Cerebrovascular Accidents

Question 1

obstruction within an intracranial blood vessel

Answer 1

ischemic stroke

Question 2

ruptured intracranial blood vessel

Answer 2

hemorrhagic stroke

Question 3

what is the most common type of stroke?

Answer 3

ischemic

Question 4

temporary obstruction within an intracranial blood vessel

Answer 4

transient ischemic attack (TIA)

Question 5

where does an embolic stroke usually come from?

Answer 5

the heart

Question 6

what causes an thrombotic stroke?

Answer 6

atherosclerosis

Question 7

what are the 3 causes of an ischemic stroke?

Answer 7

thrombus
embolus
systemic hypo-perfusion

Question 8

what can be used to determine the need for anticoagulation vs antiplatelet therapy?

Answer 8

CHADS

Question 9

what would we do for a patient with a CHADS score 2 or more? (2)

Answer 9

oral anticoagulant
(-aban)

Question 10

what is the most common location of an ischemic stroke in the anterior cerebral circulation?

Answer 10

middle cerebral artery

Question 11

in anterior circulation, which artery does a stroke come from?

Answer 11

internal carotid

Question 12

in posterior circulation, which artery does a stroke come from?

Answer 12

vertebral-basilar artery

Question 13

what is the treatment for carotid stenosis in ischemic stroke?

Answer 13

endarterectomy

Question 14

a patient presents with aphasia, amaurosis fugax, hemiparesis and contralateral weakness. what are they experiencing?

Answer 14

anterior stroke

Question 15

a patient presents with diplopia, bilateral vision loss, ataxia, loss of consciousness, and vomiting. what are they experiencing?

Answer 15

posterior stroke

Question 16

what is the most important thing to know in history of a patient with a stroke?

Answer 16

last known well

Question 17

what are 3 important parts of the physical exam in a patient with possible stroke?

Answer 17

cardiopulmonary exam
funduscopic exam (papilledema)
neuro exam

Question 18

what are the 3 exam findings for the diagnosis of acute stroke by NIHSS?

Answer 18

facial paresis
arm drift/weakness
abnormal speech

Question 19

why is the NIHSS score important?

Answer 19

correlates to stroke outcome

Question 20

what are 4 urgent tests to do for a patient with stroke?

Answer 20

head CT without contrast
brain MRI
finger stick BG
oxygen sat

Question 21

what are 4 other tests that can be run for a patient with stroke?

Answer 21

ECG
CBC + platelets
troponin
PT/PTT/INR

Question 22

what is the treatment of choice for an ischemic stroke? what are the 3 indications?

Answer 22

TPA

last known well less than 3 hrs ago
no blood on CT head
disabling deficit

Question 23

what are 4 exclusion criteria in which TPA cannot be used 3-4.5 hours after the last known well?

Answer 23

over 80 yo
hx of prior stroke
hx of diabetes
any anticoagulant use before admission

Question 24

when can intra arterial TPA be used for ischemic stroke?

Answer 24

up to 6 hours after last known well

Question 25

when can mechanical thromectomy be used for ischemic stroke?

Answer 25

up to 8 hours after last known well

Question 26

what is the antiplatelet regimen for an ischemic stroke? (3)

Answer 26

aspirin
clopidogrel (plavix)
aggrenox

Question 27

in ischemic stroke, what anticoagulation can be used if the patient has atrial fibrillation? (4)

Answer 27

warfarin
pradaxa
xarelto
eliquis

Question 28

what is the management for a hemorrhagic stroke?

Answer 28

determine cause
maintain normal BP
stop troublesome meds
manage ICP

Question 29

when should surgical intervention occur for a hemorrhagic stroke?

Answer 29

within 48-72 hours

Question 30

how can coagulopathy be corrected in hemorrhagic stroke if a patient is on warfarin?

Answer 30

2 units FFP + IV vitamin K

Question 31

how can coagulopathy be corrected in hemorrhagic stroke if a patient is on heparin or LMWH?

Answer 31

protamine sulfate