Cerebrovascular Accidents Flashcards

1
Q

obstruction within an intracranial blood vessel

A

ischemic stroke

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2
Q

ruptured intracranial blood vessel

A

hemorrhagic stroke

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3
Q

what is the most common type of stroke?

A

ischemic

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4
Q

temporary obstruction within an intracranial blood vessel

A

transient ischemic attack (TIA)

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5
Q

where does an embolic stroke usually come from?

A

the heart

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6
Q

what causes an thrombotic stroke?

A

atherosclerosis

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7
Q

what are the 3 causes of an ischemic stroke?

A

thrombus
embolus
systemic hypo-perfusion

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8
Q

what can be used to determine the need for anticoagulation vs antiplatelet therapy?

A

CHADS

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9
Q

what would we do for a patient with a CHADS score 2 or more? (2)

A

oral anticoagulant
(-aban)

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10
Q

what is the most common location of an ischemic stroke in the anterior cerebral circulation?

A

middle cerebral artery

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11
Q

in anterior circulation, which artery does a stroke come from?

A

internal carotid

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12
Q

in posterior circulation, which artery does a stroke come from?

A

vertebral-basilar artery

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13
Q

what is the treatment for carotid stenosis in ischemic stroke?

A

endarterectomy

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14
Q

a patient presents with aphasia, amaurosis fugax, hemiparesis and contralateral weakness. what are they experiencing?

A

anterior stroke

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15
Q

a patient presents with diplopia, bilateral vision loss, ataxia, loss of consciousness, and vomiting. what are they experiencing?

A

posterior stroke

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16
Q

what is the most important thing to know in history of a patient with a stroke?

A

last known well

17
Q

what are 3 important parts of the physical exam in a patient with possible stroke?

A

cardiopulmonary exam
funduscopic exam (papilledema)
neuro exam

18
Q

what are the 3 exam findings for the diagnosis of acute stroke by NIHSS?

A

facial paresis
arm drift/weakness
abnormal speech

19
Q

why is the NIHSS score important?

A

correlates to stroke outcome

20
Q

what are 4 urgent tests to do for a patient with stroke?

A

head CT without contrast
brain MRI
finger stick BG
oxygen sat

21
Q

what are 4 other tests that can be run for a patient with stroke?

A

ECG
CBC + platelets
troponin
PT/PTT/INR

22
Q

what is the treatment of choice for an ischemic stroke? what are the 3 indications?

A

TPA

last known well less than 3 hrs ago
no blood on CT head
disabling deficit

23
Q

what are 4 exclusion criteria in which TPA cannot be used 3-4.5 hours after the last known well?

A

over 80 yo
hx of prior stroke
hx of diabetes
any anticoagulant use before admission

24
Q

when can intra arterial TPA be used for ischemic stroke?

A

up to 6 hours after last known well

25
Q

when can mechanical thromectomy be used for ischemic stroke?

A

up to 8 hours after last known well

26
Q

what is the antiplatelet regimen for an ischemic stroke? (3)

A

aspirin
clopidogrel (plavix)
aggrenox

27
Q

in ischemic stroke, what anticoagulation can be used if the patient has atrial fibrillation? (4)

A

warfarin
pradaxa
xarelto
eliquis

28
Q

what is the management for a hemorrhagic stroke?

A

determine cause
maintain normal BP
stop troublesome meds
manage ICP

29
Q

when should surgical intervention occur for a hemorrhagic stroke?

A

within 48-72 hours

30
Q

how can coagulopathy be corrected in hemorrhagic stroke if a patient is on warfarin?

A

2 units FFP + IV vitamin K

31
Q

how can coagulopathy be corrected in hemorrhagic stroke if a patient is on heparin or LMWH?

A

protamine sulfate