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A: Lauren Summer 2025 > Neuro: Lecture 3 - Stroke > Flashcards

Neuro: Lecture 3 - Stroke Flashcards

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1
Q

Ischemia vs Infarction

A

Ischemia - Decreased blood flow (reversible)

Infarction - death of tissue due to lack of blood low

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2
Q

Thrombosis vs embolism

A

Thrombosis - formation of clot in vessel

Embolism- blot clot travels elsewhere and lodges in smaller vessel

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3
Q

Stroke vs TIA

A

Stroke - Disruption of blood flow resulting in change in neurological function (lasting more than 24 hours.)

TIA- Transient Ischemic Attack - Usually less than 1 hour, up to 24 hours.

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4
Q

what are the two types of stroke?

A

ischemic and hemorrhagic

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5
Q

T or F: a TIA will not show evidence on an MRI

A

T, it is a breif episode of dysfunction in the brain without evidence of an acute infarction on an MRI

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6
Q

When is the highest risk of a stroke after a TIA?

A

1st 30 days after

90 day risk after a stroke is 3-17%

Those with TIA have an 18.8% strok risk in the next 10 years

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7
Q

What are the categories of the ABCD tool used for evaluating the risk after a TIA ?

A

Age 60+ - 1pt

Blood pressure 140+ or DBP 90+ 1pt

Clinical features- unilateral weakness or speech impairment - 1 pt

Duration? 60+ minutes : 2 pt , 10-59 mins : 1 pt

Diabetes 1pt

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8
Q

ABCD2 score interpretations?

What is it used for?

0-7

A

Used to assess risk of stroke after someone had a TIA

7 total points

6-7: high risk of stroke in 2 days: 8%

4-5: Moderate risk of stroke in 2 days: 4%

0-3: Low risk of stroke in 2 days: 1%

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9
Q

What conditions can mimic a stroke?

A

Hypoglycemia/hypoxia

seizure

migraines

multiple sclerosis attacks

brain tumor/swelling

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10
Q

Why is weakness in both hands or both legs likely not indicative of a stroke

A

Because it cannot be localized to a single blood vessel

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11
Q

What is NOT an ischemic stroke?

A

Sudden loss of conciousness (note: this is true for a hemmorhagic stroke)

Pre-syncope/syncope

numbness in both feet

waxing/waning confusion

diffuse weakness

numbness in one and or foot

pain

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12
Q

Stroke is the ___ leading cause of death in the US

Globally it is the __ leading cause of death

A

5th

2nd

Note: it is the leading cause of serious disability in the US

There has been a decline in stroke mortality over past decades

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13
Q

What are considered modifiable risk factors for stroke

A

Hypertension

Diabetes

High Cholesterol

Heart disease

Smoking

Drug Abuse

Pregnancy

OCP(oral contraceptives)

Alcohol

Obesity

Physical Activity

Sleep Apnea

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14
Q

Nonmodifiable risk for stroke

A

Older age

Male

Family History

Race (Blacks > Whites)

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15
Q

Most strokes are :

A

Ischemic (87% of stroke)

note: 25-30% have undetermined etiology

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16
Q

An ischemic stroke will appear ______-dense on a CT

A

Hypo-dense

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17
Q

A hemorragic stroke will appear as _____dense on a CT scan

A

Hyperdense

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18
Q

Most ischemic strokes are ________, the second most common is ________

A

Undetermined Etiology

Small Vessel Disease

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19
Q

Of all thrombotic infarctions, –% had a warning episode

A

50%

Note: Thrombotic infarctions ofen happen during sleep, pt awakens w/ deficit

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20
Q

MCA infarctions mainly affect the ______

A

Hemiparesis of contralateral face/arm

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21
Q

MCA strokes can cause aphasia if which side of the brain is affected?

A

The dominant

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22
Q

If an MCA stroke happens on the _______ side, your neglect is more significant

A

Non-Dominant side

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23
Q

Why is a R MCA stroke worse?

