CEREBROVASCULAR ACCIDENTS AND HEMORRHAGES

Question 1

Fourth leading cause of death in the US

Answer 1

CVA

Question 2

Number one cause of adult disability in the US

Answer 2

CVA

Question 3

Death due to stroke occurs every

Answer 3

4 mins

Question 4

Most common type of CVA?

Answer 4

Ischemic

Question 5

One stroke every

Answer 5

40 secs

Question 6

Ruptured intracranial blood vessel

Answer 6

Hemorrhagic (20%)

Question 7

Where does a blood clot usually form from in Ischemic stroke?

Answer 7

heart

Question 8

What is a embolic

Answer 8

blood clot forms from somewhere else in the body and blocks an intracranial vessel

Question 9

What is thrombotic

Answer 9

blood clot forms on a blood vessel (atherosclerosis)

Question 10

What is used to determine need for anticoagulation vs. anti platelet

Answer 10

CHADS (risk factor)

Question 11

MOST COMMON place to have a stroke?

Answer 11

Middle cerebral artery

Question 12

Not a candidate for surgery

Answer 12

total occlusions

Question 13

How is carotid stenosis txt?

Answer 13

endarterectomy or stenting

Question 14

Clinical presentation for posterior circulation stroke?

Answer 14

diplopia, bilateral vision loss, vomiting

Question 15

Clinical presentation for anterior circulation stroke?

Answer 15

aphasia, amaurosis fugax, contralateral weakness

Question 16

FAST

Answer 16

Facial weakness
Arm weakness
Speech problems
Time to act

Question 17

1ST Thing to ask stroke pt

Answer 17

“Last Known Well”

Question 18

What is the 1ST urgent diagnosis of choice in stroke?

Answer 18

Noncontrast head CT

Question 19

Confirmatory tool in stroke?

Answer 19

MRI

Question 20

TXT for ischemic stroke?

Answer 20

Tissue Plasminogen Activator (tPA)

Question 21

What is the last known normal for tPA?

Answer 21

< 3hrs

Question 22

What 3 things extends the tPA window 3-4.5hrs?

Answer 22

age >80
Hx of prior stroke and diabetes
Any anticoagulant use prior to admit (INR<1.7)

Question 23

Intra Arterial tPA

Answer 23

up to 6 hours

Question 24

Mechanical Thrombectomy

Answer 24

up to 8 hours

Question 25

Hemicraniectomy

Answer 25

select population of large MCA strokes (remove brain tissue)

Question 26

Small aneruysms

Answer 26

<6mm

Question 27

Low risk

Answer 27

<6m

Question 28

Pt w/ ruptured aneurysm < ? have a better prognosis

Answer 28

<10mm

Question 29

How are small aneurysms identified?

Answer 29

screening

Question 30

How are cerebral aneurysms usually diagnosis

Answer 30

incidentally when working up other problems

Question 31

Diagnosis if fx of 2 FIRST DEGREE relatives

Answer 31

Screen w/ CTA head or MRI head starting 20s every 5-10yrs

Question 32

40% of those w/ 6-10mm have already ??

Answer 32

ruptured

Question 33

What 2 txt for aneurysms

Answer 33

Clipping | Coiling

Question 34

Mostly causes subarachnoid hemorrhage

Answer 34

ruptured aneurysm (80%)

Question 35

Mortality rate for subarachnoid hemorrhage

Answer 35

50% mortality

Question 36

THE MOST COMMON PRESENTATION OF SAH?

Answer 36

"Thunderclap" headache | worst headache of life

Question 37

What warning symptom comes 2 wks prior to discovery of SAH?

Answer 37

leaks, w/ minor loss of blood

Question 38

What is the imaging of choice for SAH?

Answer 38

CT Head w/o contrast

Question 39

Negative SAH, obtain ?

Answer 39

lumbar puncture

Question 40

To test for xanthochromia what should be done?

Answer 40

serial vials comparing first and last tubes

Question 41

When is LP negative in SAH workup?

Answer 41

<2hrs

Question 42

Subdural hematoma is due to a ....

Answer 42

ruptured vein

Question 43

What usually cause a subdural hematoma

Answer 43

head trauma

Question 44

What are two common symptoms of subdural hematoma?

Answer 44

headache | confusion

Question 45

Imaging of choice for subdural hematoma

Answer 45

CT head w/o contrast

Question 46

Txt for subdural hematoma

Answer 46

neurosurgery consult for management

Question 47

What is a subdural hemorrhage?

Answer 47

bleeding between the arachnoid mater and dura mater

Question 48

What is epidural hemorrhage?

Answer 48

bleeding between the dura mater and the skull

Question 49

Epidural hematoma is...

Answer 49

rare

Question 50

Where is epidural bleeding seen?

Answer 50

between skull and dura

Question 51

What is the most common ruptured artery in epidural hematoma?

Answer 51

middle meningeal artery

Question 52

Whom is epidural more common in?

Answer 52

< 20 yrs

Question 53

Whom is subdural more common in?

Answer 53

elderly