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CMED 311 > WEEK 2: STROKE [Salonga] > Flashcards

WEEK 2: STROKE [Salonga] Flashcards

1
Q

Stroke is
uncommon in people under 40 years; when it does occur, the
main cause is

A

High BP

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2
Q

Strokes are broadly categorized as

A

ischemic and hemorrhagic

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3
Q

Difference between ischemia and infarction?

A

Ischemia – reduction of blood flow for few seconds

Infarction – cessation of blood flow for a minutes

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4
Q

Neurologic sx resolve within 24hrs, No evidence of

brain infarct via imaging

A

TIA

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5
Q

Generalized ↓ cerebral blood flow d/t systemic

hypotension

A

syncope

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6
Q

widespread decrease in cerebral
blood flow that persists for longer duration + sx of brain
infarction

A

Global hypoxia-ischemia

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7
Q

ischemia/infarction of a small
area of the brain; usually caused by thrombosis (cerebral
vessels) or emboli (distant vessels)

A

infarction / focal ischemia

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8
Q

3 direct effects of hemorrhagic stroke that cause neuro sx?

A

Increased ICP
▪ mass effect on neural structures
▪ toxic effects of blood itself

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9
Q

supplies the medial surface of the frontal and parietal lobes and the corpus callosum.

A

ACA

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10
Q

supplies the Choroid plexus of the temporal horn of the lateral ventricle, hippocampus, amygdala, optic tract, lateral geniculate body, globus pallidus, and part of the posterior limb of the internal capsule

A

Anterior choroidal artery

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11
Q

Connects MCA to PCA

A

PCoA

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12
Q

supplies the:
o Lateral convexity of the cerebral hemisphere and insula.
o Trunk, arm, and face areas of the motor and sensory cortices
o Broca’s and Wernicke’s speech areas.

A

MCA

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13
Q

Lenticulostriate arteries are clinically relevant for what type of stroke?

A

Lacunar Stroke

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14
Q

what are the subdivisions of MCA?

A

M1 - horizontal segment
M2 - Sylvian segment
M3 - cortical segment

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15
Q

Supplies anterior 2/3 of the spinal cord

A

Anterior spinal artery

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16
Q

Formed by the confluence of the paired Vertebral arteries

A

Basilar artery

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17
Q

what arises from basilar artery? (4)

A

Pontine, AICA, SCA, PCA

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18
Q

supply corticospinal tracts and the intra-axial exiting fibers of the abducens nerve (CN VI).

A

pontine arteries

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19
Q

Supplies inferior surface of the cerebellum

A

AICA

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20
Q

supplies the superior surface of the cerebellum and the cerebellar nuclei.
o rostral and lateral pons, including the superior cerebellar peduncle and spinothalamic tract

A

Superior Cerebellar Artery

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21
Q

provides the major blood supply to the midbrain, occipital lobe, visual cortex

A

PCA

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22
Q

where does PICA arise?

A

PICA sa vertebral, pero AICA sa basilar

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23
Q

Supply of brainstem

A

pontine - from basilar

Ant Spinal Artery - Vertebral

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24
Q

Cerebrum, Cerebellum and Brainstem empty into

A

Dural venouis sinuses

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25
Q

Spinal cord venous drains in?

A

Internal and External Vertebral Plexuses

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26
Q

3 blood supply of the cerebellum?

A

SCA, AICA, PICA

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27
Q

receives most arachnoid granulations.

A

superior sagittal sinus

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28
Q

drains the superior surface of the cerebellum

A

straight sinus

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29
Q

due to occlusion of a cerebral blood vessel and causes cerebral infarction.

A

ischemic stroke

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30
Q

2 types of hemorrhagic strokes:

A

intracerebral hemorrhage

Subarachnoid hemorrhage

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31
Q

3 causes of cerebral infarction

A
  1. atherothrombotic cerebral infarction
  2. lacunar infarction
  3. cardiogenic cerebral embolism
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32
Q

etiology of ischemic stroke if large vessel, embolic

A
  1. The Heart
    o Valve diseases, A. Fib, Dilated cardiomyopathy, Myxoma
  2. Arterial Circulation (Artery to Artery Emboli)
    o Atherosclerosis of carotid, Arterial dissection, Vasculitis
  3. The Venous Circulation
    o PFO w/R to L shunt, Emboli
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33
Q

etiology of ischemic stroke if large vessel, thrombotic

A 
Virchow’s Triad
1. Blood vessel injury
o HTN, Atherosclerosis, Vasculitis
2. Stasis/turbulent blood flow
o Atherosclerosis, A. fib., Valve disorders
3. Hypercoagulable state
o Increased number of platelets
o Deficiency of anti-coagulation factors
o Presence of pro-coagulation factors
o Cancer
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34
Q

Risk factors for small vessels stroke

A 
HPN
– HLD
– DM
– Tobacco Use
– Sleep apnea
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35
Q

lacunes are how many cm?