A

the R parietal lobe pays attention to both sides while the L parietal lobe pays attentions to the dominant side only → L MCA improves faster than R MCA stroke

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24
Q

MCA strokes can cause _____ sensory loss and homonymous hemianopsia

A

Cortical

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25
MCA strokes can cause a loss of conjugate gaze to the _____ side
Opposite side (trouble looking away from the weak side)
26
Aphasia often starts as _______ and turns into only wernickes or broca's aphasia overtime
Global Aphasia
27
The anterior MCA supplies what language area? Posterior MCA?
Broca's → decreased fluency Wernicke's → decreased comprehension
28
ACA strokes (rare) will cause deficits where?
Leg > arm
29
ACA can cause urinary incontinence usually only w/
bilateral infarcts
30
ACA infarction: akinetic mutism
pt doesn't talk because they have decreased initiative (frontal lobe)
31
PCA infarcts often cause what?
Homonymous hemianopsia visual hallucinations cortical blindness inability to read (alexia)
32
Ischemia of Which cerebral artery can cause problems w/ motivation/organization behaviors
ACA
33
dominant MCA stroke symptoms
contralateral weakness of arm/face neglect gaze deviation **aphasia**
34
non-dominant MCA symptoms
contralateral weakness of arm/face neglect gaze deviation
35
PCA stroke symptoms
contralateral homonymous hemianopsia splenium of corpus callous - Alexia
36
Symptoms of vertebrobasilar ischemia
Sensory/motor abnormalities in face/extremities vertigo/clumsiness/ataxia diplopia/dysarthria, dyphagia nausea/vomiting hearing loss/hiccups
37
Basilar strokes can cause **cranial nerve** problems on the _________ side and **weakness** in the body on the _______
Ipsilateral side Contralateral
38
cerebral emboli arise in the heart from:
Mainly **atrial Fibrillation** myocardial infarction akinetic segment endocarditis
39
How will a cardioembolic stroke appear on an MRI?
Diffuse throughout brain - stroke all over in multiple vessel territories
40
_____(heart condition) can **increase** stroke risk x5 and x2 increase risk of death but ____________ therapy can **reduce** the risk of stroke by 2/3
A fib Oral anticoagulation therapy
41
What is Warfarin (coumadin)
An oral anticoagulant used to treat a-fib
42
3 places an embolic infarct can come from?
Aorta Large intracranial arteries Patent foramen ovale
43
What is a "lacunes" What are they usually related to/caused by? They typically affect what structures?
Small artery occlusion hypertension/diabetes Putamen/caudate/internal capsule/thalamus/corona radiata, pons
44
lacunar infarctions: pure motor stroke
Hemiparesis of face, arm , and leg (Internal capsule base of pons)
45
sensorimotor stroke
thalamus and internal capsule
46
lacunar infarction: pure sensory stroke
Posterolateral thalamus - face, arm, leg
47
lacunar infarction: dysarthria, clumsy hand syndrome
base of pons
48
lacunar infarction: ataxia-hemiparesis
pons/internal capsule or subcortex
49
+ Thalamic strokes cause ____________ sensory loss to all modalities + They may develop what syndrome? + Mild hemiparsis
Contralateral sensory loss May develop Thalamic pain syndrome
50
51
AICA stroke symptoms
Hearing loss, facial weakness, ataxia, horner syndrome
52
PICA/Vertebral artery strokes can cause ______ syndrome
Lateral medullar/wallenberg syndrome CN V CN VIII CN X Sympathetics Salivatory nucleus (VII, IX) Solitary (VII, IX, X) Nucleus ambiguous (IX, X)
53
Superior cerebellar artery stroke symptoms
ipsilateral ataxia and scanning/explosive speech
54
What are rare causes of a stroke
Inherited disease inflammatory disorders hematologic disorders
55
What are the 6 steps to approaching a patient w/ an acute stroke? 1. _______ 2. Categorize _______ 3. Determine _______ 4. Calculate ________ 5. Determine ________ 6. Determine ______
Stabilize patient Categorize as ischemic vs hemorrhagic Determine last known normal Calculate NIHSS score Determine if theyre a candidate for acute thrombolytics Determine if theyre a candidate for endovascular intervention
56
What is the goal of door to needle time (time they enter hospital to time they get clotbuster (TPA)
45 mins note: the standard time is 60 mins
57
For every ______ delay in TPA administration, there is a 10% decline in probability of a good outcome
30 min delay
