Flashcards in Ch. 10 - Stroke Deck (69)
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1
Stroke definition
sudden neuro deficit 2/2 vascular etiology lasting > 24 hrs
2
TIA definition
transient neuro deficit lasting < 24 hrs
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Stroke types
ISCHEMIC (infarct) vs HEMORRHAGIC vs both
4
Primary stroke prevention
lifestyle modification and treatment of risk factors in pt without cerebrovascular sx
5
Stroke risk factors
smoking, HTN, diabetes, heart dz (a fib), hypercholesterolemia, age, males, smoking
6
most common cause of cardiogenic cerebral infarct
non-valvular atrial fibrillation
7
treatment of atrial fibrillation
warfarin with INR 2-3 for pts 60+, ASA adds moderate benefit
8
Secondary stroke prevention
tailored to underlying stroke pathology including antiplatelet therapy, warfarin, CEA, and stenting
9
ASA mechanism
irreversible inhibition of platelet cyclooxygenase (no thromboxane for plt aggregation)
10
clopidogrel mechanism
inhibits platelet ADP (receptor that activates plt aggregation)
- small ARR compared to ASA but more expensive = second line
- can combo with ASA
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dipyridamole mechanism
inhibits PDE, maintaines high levels of cAMP/cGMP to prevent platelet activation
- can combo with ASA
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CEA indications
beneficial for pts with > 70% stenosis
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TIA work up
CT, carotid doppler, ECG, +/- echo within 24 hrs
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amaurosis fugax sx
transient monocular blindness "shade pulled over one eye"
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MCA occlusion
contralateral hemiplegia (arm > leg), hemianesthesia, homonymous hemianopia, aphasia, inattention, cortical sensory loss
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ACA occlusion
hemiparesis (mostly leg)
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PCA occlusion
homonymous hemianopia, disconnecting syndromes, hemianesthesia, amnesia, midbrain/thalamic syndromes
18
vertebrobasilar thrombosis
quadriparesis, bulbar paralysis, impaired gaze, cortical blindness, coma
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ventral pontine infarct
quadriparesis, bulbar paralysis, absent horizontal gaze, normal consciousness, "locked in" syndrome
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lateral medullary syndrome
ipsilateral ataxia, horners syndrome, nystagmus, facial numbness, CN9/10 palsy, contralateral spinothalamic loss
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lacunar infarcts most likely secondary to
HTN causing 'lipohyalinosis'
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most common cause of cardiogenic embolism
non-valvular arterial fibrillation > valvular heart dz, MI, post cards surgery, prosthetic valves, endocartis, atrial myxoma
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Types of cerebral hemorrhage
intracerebral vs subarachnoid hemorrhage
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risk factor for intracerebral hemorrhage
HTN --> charcot-bouchard microaneurysms
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lobar hemorrhage
superficial vascular rupture w/i cerebral lobes
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risk factor for lobar hemorrhage
amyloid angiopathy
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Principles of stroke management
early recognition, rapid transport to tx facility "time is brain", early triage/imaging, assess for thrombolysis, monitoring in stroke unit
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ddx stroke
cerebral tumor, subdural hematoma, abscess, migraine, metabolic disturbances, epilepsy
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all patients with suspected stroke need a...
CT or MRI. MRI better at identifying acute ischemia and just as good at ID'ing hemorrhage
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