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Neurology > Ischemic Stroke > Flashcards

Ischemic Stroke Flashcards

1
Q

What happens after an occlusion on neurological level?

A

lack of O2 and glucose
failure of energy production
distruction of cell components
cell death

some processes are reversible
central ischemic area and hyperemic margins

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2
Q

What is the first line imagistic investigation after a stroke?
What is the benefit of it?

A

Noncontrast CT: differentiates hemorrhagic from ischemic stroke

is good for detection of:
intracerebral hemorrhage
subarachnoidan hemorrhage
subdural hematomas

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3
Q

Which are the early signs of ischemic stroke seen on a head CT?

A

Loss of gray and white matter differentation
darkening of lentiform nucleus
sulcal asymmetry
hyperdense MCA

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4
Q

Management in a transient ischemic attack

A

FAST: face (uneven?), arms (hanging down?), speech (slurred?), time
facial paresis, decrease force of one arm, dysarthria or aphasia are present in 2/3 of cases

ABC2D: Age, BP, clinical feat of TIA, duration (10-59m/>60m), DM

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5
Q

organs which are correlated with stroke

A

heart, big vessels, small vessels, blood

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6
Q

Risk factors for a stroke coming from the heart

A 
thrombus due to AFib
atrial myxoma
endocarditis and prosthetic valves
MI
PFO, intraatrial septal defect or aneurysm
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7
Q

Risk factors for a stroke coming from big vessels

A
  • atheromatosis:
    plaques: foam cells in tunica media, hyperplasia/hypertrophy of smooth muscle cells, collagen fibers, calcifications
    stenosis
    occlusion
  • dissection: mostly in carotid channel, cleavage between t. intima and t. media
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8
Q

Risk factors for a stroke coming from small vessels

A

results in lacunar infarcts (small dimensions): in basal ganglia, pons, subcortical white matter

  • HTN
  • DM
  • Vasculitis
  • CADASIL (ceberal autosom.-domin arteriopathy and subcortical infarction and leukoencephalopathy)
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9
Q

Clinicla signs of CADASIL

A
  • migraine with aura
  • seizures
  • ischemic stroke
  • dementia
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10
Q

How is stroke diagnosed?

A

anamnesis, clinical examination, CT

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11
Q

What are the first line investigations in patients with stroke?

A
  • BP, HR, respiratory rate, pulse, temperature
  • ECG
  • blood test: CBC, electrolytes, AST, ALT, crea, BUN, chol, LDL, HDL, CK, CK-MB, LDH
  • US
  • TEE/TTE
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12
Q

What are the second line investigations in patients with stroke?

A

are performed after postive diagnosis of ischemic stroke

  • 24h-ECG, 24h-BP
  • CT- and MR angiography
  • blood analysis: thrombophilia, vasculitis, infectious diseases
  • skin biopsy (CADASIL)
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13
Q

What vessel morphology can a CT-angiography visualize in a stroke patient?

A

on either extracranial and intracranial vessels:

stenosis, occulsion, aneurysm, arterio-venous malformations

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14
Q

Management of stroke patients. primary prevention

A
  • treat risk factors: HTN, DM, dyslipidemia

- change lifestyle: less food, less alcohol, more sport,no smoking

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15
Q

Management of acute stroke

A
  • admit to stroke unit
  • stabilize vital functions: intubation, O2, IV hydration and medication, correct glycemia and electrolytes
  • for cerebral edema: mannitol 20%, 125ml IV
  • aspirin 325mg/d

BP management:
in first 48h treatment only if >220/120mmHg
if risk of thrombolysis treat until 185/110mmHg
drugs: labetalol, enalapril

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16
Q

Management of stroke patients. secondary prevention

A
  • for HTN: ACE-inhibitors, indapamide
  • lifestyle changes
  • if cardioembolic stroke:
    oral anticoagulants: warfarin, direct thrombin inhibitors, activated factor X inhibitors
  • if other stroke:
    clodiprogel 75mg/d, aspirin 75mg/d, aspirin + dipimiradol
17
Q

Clinical aspect of imagistic studies between transient ischemic attacks and ischemic stroke

A

in TIA: transient symptoms lasting for less than 24h (usually less than 1h), no MRI lesions

in ischemic stroke: permanent occlusion, leading to cerebral infarction

18
Q

What are the criteria for thrombolysis in acute stroke patients?

A

time interval froms stroke to thrombolyis: 50mg/dl

paltelets: >100000/mmc

19
Q

indications for endarterectomy

A

stenosis of carotid artery of 70 - 99%

20
Q

secondary stroke prevention in patients with angioplasty with stent for symptomatic carotid stenosis >75%

A

revascularization via endarterectomy, angioplasty, stenting

Neurology (19 decks)

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