58
What is the most important aspect of the history of someone who's had an acute stroke?
Time of onset
59
11 Categories to the NIHSS
Conciousness Best gaze- horizontal eye movemnent visual field- determine if there's hemianopia or blindless Facial palsy - ask them to make faces Motor (arm)- ask them to raise arms Motor (leg)- ask them to raise leg in supine for 5 seconds Limb Ataxia - check finger to nose Sensory- use safety pin Language Dysarthria Extinction/neglect
60
What is the only FDA approved medicine for acute strokes?
TPA Tissue plasminogen activator
61
Contraindications for TPA: _____ hours from last known normal hemorrage head trauma or stroke in last 3 months severely high BP Endocarditis Bleeding disorder High Glucose 50+
4.5 hours from last known normal
62
T or F: TPA has no benefit to mortality of acute strokes
T No benefit to mortality However it does increase the likelihood of a good outcome within 3 months
63
For patients who have received TPA, BP must be measured ____________ for the first 24 hours
Check every 15 mins for first 2 hours every 30 mins for first 6 hours Every hour for next 18 hours
64
Patient's who have taken TPA need to maintain a bloodpressure of what?
Under 180/105, however it's suppose to be high, its bad if it's low or normal
65
BP goal for patient w/ TPA vs without?
With TPA: 180/105 Without: 220/110 Why? Because we want the higher BP in order to reestablish perfusion to the ischemic areas
66
If a patient is worsening after receiving TPA what should the medical team do?
Repeat imaging keep BP up Keep patient supine NO PT May do craniotomy to reduce swelling
67
penumbra
area of the brain around the core of a stroke that is impaired but still viable.
68
mass effect
pressure or displacement exerted by an abnormal lesion (like a tumor, hemorrhage, abscess, or swelling) on nearby brain structures.
69
What is a carotid endarterectomy?
Surgical procedure to remove plaque build up from carotid artery
70
An ischemic stroke on a DWI will appear : An ischemic stroke on an ADC will appear:
Light area on DWI Dark area on ADC
71
On a DWI, a new stroke will appear as a : An old stroke will appear as a:
New stroke: Light hyperdense area Old stroke: Dark hole
72
The highest rate of recovery for a stroke is seen when?
1st 3-6 months but can have improvement (small) for several years
73
What abilities usually recover quicker after a stroke?
Swallowing/facial movements/ gait note: recovery tends to begin proximally
74
What abilities recover more slowily after a stroke?
Language, spatial attention, dominant hand movement
75
What are signs of an intracranial hemorrhage?
Very rapid onset Intracranial pessure symptoms: Headache, vomiting, decreased conciousness CT scan will show blood fast
76
T or F, you can tell an ischemic and hemorrhagic stroke apart using a physical exam
F U need imaging
77
What are the causes of an intracerebral hemorrhage? Most common?
Most common: Hypertension Trauma Rupture of Arteriovenous malformation aneurysm tumor hemorrhagic conversion
78
Common locations of an intracerebral hemorrhage?
Putamen, cerebral hemisphere, thalamus, cerebellum, pons
79
A higher score on the glasgow coma scale means what?
More conscious note: 3 is minimum score
80
How to treat intracerebral hemorrhage?
Treat intracranial pressure (Craniotomy/ectomy) Intubate reversal of antiplatelet or anticoagulation Aggressive BP management
81
80% of subarachnoid hemorrhage are caused by what
**Rupture of intracranial aneurysm** Note: 10% die b4 medical attention 40% die in 3 months 50% of survivors have disabilities
82
Symptoms of aneurysm rupture?
Sudden explosive (thunderclap) headache loss of conciousness stiff neck/light sensitivity nausea/vomiting Note: 50% of patients have a warning leak with more subtle signs b4 a rupture
83
What kind of stroke is the leading cause of death and disability
Aneurysmal subarachnoid hemorrhage
84
How can vasospasm from a hemorrhage lead to an ischemic stroke?
The blood irritates the smooth muscles of vessels and leads to vasospasm
85
Signs of a venous stroke?
Headache Focal neurological signs Hemorrhage Altered mental state/seizures Diagnose w/ CT or MRI
86
Who does a venous stroke usually occur in?
Pregnant woman/ women on birth control
87

A: Lauren Summer 2025 (16 decks)

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