A

<1.5 cm

36
Q

duration of transient neurologic symptoms

lasting less than 1 hour

A

TIA

37
Q

Transient reduction of blood flow to a region in brain in the
absence of evidence of infarction on brain imaging

A

TIA

38
Q

T or F? Significance of TIAs is increased risk of stroke after a TIA
specifically early on after a TIA

A

T

39
Q

what are 2 cortical signs on (R) Brain?

A

Right gaze preference

Neglect

40
Q

cortical left brain signs? (2)`

A

left gaze preference
aphasia

basta pag nasa cortex ang tingin ng mata nasa side ng lesion. pag infratentorial nasa opposite ng lesion

41
Q

gyrus of brocas?

A

Left posterior inferior

frontal gyrus

42
Q

gyrus of wernickes

A

Posterior part of the superior temporal gyrus

– Located on the dominant side

43
Q

Small Vessel:
– No cortical signs on exam

t or F?

A

T

44
Q

stroke syndrome that Rarely presents with an isolated symptom. Usually a combination of cranial nerve
abnormalities, and crossed motor/sensory
findings such as:

A

Brainstem stroke syndromes

45
Q

Causes of hemorrhagic stroke?

A

Htn, aneurysm, trauma, tumor, AVM

46
Q

“star shaped” lesion on CT

A

Sub arachnoid hemorrhage

47
Q

Sudden onset, severe
headache (worst headache
of your life)

A

Sub arachnoid hemorrhage

48
Q

From congenital aneurysms
of the Circle of Willis, less
commonly from AV
Malformations

A

Sub arachnoid hemorrhage

49
Q

Rupture of thin walled
lenticulostriate arteries,
commonly seen in
hypertensives

A

intracerebral hemorrhage

50
Q

typical sites of hypertensive ICH?

A

Basal Ganglia
– Cerebellum
– Pons

51
Q

`Vomiting is more common
in IntraCerebellar Hemorrhage, SAH or
Ischemic CVA?

A

Intracerebellar

52
Q 
Pin-point but
reactive pupils Abrupt onset of
coma
Decerebrate
posturing or
flaccidity
Ataxic breathing
pattern typical of?
A

Pontine hemorrhage

53
Q 
“Worst headache of my
life”
AMS
Photophobia
Nuchal rigidity
Seizures
Nausea and vomiting

typical of?

A

Subarachnoid hemorrhage

54
Q

meaning of FAST in stroke eval?

A

Facial Drooping, Arm Weakness, Speech Difficulty, Time to call 911

55
Q

give some diff dx to stroke?

A 
Space occupying lesion
(tumor, infection/
abscess, Epidural,
Subdural Hematomas)
• Subarachnoid
hemorrhage
• Seizures
• Hypoglycemia
• Migraine
• Syncope
• Labyrinthine disorders
56
Q

what are some initial eval or diagnostics you can do in a stroke?

A 
Cardiac monitoring, pulse-ox, ECG
§ Stat CT brain
§ c-xray
§ CBC, Platelet, PT, PTT
§ blood glucose, serum electrolytes
§ Cardiac markers, ABG’s
§ Blood alcohol level, Toxicology screen,
Pregnancy test( as necessary)
57
Q

remains
the gold standard as it is
superior for showing IVH
and ICH

A

non contrast CTH

58
Q

Superior for showing

underlying structural lesions

A

MRi

59
Q

primary objective in the management of stroke?

A

The primary objective is to restore adequate cerebral
perfusion to ensure adequate cerebral metabolism
and function:

1) Airway for adequate oxygenation
• 2) BP - maintain mean arterial pressure
• 3) Normal glucose level
• 4) Avoid hyperthermia

60
Q

Goal in BP mx of stroke patients?

