Flashcards in Exam 3 -- Cerebrovascular Disease Deck (21):
Cerebrovascular disease is the fifth leading cause of death in the US, second worldwide. What percentage of these events are ischemic, and what percentage are hemorrhagic?
80% are ischemic; 20% are hemorrhagic
An ischemic stroke that is caused by a thrombus can be atherosclerotic or an artery dissection. What are the symptoms of an artery dissection thrombus?
Headache, amaurosis fugax, Horner's
True or false: an embolytic stroke has symptoms that are more acute than thrombolytic.
What type of infarcts are common with emboli in arteries with acute right angles?
In what area of the brain are embolytic strokes common?
Transient ischemic attacks involve no infarction (tissue death) and there is full recovery of function. How long does a TIA usually last?
About 1 minute, but possible up to under 24 hours.
ABCDD is an acronym used to estimate the risk of a stroke in the first two days after a transient ischemic attack. What do these letters stand for?
Age (over 60)
Blood pressure after TIA (over 140 systolic OR over 90 diastolic)
Clinical features (unilateral weakness, speech disturbance)
What sort of workup can be done for a patient who has had a transient ischemic attack?
MRI (with diffusion weighted imaging), CT, MRA, CTA, ECG, CBC, metabolic panel, coagulation screening, lipid profile, ESR, CRP, Doppler and carotid Doppler
What drugs are antiplatelets that can be used for reducing risk of a stroke?
Aspirin, aggrenox, clopidogrel, ticlopidine
Alteplase is a tissue plasminogen activator that is sometimes used to break down clots. It must be used within 4.5 hours of the onset of symptoms. What are two scenarios that would contraindicate the use of alteplase?
If there is evidence of hemorrhage, or if the patient is an anticoagulants (warfarin, coumadin, heparin).
Carotid endarterectomy is surgical treatment that involves removal of the plaque. What two criteria must be met in order to consider this procedure for a patient?
70-99% lumen occlusion and 5+ year life expectancy
What is the most common location for an intracerebral hemorrhage?
What are the cardinal signs of hemorrhagic stroke?
Headache, N&V, seizures.
Comparing intracerebral hemorrhage with subarachnoid hemorrhage, which has the more sudden onset?
What clinical feature is found in 97% of patients with a subarachnoid hemorrhage?
A sudden, severe headache.
In terms of pharmacologic treatment for hemorrhagic stroke, you want the patient off any anticoagulants and antiplatelets. You would also initiate anti-HTN meds, and possible anti-epileptic drugs if the patient is having seizures. What specific drug can be used for subarachnoid hemorrhage?
Bell's Palsy is the most common cranial nerve palsy and is most common in what kind of patient?
Bell's Palsy is thought to be related to which viral organisms?
Herpes simplex or herpes zoster.
Does Bell's Palsy typically involve an acute or chronic onset?
Acute (within about 48 hours)
If resolution of a Bell's Palsy begins within 21 days, full recovery is likely. There is a poorer prognosis if the symptoms last more than 4 months.