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Flashcards in left side weakness Deck (32):
1

when pt is weak on one side

define: numbness, tingling, unable to hold/lift things
-where is the weakness; i.e. fingertips-whole arm
"christmas lights" CNS or peripheral, impinging nerve by sleeping with neck "kinked"- nerve palsy

2

5 most common causes of left-sided weakness

CVA-stroke
TIA
Intracranial bleed
Intracranial mass
Migraines (hemiplegic-presents like a stroke, N/V)

3

other causes

radiculopathy i.e. pressure on brachial plexus while drunk

dissection (subclavian, another-->hematoma)

C-spine arthritis/herniation (compresses nerve-->injury) -trauma

AVM (AV malformation)-"jumbled BVs"

Todd's paralysis (hemiplegia after seizure)-usually self-resolving

MS

Psychiatric (anxiety/panic attack)

drugs-vasospasm of BVs

4

Life threatening conditions with left sided weakness

Acute CVA
Intracranial bleed
Aneurysm
Meningitis-intracranial abscess
Intracranial mass

(stroke, blood, vessel bulge, infection, tumor)

5

stroke mnemonic


timing

prevelance

FAST
face, arm, speech, time

clock starts at onset of symptoms
1/6 ppl ww will have stroke

6

CVA: thrombotic stroke

thrombus in BV-occlusion to part of brain
-destroy clot

7

CVA: embolic stroke

dislodged embolus from a fib-->to small BV in brain
*from somewhere else

"fix" heart
ventral septal defect-->to brain

8

CVA: hemorrhagic stroke

bleeding is cause
subarachnoid or intraparenchymal bleed

9

risk factors for CVA

DM
HTN
smoking
afib
hyperlipidemia
obesity
fam risk factors
CAD
previous strokes
OCPs
*similar to MI risk factors*

10

TIA

-resolved symptoms

-high risk for CVA development-may have thrombus/emobolus present-->admit

-need to find risk factors and tx

-opportunity to prevent CVA

11

CVA imaging: CT scan

initial (inflammation-deviation)

6 mos: goes back, swelling goes down

helps determine: *is there a mass or bleed?*
-can be done v. quickly, 10 min

12

CVA imaging: MRI

MRA

can see more detail of injury

Magnetic resonance angiography, see BVs-can see occlusions-thrombus, where no perfusion

*both take longer than CT and $$
not all pts require

13

intracranial mass

see inflammation, pushes opposite ventricle-deviation

14

intracranial bleed

INR 3.6 (high, on blood thinner) HTN-->aneurysm-->may have spontaneous bleed

15

hemiplegic migraine

unilat. musc. wkness, and/or paralysis

familial hemiplegic migraine- mult. fam members
vs. sporadic: gene mutations

*stroke (esp. ischemic) pts don't typ. present with ha unless "popped" BV-aneurysm

IC mass may have ha

16

MS

demyelination of brain/SC

may present as stroke symptoms-photophobia, optic neuritis, painful EOM, weakness, pain on one side, other neural exam abnormalities

usually in younger pts-may have no risk factors

dx: MRI- shows plaques, brain atrophy-enlarged ventricles, spots

tx: high dose steroids (i.e. 1000 mg)

17

AVM

jumbled up BVs compress brain tissue-->symptoms

18

radiculopathy

C-spine arthritis, disc herniation

observe dermatome pattern

MRI

PT, steroids, surgery

19

carpal tunnel syndrome

transverse carpal ligament

numbness, tingling in arm, moves proximally

what dermatome pattern?

peripheral prob if specific fingers, NOT stroke

20

dx: NIH stroke scale

LOC

best gaze
visual fields
facial palsy
motor
limb ataxia
sensation
best language
dysarthria
extinction and inattention
*see scale
*tPA advised?

21

dx modalities

Imaging
CT scan
MRI/MRA

Labs

EEG-seizure, may have stroke-like symptoms

Invasive techniques

22

when change in mental status,

call stroke alert

23

complications of stroke

chronic pain, disability, death

24

left side weakness questions

stroke?
ischemic(meds) or hemorrhagic (OR)?

onset of symps?

candidate for tPA? (3 hr)- TOU-time onset unknown, can't use tPA

CIs for tPA? *inc. bleeding risk*

need consent? pt w. in time frame (3 hr)?

what are possible legal risks? -lawsuits, more lawsuits for NOT giving tPA

25

stroke centers

acute stroke ready center: rural, basic, may use tele medicine-->neurologist

primary stroke center: standard, stroke unit, tPA

comprehensive stroke center: academic

26

stroke certification is a big deal for hospitals

high volume, insured, high risk pts-->$$$ for hospitals

27

tPA

3-4.5 hrs
*may extend from 3 hrs
Hussain stops at 3, may be sued if given after 3 hrs

28

more invasive clot tx: intra-arterial

take catheter to thrombus and give small dose tPA
-dec. risk factor for bleeding
-up to 6 hr time window

29

more invasive tx: if see clot on MRA

clot retraction- take out in situ with suction
-v. specialized centers

30

CIs to tPA

bleeding anywhere
trauma, chest compressions
anemia
blood thinners
HTN
platelets low
recent sx
hx of IC hemorrhage

31

tx

Depends on the etiology
Antiplatelet agents
Thrombolytics
Invasive techniques
Pain control
Treating the underlying medical conditions

32

ischemic stroke

ASA/plavix (anti-platelet)
tPA
invasive: clot retraction
supportive: BP, glucose control