Neurology (5-10%) Complete Flashcards
Lateral medullary syndrome:
AKA? ___________
Vessel involved? ___________
Signs and Symptoms? ___________
AKA? Wallenburg
Vessel involved? PICA or vertebral artery
Signs and Symptoms?
- ipsilateral ataxia (wide-based, staggering gait)
- ipsilateral Horner’s (ptosis, miosis, anhidrosis)
- ipsilateral face: loss of pain/temp sense (& reduced corneal reflex
- Ipsilateral absent/reduced gag reflex
- contralateral body: loss of pain/temp sense
- Vertigo
- Nystagmus (fast phase beating away from lesion)
- Dysphagia
- Hoarseness
- Hiccups
- Coordination: Ipsilateral dysmetria with Finger-to-Nose & Heel-to-Shin, Ipsilateral dysdiadochokinesia with rapid alternating movements
-Motor: Normal strength, Normal reflexes
Medial medullary syndrome:
Vessel involved? ___________
Signs and Symptoms? ___________
Vessel involved? Anterior spinal artery.
Signs and Symptoms?
1. Ipsilateral tongue weakness.
2. Contralateral arm, and leg weakness.
3. Contralateral body vibration, loss of proprioception.
Mid-brain Stoke:
AKA? ___________
Vessel involved? ___________
Signs and Symptoms? ___________
AKA? Weber
Vessel involved? PCA affected.
Signs and Symptoms?
- Ipsilateral CN 3 palsy (ptosis, mydriasis, diplopia (down & out))
2. Contralateral hemiplegia (face, arm, leg)
What are the findings of ACA infarct?
Contralateral leg weakness
Contralateral leg numbness
Contralateral grasp reflex
Other frontal signs
What are the findings?
LEFT MCA -
superior branch involvement
Broca’s (expressive/non-fluent) Aphasia
Right weakness face & arm > leg
Gaze deviation to left
What are the findings?
LEFT MCA -
inferior branch involvement
Wernicke’s (receptive/fluent) Aphasia
Right cortical sensory loss
Right “pie-in-the-sky” = right homonymous
superior quadrantonopsia
What are the findings?
LEFT MCA -
main branch (M1)
- Global aphasia + findings of the both superior and inferior branch
What are the findings?
Right MCA -
superior branch involvement
Left weakness face & arm > leg
Gaze deviation to right
What are the findings?
Right MCA -
Inferior branch involvement
Left cortical sensory loss
Left hemineglect
Left “pie-in-the-sky” = left homonymous
superior quadrantonopsia
What are the findings of PCA infarct?
Contralateral homonymous hemianopia.
Findings of Lacunar infarct:
Pure Motor?
Possible localizations?
Artery?
Symptoms?
Possible localizations: Posterior Limb Internal Capsule, Corona Radiata, Midbrain - cerebral peduncle, Ventral Pons
Artery? Anterior Choroidal, Small MCA branch, Small PCA branch, Basilar
Symptoms? Contralateral face, arm, & leg weak
Findings of Lacunar infarct:
Pure SENSORY?
Possible localizations?
Artery?
Symptoms?
Possible localizations: Thalamus
Artery? Thalamoperforators from PCA or MCA
Symptoms? contralateral face, arm, leg sensory sx
Duration of Holter needed if you suspect cardioembolic stroke?
2 weeks
tPA Inclusion Criteria?
________ stroke causing ________ neurologic deficit in patient _________ year old
Time from last known well (onset of stroke symptoms) _________
Ischemic stroke causing a disabling neurologic deficit in patients >18yo
Time from last known well (onset of stroke symptoms) <4.5h
Disabling = NIHSS ≥6
Disabling = aphasia, hemianopia, weakness limiting sustained effort against gravity, visual/sensory extinction
Absolute exclusion criteria for tPA?
Active hemorrhage or any condition that increases risks of major hemorrhage with tPA
Any hemorrhage on brain imaging
*if on DOAC, cannot give tPA, but can consider EVT
EVT Inclusion Criteria
_____ year old w/ disabling stroke AND functionally independent and life expectancy > ______
______ hours from onset of stroke or last known well
CT Head shows ___________________ (ASPECTS score of _________)
CTA shows occlusion in the _____________
No evidence for EVT in ___________ stroke, but can consider it for __________ because of ____________
EVT Inclusion Criteria
>18yo w/ disabling stroke AND functionally independent and life expectancy >3m
<6h* from the onset of stroke or last known well
CT Head shows small-to-moderate ischemic core (ASPECTS score of 6 or higher)
CTA shows occlusion in the anterior circulation of the proximal large vessel (distal ICA
or MCA)
no evidence for EVT in proximal posterior circulation stroke, but can consider it for basilar thrombus because of high morbidity/mortality
BP Management in acute ischemic stroke?
if getting/got tPA, ________ x 24h
if tPA and EVT, ________ x 24h
if no tPA, __________ (treat BP only if SBP ______ or DBP __________) x 24h
if getting/got tPA , <180/105 x 24h
if tPA and EVT, <180/105 x 24h
if no tPA, <220/120 (treat BP only if sBP>220 or dBP>120) i.e. permissive HTN x 24hr
Antiplatelets in acute ischemic stroke?
All acute stroke pts + not on antiplatelet + no tpa + CT no bleed = ASA 160mg (or sometimes Dual Antiplatelet)
if tPA = wait ____ hours before starting ASA ( ____ dual antiplatelet)
if tPA = wait 24h before starting ASA (no dual antiplatelet)
ABCD2 score?
High-Risk TIA score?
Risk-stratification tool to identify patients at high risk of stroke following a transient ischemic attack (TIA).
A - Age>60 (1 point)
B - BP>140/90 (1 point)
C - Clinical features (unilateral weakness = 2 points, speech disturbance without weakness = 1 point)
D - Duration of symptoms (>/= 60 mins (2 points), 10-59 minutes (1 point)
D - Diabetes (1 point)
High-Risk TIA score? >/= 4 points
Antiplatelets in stroke?
For high risk TIA (ABCD2 _____) or minor stroke (NIHSS _____) of __________ origin:
___________ for _______ days then ___________
For high risk TIA (ABCD2 ≥4) or minor stroke (NIHSS ≤3) of non-cardioembolic origin
Clopidogrel + ASA for 21days then antiplatelet monotherapy.
Minimal loading dose of clopidogrel 300-600mg and 160 mg of acetylsalicylic acid should be given at the start of the treatment
Start ASAP after brain imaging, within 24 hours of symptom onset, ideally within 12 hours.
Antiplatelets in Stroke?
Patients with TIA/stroke in last ___ days + ______% stenosis in major intracranial vessel and ___ bleeding risk = consider _________ for ________ days, followed by ________
Patients with TIA/stroke in last 30 days + 70-99% stenosis in major intracranial vessel and low bleeding risk = consider dual antiplatelet (ASA & Clopidogrel) x 3 months (followed by single antiplatelet) + LDL lowering, BP treatment, structures lifestyle medication (smoking cessation, exercise, diet)
When to do a Carotid endarterectomy (CEA)?
Men with 50%–99% symptomatic carotid stenosis & women with 70%–99% symptomatic carotid stenosis
LDL Target after stroke?
target LDL<1.8
