Flashcards in 13. Stroke Deck (34)
1
what are the 2 types of stroke?
ischemic, hemorrhagic
2
what are 5 warning signs of stroke?
-sudden confusion, trouble speaking or understanding
-sudden weakness of numbness of the care, arm, or leg esp on one side
-sudden trouble seeing in one or both eyes
-sudden trouble walking, dizziness, loss of balance or coordination
-sudden severe headaches without known cause
3
a few things that mimic stroke?
-seizures
-brain tumors
-migraine
-hysteria
-vestibulitis
-hypoglycemia
-hypertension/hypotension
-multiple sclerosis
4
heart attack v. stroke: level of pain?
heart: painful
stroke: no pain, often poor awareness
5
heart attack v. stroke: public awareness?
heart: public awareness of sx and need for action
stroke: poor recognition of sx and need for action
6
heart attack v. stroke: bleeding issues?
heart: bleeding into heart doesn't occur
strok: brain hemorrhage is common
7
heart attack v. stroke: diagnosis?
heart: diagnosis is easy with EKG and cardiac enzymes
stroke: no 'EKG' for the brain
8
heart attack v. stroke: cause?
heart: in-situ plaque rupture
stroke: causes are numerous
9
heart attack v. stroke: similarities
time is critical
3 hour time limit for tPA
10
heart attack and stroke: brought in by ambu vs private car?
ppl brought by ambu are treated faster
11
what is the best treatment we have for stroke?
risk factor control, preventing an event
12
warfarin v aspirin for stroke prevention?
warfarin have to treat only 13 ppl to prevent 1 stroke. aspirin have to treat 77 to prevent 1 stroke.
13
3 causes of hemorrhagic stroke that is subarachnoid?
-aneurysms
-trauma
-drugs
14
6 causes of hemorrhagic stroke that is intracerebral?
-small artery disease/HTN
-anticoagulants
-trauma
-bleeding disorder
-vascular malformations
-tumors
15
5 ways to prevent hemorrhagic stroke?
-prevent inappropriate anticoag
-control HTN
-control smoking
-prevent trauma
-prevent illicit drug use
16
What's a stroke?
A sudden neurological deficit caused by a blood vessel problem
17
what is the usual presentation of hypoglycemia?
mainly sleepiness - but can mimic a stroke
18
hemorrhage. v stroke on CT?
hemorrhage looks white, infarction looks darker grey
19
Perfusion MRI tells us what?
how much blood flow is actually reaching tissues despite flow occlusion. there may be anastomses, alternate flow.
20
what is the penumbra?
ischemic but still viable cerebral tissue. surrounds the ischemic center. where interventions are most likely to be effective.
21
causes of ischemic stroke?
Cardiomyopathies
Atrial fibrillation
Aortic atherosclerosis
Carotid artery atherosclerosis
Vertebral artery disease
Arterial dissection
Intracranial disease
Hypercoagulable states
Drugs
Cerebral venous thrombosis
22
treatments for stroke due to clot?
tPA, catheters to open up occlusion
23
what kind of metabolic derangements would be bad in the setting of a stroke?
hyperglycemia, hyperthermia, hypoxia, dehydration
24
what is the time window for tPA?
3 hrs
25
what is the time window for intra-arterial thrombolysis?
6 hrs
26
what is the time window for mechanical devices?
8 hrs
27
what is the best stroke prevention we have?
warfarin for afib
28
why is cerebellar hemorrhage so deadly?
obstruction of the 4th ventricle --> higher ICP, compression of the brainstem
29
Cocaine and AVM: what's the deal?
the AVM is congenital, but cocaine worsened the problem. hemorrhage.
30
what are some unique barriers to stroke care in this region?
-shortage of specialists
-low comfort level with stroke care, yet high level of ambivalence
-accuracy of dx is difficult in ambu or ED
-clinical/imaging information is not easily communicated
31
what recent act in VT aimed to close gaps in stroke care? what is the focus?
Act 61. Focused on ED phase of care
32
tx of ischemic stroke?
-carotid revascularization
-hemicraniectomy for massive hemispheric infarction (temporary removal of bone to relieve pressure)
-decompression for cerebellar infarction
33
tx of hemorrhagic stroke? both SAH and ICH
for SAH: clipping aneurysms
for ICH: rapid correction of coagulopathy, BP control, hematoma evacuation in select cases
34