Flashcards in Neurology 3.5 Deck (28):
What is a stroke?
injury to the brain caused by interruption of blood flow or bleeding into or around the brain, retina, or spinal cord
What are the major mechanisms which produce stroke?
blockage of an artery; ischemia (80%)
rupture of artery; hemorrhage (20%)
Who is most likely to have a stroke?
older African Americans with comorbidities
What is the clinical presentation of stroke?
-weakness or paralysis
-loss of sensation
-difficulty with speech and understanding
-difficulty with organizing thought
-clumsiness or lack of balance
What would a patient look to one side of the body after a stroke?
In a stroke the pt will look towards the side of injury
What are the key functional areas of the anterior cerebral artery?
-leg and foot
-control urinary bladder
What are the key functional areas of the middle cerebral artery?
-face and arms
-frontal/parietal: langauge and visuospatial
What are the key functional areas of the vertebral-basilar circulation?
-brainstem and cerebellum
-most of thalamus and hypothalamus
-cortex and deep white matter
What are the key functional areas of the posterior cerebral artery?
visual radiations and primary visual cortex
What is the clinical presentation of damage in the carotid territory?
-one-sided limb weakness, clumsiness, paralysis
-one-sided numbness, paresthesia, sensory loss
-dysarthria (inability to articulate words)
What is the clinical presentation of damage in the vertebral-basilar territory?
-vertigo or dizziness
-weakness or clumsiness
-numbness or sensory loss
-limb ataxia or coarse tremor, staggering gait
-visual field defect, blindness, diplopia
**unilateral or bilateral
What is TIA?
transient ischemic attack;
brief episode in which neurologic deficits suddenly occur then disappear
Why do patients often ignore TIAs?
episode of impaired function is brief
What is TMB?
transient monocular blindness; retina becomes temporarily ischemic
What is the clinical presentation of TMB?
gray or black fog or mist clouding vision in all or part of one eye
What is the first test we do when a patient presents with stroke-like symptoms?
What is a lacunar stroke?
small subcortical infarcts in the territory of deep penetrating arteries
What are the common sites for a lacunar stroke?
What is a putamen?
smalla rtery which is damaged in a lacunar stroke
What are the 4 classic lacunar stroke syndromes?
1) pure motor stroke/hemiparesis
2) pure sensory stroke
a. persistent or transient numbness +/- tingling on one side
b. pain, burning, unpleasant sensation [thalamus]
c. clumsy hand dysarthria, slurred speech, impaired coordination [pons, internal capsule, basal ganglia]
What is the main difference between a lacunar stroke and an ischemic stroke?
no aphasia or visual field loss in lacunar
Which common ailment is often confused with a stroke?
What is the treatment for a stroke?
-alteplase (dissolves thrombus) aka "tpa"
-may be given if symptoms began 4.5 hrs prior or less
What is the action when a patient arrives with stroke-like symptoms after 10 minutes?
evaluate patient for potential stroke
What is the action when a patient arrives with stroke-like symptoms after 15 minutes?
notify stroke team
What is the action when a patient arrives with stroke-like symptoms after 25 minutes?
initiate head CT
What is the action when a patient arrives with stroke-like symptoms after 45 minutes?