Stroke

Question 1

ischemic arterial stroke

Answer 1

severity depends on the number of collateral vessels that a patient has
additional collaterals can develop in response to ischemia

Question 2

penumbra

Answer 2

at risk tissue that is still perfusing but may be damaged

Question 3

transient ischemic attack

Answer 3

transient focal neurological deficits without stroke presentation on imaging

Question 4

ischemic stroke symptoms

Answer 4

sudden onset
focal deficits (negative symptoms)
follows vascular territory

Question 5

ischemic stroke risk factors

Answer 5

prior stroke
male
atrial fibrillation
hypertension

Question 6

ischemic stroke locations

Answer 6

MCA trunk: very large stroke
MCA inferior: can be confused with psychiatric condition
ACA: contralateral hemiplegia, urinary incontinence, grasp reflex
PCA: harder to diagnose, no weakness, mostly visual

Question 7

ischemic stroke management

Answer 7

rapid diagnosis
stabilization (ABCs)
thrombolysis or thrombectomy
stroke unit
possible decompressive surgery
investigate mechanism
secondary prevention
rehabilitation

Question 8

IV thrombolysis (rtPA)

Answer 8

indicated if stroke onset less than 4.5 hours and normal CT
doubles the odds of favorable outcomes at 3 months
in few cases: hemorrhagic transformation

Question 9

IV thrombolysis absolute contraindications

Answer 9

significant head trauma
active internal bleeding
high blood pressure
hypoglycemia
low platelets
anti-coagulation medication

Question 10

IV thrombolysis possible contraindications

Answer 10

pregnancy
less than 18 or more than 80 years old
major surgery in the last 14 days
recent stroke

Question 11

mechanical thrombectomy

Answer 11

complements IV rtPA
works best in proximal vessels
time dependent but can be done later if patients are slow progressors

Question 12

ischemia pathophysiology

Answer 12

depolarized external membrane
increased intracellular calcium

Question 13

Is the translation of stroke research from animals to humans successful?

Answer 13

most often no

Question 14

mechanism of ischemic arterial stroke

Answer 14

arteriopathy
embolic
hematological

Question 15

diagnostic test for establishing subtype of ischemic stroke

Answer 15

MRI
lipid screen
carotid duplex
ECG
MRI
CT

Question 16

secondary prevention of ischemic stroke

Answer 16

antithrombotic medication
surgical intervention
statins
antihypertensive medication

Question 17

symptoms of hemorrhagic stroke

Answer 17

very sudden onset
focal deficits
severe headache
nausea and vomiting
decreased consciousness

Question 18

mechanisms of hemorrhagic stroke

Answer 18

arteriopathy: hypertension, amyloid angiopathy, vascular malfunction
hematological: iatrogenic (caused by treatment of other conditions), congenital, acquired

Question 19

risk factors for intracerebral hemorrhage

Answer 19

age
male
hypertension
alcohol intake
stimulant drugs

Question 20

management of hemorrhagic stroke

Answer 20

stabilize ABCs
clinical diagnosis
surgery consideration
blood pressure control
correct coagulation
life-saving surgical evacuation
manage complications
investigate cause
secondary prevention

Question 21

subarachnoid hemorrhage

Answer 21

ruptured aneurysm

Question 22

symptoms of subarachnoid hemorrhage

Answer 22

very sudden headache
decreased level of consciousness
vomiting
neck stiffness
cardiac symptoms

Question 23

subarachnoid hemorrhage can be confused with:

Answer 23

migraine
influenza
arterial dissection
cardiac diseases
meningitis

Question 24

risk factors for subarachnoid hemorhage

Answer 24

woman
smoking
hypertension
family history

Question 25

management of subarachnoid hemorhage

Answer 25

stabilize ABCs
arterial imaging
coiling or clipping aneurysm
management of vasospasm: calcium channel blockers
management of hydrocephalus
management of hyponatremia