Ischemic stroke - simpson

Question 1

Definition of ischemic stroke

Answer 1

Fixed focal neurological deficit with evidence of acute infarction (that persists after the precipitating event, eg a neurologic deficit remains)

Question 2

Definition of TIA (Transient Ischemic Attack)

Answer 2

A brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction (ie no sequelae)

Question 3

Localize the stroke (which artery): Sudden leg paralysis or foot drop, without any associated pain that does not fit with a neurogenic pattern.

Answer 3

ACA

Question 4

Localize the stroke (which artery): vision problems

Answer 4

PCA

Question 5

Gerstmann’s syndrome?

Answer 5

Can’t WRITE, Can’t RIGHT, Can’t HANDle MATH

Agraphia (can’t write)
Right-left disorientation
Finger agnosia (can’t recognize fingers)
Acalculia (math)

Question 6

What differential diagnoses must be considered when stroke-like symptoms are seen?

Answer 6

Stroke, TIA, migraine, seizure, MS, Psychiatric, metabolic

Question 7

What are modifiable risk factors for stroke?

Answer 7

HTN!!!

Lipids, alcohol abuse, inactivity, diabetes, obesity, SMOKING

Question 8

What are causes of stroke in “young” patients?

Answer 8

Vasculopathies, FMD (Fibromuscular dysplasia), Moya-Moya, arterial dissection, hematologic causes (Protein C, S, sickle cell, Factor V leiden, antiphospholipid ab, oral contraceptives, malignancy) infectious endocarditis, substance abuse, congenital heart defects,

Question 9

What is important to know about FMD (Fibromuscular dysplasia)?

Answer 9

Women 30s/40s. Hypertrophy of the tunica media resulting in segmental occlusion or stenosis (seen as a “crunchy cheeto” on angiography). Classically involves the renal a, but carotid and vertebral commonly involved.

Question 10

What is important to know about moya-moya?

Answer 10

Means “puff of smoke” and causes occlusion of the MCA in young people. Arteriogram looks like a “puff of smoke.” Occlusion is due to intimal thickening.

Question 11

A young person suffers an carotid dissection while playing tennis. What might this look like on angiogram? What underlying conditions might you look for?

Answer 11

Might see a flame-shaped lesion (left) where the artery seems to stop. Classic for dissection.

Patients with other arterial vasculopathies (FMD, Marfan’s, Coarctation, intracranial aneurysms, etc.) have a higher incidence of spontaneous dissection supporting a structural defect in the arterial media as the primary cause

Question 12

A 32 y/o female presents with a history of thrombocytopenia, two miscarriages, and a large vessel thrombosis. What is your clinical suspicion?

Answer 12

antiphospholipid antibodies

Question 13

What is the first line treatment in stroke prevention?

Answer 13

Aspirin 81mg/day

Question 14

What is the second line treatment in stroke prevention?

Answer 14

Clopidogrel ($$)

**NOt sure about primary vs. secondary prevention.

Question 15

What patients are considered for carotid endarterectomy?

Answer 15

Perform for people who have a SYMPTOMATIC stroke (70-99% in the notes…but she said don’t do it if no symptoms). Don’t generally treat asymptomatic patients

Question 16

I think I’m having a stroke! Should I take tPA?

Answer 16

No. to difficult to differentiate hemorrhagic from ischemic. Must wait until ED.

Question 17

What is the most important treatment for emergent ischemic stroke? What is the timeline for administration?

Answer 17

tPA!!! ASAP until 4.5 hours.