anton syndrome

A

PCA lesion

b/l visual cortex stroke/ blindness and denial of blindness

28
Q 
lacunar stroke
post limb of internal capsule/ corona radiata
thalamus
basal ganglia
pontine
A

pure stroke (motor or sensory)
corona radiata= contralateral hemiplesia (pure motor)
thal= contralateral numbness (pure sensory) w/ neuropathic pain hard to tx
basal ganglia- contralateral hemiballismus (subthalamic nucleus) or contralateral hemichoria (caudate nucleus)
pontine: contralateral dysarthia/ clumsy hand syndrome

29
Q

Brainstem stroke does not have…

A

no aphasia
no cog deficit
no personally d/o

30
Q

Wallenberg syndrome

A

1.10

Recapping (4 decks)

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