63 Clinical: Stroke

Question 1

Stroke

• How often is this a cause of death in the US?

Answer 1

Question 2

Stroke

• What is TIA?
• What is the difference between embolic and thrombotic stroke?
• Differentiate between ischemic, hemorrhagic and hypoxic stroke/

Answer 2

Stroke

• What is TIA?
  
  • A Transient Ischemic Attack (TIA) is often called a mini-stroke, but it’s really a major warning. TIA is a temporary blockage of blood flow to the brain. Since it doesn’t cause permanent damage, it’s often ignored. But this is a big mistake. TIAs may signal a full-blown stroke ahead.
• What is the difference between embolic and thrombotic stroke?
• Differentiate between ischemic, hemorrhagic and hypoxic stroke/

Question 3

Ischemic Stroke

1. What amino acid is released upon material occlusion?
2. What does the above answer do to cells?

Answer 3

Question 4

Ischemic Stroke

• What are the common causes of this? (5)
• What are the uncommon causes of this? (6)

Answer 4

Question 5

Ischemic Stroke

• What are the 6 most common risk factors for this?

Answer 5

Question 6

Ischemic Stroke

• For thrombotic strokes from this category:
  
  • How do these present?
  • When do they occur?
  • What is the major cause?

Answer 6

Question 7

Ischemic Stroke

• For embolic strokes from this category:
  
  • How do these present?
  • When do they occur?
  • What is the major cause?

Answer 7

Question 8

Ischemic Stroke

• For lacunar strokes from this category:
  
  • How do these present?
  • When do they occur?
  • What is the major cause?

Answer 8

Question 9

Hemorrhagic Stroke

• For intracerebral hemorrhages from this category:
  
  • How do these present?
  • When do they occur?
  • What is the major cause?

Answer 9

Question 10

Hemorrhagic Stroke

• For subarachnoid hemorrhagic strokes from this category:
  
  • How do these present?
  • When do they occur?
  • What is the major cause?

Answer 10

Question 11

Hypoxic Stroke

• For anoxia strokes from this category:
  
  • How do these present?
  • When do they occur?
  • What is the major cause?

Answer 11

Question 13

Diagnosis of Strokes

• What arteries are associated with anterior circulation? (3)
  
  • What are the 4 most common signs/symptoms associated with this?
• What arteries are associated with posterior circulation? (8)
  
  • What are the 2 most common signs/symptoms associated with this?

Answer 13

Question 14

Diagnosis of Strokes

• What artery supplies each colored area?

Answer 14

Question 15

Watershed infarcts

1. What is a watershed Zone?
2. What can cause these, and what arteries are implicated?
3. Anterior Water Shed Infarcts
   
   • What arteries are these between?
   • What 3 signs/symptoms usually occur?
4. Posterior Water Shed Infarcts
   
   • What arteries are these between?
   • What 2 signs/symptoms usually occur?

Answer 15

Question 16

Clinical Dx Of Stroke

• Clinical Finding
  
  • Contralateral Leg Weakness
    
    • What circulation is implicated?
    • What artery is implicated?

Answer 16

Question 17

Clinical Dx Of Stroke

• Clinical Finding
  
  • Contralateral face arm> leg weakness with sensory loss, visual field loss, apraxia/aphasia
    
    • What circulation is implicated?
    • What artery is implicated?
      
      • How would the above answer change if the patient had neglect instead of apraxia/aphasia?
    • What is important to know about these findings?

Answer 17

Question 18

Clinical Dx Of Stroke

• Clinical Finding
  
  • Contralateral motor or sensory deficits WITHOUT cortical signs?
    
    • What circulation is implicated?
    • What artery is implicated?
    • What else is important to know about this presentation?

Answer 18

Question 19

Clinical Dx Of Stroke

• Clinical Finding
  
  • Contralateral Visual Field Loss
    
    • What circulation is implicated?
    • What artery is implicated?
    • What else is important to know about this stroke?

