Ch. 10 - Stroke Flashcards Preview

Neurosurgery > Ch. 10 - Stroke > Flashcards

Flashcards in Ch. 10 - Stroke Deck (69)
Loading flashcards...
1

Stroke definition

sudden neuro deficit 2/2 vascular etiology lasting > 24 hrs

2

TIA definition

transient neuro deficit lasting < 24 hrs

3

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

11

dipyridamole mechanism

inhibits PDE, maintaines high levels of cAMP/cGMP to prevent platelet activation
- can combo with ASA

12

CEA indications

beneficial for pts with > 70% stenosis

13

TIA work up

CT, carotid doppler, ECG, +/- echo within 24 hrs

14

amaurosis fugax sx

transient monocular blindness "shade pulled over one eye"

15

MCA occlusion

contralateral hemiplegia (arm > leg), hemianesthesia, homonymous hemianopia, aphasia, inattention, cortical sensory loss

16

ACA occlusion

hemiparesis (mostly leg)

17

PCA occlusion

homonymous hemianopia, disconnecting syndromes, hemianesthesia, amnesia, midbrain/thalamic syndromes

18

vertebrobasilar thrombosis

quadriparesis, bulbar paralysis, impaired gaze, cortical blindness, coma

19

ventral pontine infarct

quadriparesis, bulbar paralysis, absent horizontal gaze, normal consciousness, "locked in" syndrome

20

lateral medullary syndrome

ipsilateral ataxia, horners syndrome, nystagmus, facial numbness, CN9/10 palsy, contralateral spinothalamic loss

21

lacunar infarcts most likely secondary to

HTN causing 'lipohyalinosis'

22

most common cause of cardiogenic embolism

non-valvular arterial fibrillation > valvular heart dz, MI, post cards surgery, prosthetic valves, endocartis, atrial myxoma

23

Types of cerebral hemorrhage

intracerebral vs subarachnoid hemorrhage

24

risk factor for intracerebral hemorrhage

HTN --> charcot-bouchard microaneurysms

25

lobar hemorrhage

superficial vascular rupture w/i cerebral lobes

26

risk factor for lobar hemorrhage

amyloid angiopathy

27

Principles of stroke management

early recognition, rapid transport to tx facility "time is brain", early triage/imaging, assess for thrombolysis, monitoring in stroke unit

28

ddx stroke

cerebral tumor, subdural hematoma, abscess, migraine, metabolic disturbances, epilepsy

29

all patients with suspected stroke need a...

CT or MRI. MRI better at identifying acute ischemia and just as good at ID'ing hemorrhage

30

Do you ever LP a suspected stroke patient?

yes if negative imaging and you suspect meningitis or SAH