Acute CVA and TIA

Question 1

Acute stroke events are most often the result of which pathologic process?

• acute hemorrhage?
• acute embolic event?
• acute thrombotic event?

Answer 1

Thrombotic event followed by embolic event

Question 2

What is the major modifiable risk factor in prevention of strokes?

Answer 2

HTN, treat if > 140/90

Question 3

Who should be on aspirin for primary prevention of stroke? How would you figure this out?

Answer 3

40-74 years old with ASCVD score > 10%

Question 4

What feature of family history is concerning for increased risk of stroke?

Answer 4

Documented parental stroke by 65 yrs of age is associated with a 3 fold increase in stroke in offspring

Question 5

What is the peak age group for subarachnoid hemorrhage?

Answer 5

peak age 50

“worst headache of my life”

Question 6

What are the recommendations for initiation of TPA after stroke onset?

Answer 6

Recommended when

• CT shows no hemorrhage
• no hx of intracranial hemorrhage
• no seizure at onset of stroke
• BP < 185/110
• within correct time frame

Question 7

What is the BP threshold for administration of TPA?

Answer 7

<185/110

Question 8

What is the time limit for administration of TPA after onset of stroke?

Answer 8

• Age < 80 yo: onset of sx < 4.5 hours and INR < 1.7

- Age > 80 yo: onset of symptoms < 3 hrs and not on anticoagulants

Question 9

What are the BP treatment parameters after acute ISCHEMIC stroke?

• systolic
• diastolic
• goal of treatment

Answer 9

• systolic > 220
• diastolic > 120
• goal is to decrease BP by 15%

Question 10

What are the BP treatment parameters after acute HEMORRHAGIC stroke?

• systolic
• goal of treatment

Answer 10

• Treat if systolic BP 150-220

- lower BP to systolic < 140

Question 11

What are the BP treatment parameters after subarachnoid hemorrhage?

• systolic

Answer 11

• decrease systolic BP to < 160

Question 12

In management of acute stroke should you do the following?:

Give Aspirin

Answer 12

YES

Question 13

In management of acute stroke should you do the following?:

Give antipyretic if fevering

Answer 13

YES

Question 14

In management of acute stroke should you do the following?:

treat hyperglycemia
What is your threshold?

Answer 14

YES if > 180 mg/dL

Question 15

In management of acute stroke should you do the following?:

Assess swallow before feeding

Answer 15

YES

Question 16

What are BP goals in secondary prevention of ischemic stroke or TIA?

Answer 16

< 140/90 (class IIA)
? < 130 for lacunar CVA (class IIB)

Question 17

What are Statin goals in secondary prevention of ischemic stroke or TIA?

Answer 17

Add statins for LDL > 100

Question 18

Should antiplatelet agent be used for secondary prevention of ischemic stroke or TIA?

Answer 18

Yes

- aspirin or plavix

Question 19

Definition of TIA

Answer 19

A transient episode of neuro dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction

• ** no time limit
• ** tissues based definition

Question 20

After TIA, how do you figure out who needs hospitalization?

Answer 20

ABCD2 score:
Age > 60
BP > 140/90
Clinical features: focal weakness/speech impairment
Duration > 60 minutes
Diabetes

Question 21

When should you recommend endarterectomy in carotic artery disease?

Answer 21

indicated: symptomatic w/ 70-99% stenosis
consider: symptomatic with 50-70% stenosis