Stroke

Question 1

Storke definiton

Answer 1

brain ischemia, focal onset resulting in neurological deficit

Question 2

types of stroke

Answer 2

ischmia - occlusion due to emboli or thrombus

hemorrhagic - bleeding in brain or other CNS regiosn

Question 3

what is TIA

Answer 3

ischemic stroke present along a spectrum with TIA being the least sevre

TIA is an episode of neuronal deficit that lasts from minutea to hours. usually only lasts an hour

Question 4

types of hemorhagic storke

Answer 4

intracranial hemorrhage

sudural hemorhage

subarachnoid hemmorahe

Question 5

whats more common hemorrhagic or ischemic stroke?

Answer 5

hemorrhiga - 15 %

Ischmic - 85%

Question 6

what are non modifiable risk factors for stroke?

Answer 6

age (above 55)
sex (M)
ethnicity
family histoyr

Question 7

what are some modifiable risk factors for stroke

Answer 7

HTN
Dyslipidemia
A Fib
DM
Smoking
Cardiac disease
Lifestyle
Hormone replacement therapy

Question 8

how do we distinguish between thrombotic and embolic stroke?

Answer 8

• usualy can’t
• TIa preceded thrombotic 10% of time
• emboli present with max deficits

Question 9

what does loss of cerebral blood flow cause?

Answer 9

hypoperfusion- tissue hypoxia- cell death

Question 10

what do we know above hemohagic stokre?

Answer 10

• not much
• compression is main outcome

Question 11

risk factors for hemorhagic stroke?

Answer 11

• illicit drug use
• htn
• smoking
• ruptured aneurysm
• systmic bleeding (hemophilia, anticogaulants)

Question 12

why would we get ahemorrhig stroke after an ischmic one?? risk factors

Answer 12

due to tissue reperfusion

risk factors:
- HTN
- two or more antiplatentles
- signs on CT of edema or mass effect

Question 13

symtoms distinguish between ischmis or hemmorhagica

Answer 13

hemorrhagic
- the worst headache of life
- N, V
- LOC
- COMA
- Seizures

Question 14

how should we diagnose stroke?

Answer 14

• s and s are not enough for a dignosis
• neede CT or MRI
• A fib is sig risk factor
• patients with TIA or storke should get a 12 lead EKG in first 24 hours

Question 15

what is the clinical presentation of stroke

Answer 15

F
A
S
T

Question 16

what is the acute management of ischemic stroke?

Answer 16

• reperfusion therapy using thrombolytics and endovascular thrombectomy (EVT)
• antiplatelet therapy single or dual

Question 17

what kind of support is needed for ischmic strokes

Answer 17

• time is brian
• respiratoyr, cardiac
• neurological deficit/ imagining
  -Asses BP
• ECG to rule out cardiac causes
• swallowing assement

Question 18

reperfusion therpay - thrombolytic

Answer 18

• recommended for all that are not CI
• done with 4.5 hours of symptom onset
• door to needle time is less than 60 mins and a median of 30 minutes
• works by dissolving the clot
• agents: tPA and TNK

Question 19

exclusion for thromboltic

Answer 19

Absolute:
- active bleed
- BP above 180/105

Relative:
- hisotyr
- Symptoms of SAH, stroke,
- DOACS
- LAB abnormalities - hypo/hyperglycemia, elevated aPTT, INR, low platent count

Question 20

Adminstrtaion, adverse effects moniotring of thrombolytic

Answer 20

Admin
- 4.5h of symptoms
- door to needle <60 min
- can’t give another anticoagulant or antiplatelet for 24 hours

Dose
- TNK weight-dependent

Adverse effect
- hypo
- bleeding

Monitor:
- BP
- neurologic
- if severe headache, acute HTN, N and V, D/C drug!!!! and get CT

Question 21

Endovascualr thrombectomy

Answer 21

• with or without thormblytic
• 12-24 hours window
• mechanical revascularization

Question 22

Single antiplatelet therapy

Answer 22

• ASA / clopidogrel
• all patients should receive the only rule is if you have a thrombolytic don’t use an ASA till 24 hours after
• continued indefiitly
• rule out hemorrhage
• can use safely with LMWH/UH for DVT prophylaxis

Question 23

Dual antiplatelet therapy

Answer 23

-used only for high risk TIA, minor stroke (not mod/ severe stroke or those who get reperfusion therapy)

ASA plus clopdirgorl for 21 days

ASA plus ticagrelor for 30 days

Question 24

LMWH/UH storke?

Answer 24

• no benift may increase bleeding risk hemmorhage
• use an lowest dose possible for VTE prophylaxis

Question 25

TX for hemorhagiv storke

Answer 25

neurosirgical consutl - supportive care is our focus

Question 26

supportive care for hemorhage

Answer 26

• BP lower then 140
• ## hold anticoagulants and antiplaentes

Question 27

aptient with subsarchnoid hemoorhage

Answer 27

• delayed symptoms - 4-21 days of vasopasms, causing ischmia
• give nimodipine for 21 days

Question 28

prevention and managment of hemorhgic stoke

Answer 28

• htn
• cerebral edmea - CS harmful relive pressure
• DVT prphylaix
  UH/LMWH or ICP if drug CI

Question 29

seizures and stroke

Answer 29

• i in first 24 hour normal
• recurrent is cause for tx

Question 30

most important risk factor mangment for stroke

Answer 30

HTN