A

The goal is to maintain cerebral perfusion!!

61
Q

formula of CPP?

A

CPP = MAP – ICP (needs to be at least 70)

62
Q

difference in BP Goals in Ischemic vs Hemorrhagic

A

Higher BP goals with Ischemic stroke MAP 110-130 mm Hg
– Lower BP goals with Hemorrhagic stroke (avoid hemorrhagic
expansion, especially in AVMs and aneurysms) < 160 mmHg
systolic

63
Q

T or F? Failure to recanalize (w/ or
w/o thrombolytic therapy)
results in high BP and poor
neuro outcomes

A

T

64
Q

T or F? Infarction size and edema increase with acute and chronic
hyperglycemia

A

t

65
Q

Hyperglycemia is an independent risk factor for hemorrhage when
stroke is treated with t-PA. T or F?

A

T

66
Q

Seizures are common after hemorrhagic CVAs. T or F?

A

t

67
Q

why is it important to treat fever in CVA?

A

because fever >24 hrs correlates with ventricular extension of the bleed

68
Q

window when to give the IV tPA

A

3 to 4.5 hrs

69
Q

Inclusion criteria for IV tPA?

A 
§ Ischemic Stroke clinically
§ Persistent neurologic deficit beyond an
isolated sensory deficit / ataxia
§ CT brain: No Blood
§ Initiation of Rx within 3 hours
70
Q

exclusion criteria IV tPA?

A 
Onset to treatment >3 hr
(NINDS)
§ Rapid improvement
§ Blood on CT
§ Oral anticoagulant &
PT>15 sec, INR>1.7
§ Heparin (last 48 hr) &
increased PTT
§ Platelet<100,000
§ SBP>185 or DBP>110
§ Aggressive treatment of
b.p.
§ Stroke or head trauma (3
months)
§ Major surgery (2 wks)
Prior ICH
§ GI tract/ Urinary bleed
(14 d)
§ Seizure at onset
§ Signs & Sx’s of SAH
§ Non-compressible site
of arterial puncture
(7d)
71
Q

if umabot ng 3 to 4.5 hrs, any exclusion criteria?>

A

Age >/= 80
Any use of anticoagulant regardless of the
PT/PTT
• NIHSS≥25
• Coexistent history of stroke and diabetes
mellitus

72
Q

Management Post Thrombolysis

A

Admit to ICU
§ BP monitoring (Q 15 m x2 h, Q 30 m x6 h, Q 1 h
x16 h)
§ Treat SBP≥185 and DBP≥110
§ No anticoagulants, no anti-platelet for 1st 24 hr
post t-PA
Worsening of neurologic state—CT brain
§ ICH—Neurosurgery consult
§ Possible surgical intervention
§ Preferably: no foley or NG for 2 hr > t-PA
(t1/2-t-PA = 8-12 min)

73
Q

What test?

Designed for acute stroke trials.
§ Quick (5-10 min) & reproducible.
§ Requires speech/language cards & safety pin.
§ Quantifies clinical stroke deficit:

A

NIH stroke scale

74
Q

what NIH stroke scale has inc risk for ICH

A

> 22

75
Q

what NIH Scale has poor prognosis if no treatment?

A

> 15

76
Q

NIH stroke scale that is mild stroke?

A

<4

77
Q

NIH score that will have will have an 80%

good or excellent outcome

A

12 to 14 and below

78
Q

NIH Score of what will have less
than a 20% good or excellent
outcome

A

20-26

79
Q

meaning of CADASIL?

A

Cerebral autosomal dominant arterof iopathy with subcortical

infarcts and leukoencephalopathy

80
Q

mutation on CADASIL?

A

NOTCH 3 gene mutation on Ch 19

81
Q

ICH total score?

A

6

82
Q

ICH components on exam?

A 
GCS
IVH
ICH Volume
Infratentorial origin of ICH
Age
83
Q

NIHSS grading?

A 
0 No stroke symptom
1 - 4 Mild
5 - 15 moderate
16 - 20 moderate to severe
21 - 42 severe stroke
84
Q

triad of increased ICP:

A

headache, papilledema, vomiting

85
Q

cushing’s triad

A

hypertension, bradypnea, bradycardia

CMED 311 (47 decks)

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