Answer 19

Question 20

Clinical Dx Of Stroke

• Clinical Finding
  
  • Dysphagia, Dysarthria, tongue/palate deviation, and/or ataxia with crossed sensory-motor deficits (ipsilateral face with contralateral body?
    
    • What circulation is implicated?
    • What artery is implicated?
    • What else is important to know about this stroke?

Answer 20

Question 21

Midbrain Strokes

• What syndrome is shown?

Answer 21

Weber

Question 22

Midbrain Strokes

• Weber Syndrome
  
  • What 3 fibers are affected?

Answer 22

Question 23

Midbrain Strokes

• Weber Syndrome
  
  • What deficits are seen when these fibers are damaged?

Answer 23

Question 24

Midbrain Strokes

• What syndrome is shown?

Answer 24

Claude

Question 25

Midbrain Strokes * Claude Syndrome * What 2 structures are affected?

Answer 25

Question 26

Midbrain Strokes * Claude Syndrome * What deficits occur when these structures are damaged?

Answer 26

Question 27

Midbrain Strokes * What syndrome is shown? * What is it a combination of?

Answer 27

Benedikt Benedikt = Claude + Weber

Question 28

Pons Strokes * What syndrome is shown to be more posterior? * What syndrome is shown to be more lateral?

Answer 28

Question 29

Pons Strokes * What structures are affected by Raymond syndrome? (6) * What structures are affected by Gubler syndrome? (2)

Answer 29

Question 30

Pons Strokes * What are deficits appear when the indicated structures are damaged?

Answer 30

Question 31

Medulla Strokes * What syndrome is shown to be more posterior? * What syndrome is shown to be more lateral?

Answer 31

Question 32

Medulla Strokes * What structures are affected by Dejerine syndrome? (3) * What structures are affected by Wallenberg syndrome? (4)

Answer 32

Question 33

Medulla Strokes * What are deficits appear when the indicated structures are damaged?

Answer 33

Question 34

Acute Treatment and Work Up * What 4 tests/labs do you need to do if you suspect a stroke?

Answer 34

Question 35

Acute Tx for Stroke * What is the main goal of treatment? * What 3 things can accomplish this?

Answer 35

Question 36

Algorithm for stroke and TIA * If you suspect a stroke/TIA, what labs do you run before getting brain imaging? * What is more common, Ischemic stroke/TIA OR Hemorrhages? * What do you consider doing for Ischemic stroke/TIA? * What do you consider doing for Hemorrhages?

Answer 36

Question 37

Algorithm for stroke and TIA * Ischemic stroke/TIA * What are the 3 main causes of this? * Hemorrhages * ​​What are the 3 main causes of this?

Answer 37

Question 38

Algorithm for Stroke and TIA * What treatments are considered for all 6 of the causes? * What do all potential treatments follow up with?

Answer 38

Question 39

Treatment/Work Up * Imaging * What 3 types of imaging are conducted? * Blood Work * What 5 types of test are conducted? * What 2 other tests can you conduct?

Answer 39

Question 40

Stroke Prevention * What 6 things can be done to decrease the risk for stroke?

Answer 40

Question 41

Stroke Prevention * What are the categories of the CHADS-VASc evaluation? * What heart condition do the patients have?

Answer 41

Question 42

Stroke Prevention * When a patient has nonvalvular A-FIB, what is recommended when: * The patient has a CHAD score of 0 * The patient has a CHAD score of 1 * The patient has a CHAD score of 2 or greater

Answer 42

Question 43

Stroke Prevention * Give the recommended TX for the following conditions: * A-FIB * Patent Foramen Ovale * Patent Foramen Ovale + DVT/Hypercoag State * Mechanical Heart Valve * Infective Endocarditis

Answer 43

Question 44

Stroke Prevention * If a patient has carotid atherosclerosis, what 2 things can be done?

Answer 44