Section 10: CNS Miscellaneous Flashcards
(38 cards)
What does Broca’s (expressive) aphasia involves?
Broca’s (expressive) aphasia involves:
- Nonfluent speech
- Good auditory comprehension; and
- Poor repetition and naming
How does stroke involving the superior division of the middle cerebral artery present?
- Contralateral hemiparesis that affects the face, hand, and arm
- Contralateral hemisensory deficit in the same distribution
- Iipsilateral gaze preference
- Facial droop
- If the dominant hemisphere is affected, Broca’s aphasia results
How does stroke involving the inferior division of the middle cerebral artery present?
- Contralateral homonymous hemianopia
- Neglect of the contralateral limbs
- Apraxia
- If the dominant hemisphere is affected, Wernicke’s aphasia results.
What does Wernicke’s (receptive) aphasia involves?
Wernicke’s (receptive) aphasia involves:
- Fluent speech
- Poor auditory comprehension
- Poor repetition and naming
What is the presentation of anterior cerebral artery (ACA) stroke?
Leg paresis
What is the presentation of posterior cerebral artery (PCA) stroke?
- Homonymous hemianopia with macular sparing
- Prosopagnosia (inability to recognize familiar faces)
How does basilar artery stroke present?
- Coma
- Cranial nerve palsies
- “Locked-in” syndrome
How does lacunar stroke present?
- Pure motor or sensory deficit
- Dysarthria – clumsy hand syndrome
- Hemiparesis involving face, arm and leg
What is the most effective way to reduce aspiration in stroke or in a ptc with swallowing dysfunction
Upright supine position
When to start fibrinolytic therapy in stroke patient?
- First 3 to 4.5 hours following symptom onset
- CT scan should be done first to r/o intra-cranial hemorrahge
How to Rx stroke patient who came in after 6h?
- Aspirin
- Control HTN
- Swallow evaluation before giving any oral meds
Inclusion criteria for IV recombinant tPA (thrombolytics)
- Symptom duration of 4.5 hours
- Age > 18 years
- CT scan without hemorrhage
- A diagnosis of ischemic stroke, and
- A measurable neurologic deficit.
What is the permissible BP for stroke ptc who are tPA candidates
185/110 mmHg
What is the permissible BP for stroke ptc who are not tPA candidates
>160/>80 mmHg
Why is ASA (aspirin) important in acute ischemic stroke?
ASA reduces the incidence of a second event
For ptc already on ASA with acute iscemic strokes, what other antiplatelet medications should be given?
Clopidogrel, ticlopidine, or dipyridamole
What are the exclusion criteria for use of tPA in pt with acute ischemic stroke?
- Stroke or head trauma within the prior three months
- A history of intracranial hemorrhage
- Major surgery within two weeks
- Acute MI within the past three months
- LP within seven days
- Uncontrolled hypertension requiring aggressive therapy
- Pregnancy or lactation
- Evidence of cerebral hemorrhage.
Patients with basilar artery thrombosis may receive intra-arterial tPA up to how many hours after symptom onset?
Six hours
What measures can be taken to prevent (ischemic) stroke?
- Antiplatelet therapy: ASA, ASA/dipyridamole (Aggrenox), or clopidogrel (Plavix)
- BP goals: Treat most patients to 130/80
- Lipid goals: Treat patients to an LDL of 100 mg/dL
- The HbA1c goal is 7%
- Discontinue smoking
- Encourage physical activity
- If > 50% carotid stenosis is seen on angiography, consider carotid endarterectomy
- If AF is present or if the LVEF is ≤ 25%, consider warfarin
What is best initial test for a ptc with stroke?
CT scan of the head without contrast to rule out hemorrhage
What does MRI with diffusion-weighted imaging (DWI) show?
DWI shows dying tissues
What does MRI with perfusion-weighted imaging (PWI) show?
PWI shows penumbra, that is tissues at risk of dying.
What is the role of MRA or CT angiography in stroke patients?
To evaluate vessels including the carotids and circle of Willis
What is the role of Transesophageal echocardiography (TEE) in stroke patients?
To evaluate for cardiac emboli and patent foramen ovale
