CC - Early recognition of Stroke

Question 1

What are the non-modifiable risk factors for stroke?

Answer 1

Age, sex, race/ethnicity, family history

Question 2

What are the modifiable risk factors for stroke?

Answer 2

Hypertension, diabetes, smoking, hyperlipidemia, carotid stenosis, atrial fibrillation

Question 3

What are the Symptoms of a Stroke?

Answer 3

1) Sudden numbness or weakness of face, arm, or leg, especially on one side of the body. 2) Sudden confusion or trouble speaking or understanding speech. 3) Sudden trouble seeing in one or both eyes. 4) Sudden trouble walking, dizziness, or loss of balanc

Question 4

What are the stroke subtypes?

Answer 4

1) ischemic stroke; small vessel thrombosis, large vessel thrombosis, embolic stroke 2) hemorrhagic stroke; intracerebral hemorrhage, subarachnoid hemorrhage

Question 5

What are the stroke mimics?

Answer 5

1) hypoglycemia 2) mass lesions 3) seizures and postictal states 4) migrane 5) psychogenic hemiparesis

Question 6

What are the common presentations of stroke?

Answer 6

1) left middle cerebral artery 2) right middle cerebral artery 3) posterior cerebral artery 4) basilar artery 5) lacunar syndromes

Question 7

What are the common stroke presentations for left middle cerebral arteries?

Answer 7

1) right hemiparesis 2) aphasia 3) anterior and posterior divisions

Question 8

What is involved in the right hemiparesis from the left middle cerebral artery?

Answer 8

Face=Hand>Arm>Leg

Question 9

What is involved in the aphasia from the left middle cerebral artery?

Answer 9

Often mistaken as confusion; expressive and receptive aphasia

Question 10

Expressive aphasia

Answer 10

difficulty producing language or no language output

Question 11

Receptive aphasia

Answer 11

poor comprehension and / or incomprehensible speech

Question 12

Stroke of the anterior division of the left middle cerebral artery

Answer 12

left head and eye deviation

Question 13

Stroke of the posterior division of the left middle cerebral artery

Answer 13

visual field deficit, aphasia

Question 14

What are the common stroke presentations for right middle cerebral arteries?

Answer 14

1) left hemiparesis 2) neglect 3) anterior and posterior division problems

Question 15

Left hemiparesis in right middle cerebral artery stroke

Answer 15

face = hand >arm>leg

Question 16

What is neglect in right middle cerebral artery stroke

Answer 16

doesn’t acknowledge left visual space or denies their own body parts

Question 17

Anterior division for right middle cerebral artery stroke

Answer 17

Right head and eye deviation

Question 18

Posterior division for right middle cerebral artery stroke

Answer 18

Visual field deficit, neglect

Question 19

What are the stroke common presentations for the Posterior Cerebral Artery?

Answer 19

1) Visual field deficit or cortical blindness if bilateral 2) May have Hemihypaesthesia: Complete loss of sensation of the contralateral face, arm, trunk and leg

Question 20

What are the stroke common presentations for basilar artery?

Answer 20

(brainstem strokes) 1) Altered Consciousness or Coma. 2) Often bilateral signs. 3) Cranial Nerve signs and “crossed” signs.

Question 21

For basilar artery stroke what is an example for cranial nerve signs and crossed signs?

Answer 21

1) Right facial weakness and left arm and leg weakness. 2) Loss of pin sensation on left face and right arm and leg. 3) Oculomotor palsy, nystagmus, palate or tongue weakness.

Question 22

Lacunar Syndromes:

Answer 22

1) Pure Motor Hemiplegia: Internal Capsule (Face=Arm=Leg) 2) Pure Sensory Hypaesthesia: Thalamus (Face=Arm=Leg) 3) Dysarthria Clumsy Hand Syndrome: Pons 4) Ataxic Hemiparesis

Question 23

Lacunar Syndromes - Pure Motor Hemiplegia

Answer 23

Internal Capsule (Face=Arm=Leg)

Question 24

Lacunar syndromes - Pure Sensory Hypaesthesia

Answer 24

Thalamus (Face=Arm=Leg)

Question 25

Lacunar syndromes - Dysarthria Clumsy Hand Syndrome

Answer 25

Pons

Question 26

Aphasia usually corresponds to what?

Answer 26

left hemispheric stroke (right sided weakness)

Question 27

Neglect (hemi‐inattention) usually indicates what?

Answer 27

Right hemispheric stroke

Question 28

Do patients usually look toward or away the lesion?

Answer 28

Towards the lesion (frontal eye fields)

Question 29

Crossed signs indicate what?

Answer 29

brainstem involvement

Question 30

Vertigo of central origin almost always is associated with what?

Answer 30

other cranial nerve deficits

Question 31

Vertical nystagmus is what?

Answer 31

brainstem ischemia until proven otherwise

Question 32

What are the early CT changes of a stroke?

Answer 32

1) early infarct signs 2) hypodensity of grey or white matter 3) obliteration of cortical sulci 4) obscured basal ganglia 5) loss of insular ribbon

Question 33

What are the inclusion criteria for thrombolytic therapy?

Answer 33

1) acute ischemic stroke (not mimic) 2) Age< 3 hours 4) CT normal or indicates early focal infarction 5) NIHSS < 24 6) absence of exclusionary criteria 7) informed consent (patient and/or family)

Question 34

What are the Thrombolytic Therapy Exclusion criteria?

Answer 34

1) CT signs of Homorrhage or Very Large Infarction 2) Undetermined Time of Onset 3) Uncontrollable Hypertension or Blood Sugar 4) Recent Trauma, Major Surgery or Bleeding 5) Abnormal Coagulation Profile 6) Rapidly Resolving Deficit 7) Hemodynamic Compromi

Question 35

What are the Benefits of thrombolytic therapy?

Answer 35

1) Treatment group had 30% more patients rated as good outcome at 3 months 2) Risks: Intracerebral Hemorrhage 3) placebo 1% (other bleeding) vs. treatment 6% (50% fatal)

Question 36

Primary and Secondary Prevention.

Answer 36

1) Control of modifiable risk factors: HTN, DM, CAD, Obesity 2) Antihypertensive, cholesterol lowering medications 3) Antiplatelet medication 4) Anticoagulants 5) Carotid Endarterectomy