Carlson: Stroke Wrap-Up

Question 1

How many strokes occur per year in the US?

Answer 1

800,000

Question 2

Things that mimic a stroke?

Answer 2

migraine
seizure
hypo/hyperglycemia

Question 3

Recall the difference b/w a hemorrhagic and ischemic stroke

Answer 3

hemorrhagic: ruptured blood vessel
ischemic: occlusion and necrosis

Question 4

Two types of hemorrhagic bleeds

Answer 4

subarachnoid

intracerebral

Question 5

Two types of ischemic strokes

Answer 5

embolic

thrombotic (large vs small vessel)

Question 6

Explain your thought process working through stroke diagnosis

Answer 6

Is it a stroke?
Hemorrhagic or ischemic?
If ischemic, is it embolic or thrombotic?
If thrombotic, is it large or small vessel?

Question 7

Describe the course of an embolic stroke

Answer 7

embolic strokes will have the maximum neurologic deficit right away, and then will “get better” as collateral vessels “chime in,” emboli fragments and tPA released from capillary endothelial cells

Question 8

Describe the course of an intracranial hemorrhage

Answer 8

slow smooth progression of symptoms as the bleed expands

Question 9

What is the classical presentation of basilar artery thrombosis?

Answer 9

Acute onset of dysarthria and left face, arm and leg numbness;
develops stupor and a complete right gaze palsy;
w/i 12 hours, densely stuporous and quadriplegic

Question 10

What is this associated with?

Pt abruptly develops numbness and tingling of all 4 extremities; in addition, with flexing her neck or taking a hot shower she develops a “electrical pain” that travels down her back and into all 4 extremities

Answer 10

MS

Question 11

What is happening?

A 56-year-old Afro-American male with a history of poorly controlled hypertension abruptly develops “dizziness” and difficulty walking. When he presents to the ED later that day he is unable to sit or stand, consistently falling towards the left.Six hours after admission you are called to see him because he is unarousable and exhibits midposition, light-fixed pupils bilaterally.

Answer 11

hemorrhagic stroke leading to intracerebellar hematoma

• *signs of cerebellar lesion are ipsilateral to the stroke
• *this pt needs to be operated on immediately

Question 12

What is happening?

A 57-year-old retired marine colonel experiences 11 episodes of left eye amaurosis fugax over a 3 day period. While eating breakfast with his family he is suddenly unable to speak intelligibly and develops severe right body weakness. His deficits persist but improve over the next hour.

Answer 12

this pt probably has a clot which keeps breaking off small emboli; eventually, a big clot breaks off and occludes a larger vessel like the distal carotid

Question 13

What is happening?

A 46-year-old Afro-American female with hypertension and insulin dependent diabetes presents with acute dysarthria and left face, arm and leg numbness and weakness. Within hours she develops stupor and a complete right gaze palsy. Within 12 hours of admission she is densely stuporous and appears to be quadriplegic.

Answer 13

ischemic, thrombotic large vessel stroke

Question 14

What is happening?

A 41 year old female with no prior history of significant headache abruptly develops an “explosive” headache during orgasm. Two hours later in the ED, her exam is normal; she complains of neck stiffness, but her neck is described as “supple”. Three nights later she again develops an “explosive” headache during orgasm, and over the next 30 minutes her level of consciousness progressively decreases. In the ED 1 hour after headache onset, she is densely stuporous and exhibits intermittent spontaneous decerebrate posturing.

Answer 14

This patient has a congenital berry aneurysm, which sat there for years, and during exertion, she gets a sentinel bleed, which bleeds into subarachnoid space and causes the thunderclap headache