1. Embolic 2. Lacunar 3. Large artery

Stroke Flashcards by K Medina

Define stroke

Acute focal injury are the central nervous system by vascular cause → deficit

(irreversible brain damage, brain cell death)

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Two main different types of stroke

Ischemic ~80% (TOAST)
Hemorrhagic ~20% (SAH & ICH)

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New criteria for dx stroke

TOAST

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stroke is the _______ MC cause of death in the US

3rd

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Types of ischemic Strokes

Large artery
Lacunar
Cryptogenic (unknown origin)

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Difference between a ischemic stroke and “mini stroke”

TIA = “mini stroke”: FND (focal neurologic deficit) resolves in minutes, imaging normal
Ischemic stroke: permanent, irreversible FND

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Modifiable risk factors for stroke (5)

HTN
Hyperlipidemia
DM
Heart: CAD, A-fib
Diet/lifestyle: Tobacco

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Stroke: non-modifiable risk factors (4)

Age (increases every year, 60+)
Sex (young male & 65+ females MC)
Genetics
Fam Hx

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What is included in the ABCD2 score?

Age
BP >140/90
Clinical feature: weakness 2 points, speech=1
Duration
Diabetes 2

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3 Types of TIA

Embolic
Lacunar
Large artery

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2 Types of hemorrhagic stroke

Intraparenchymal
Subarachnoid hemorrhage

(star of death: aneurysm)

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Watershed stroke looks like ______ on imaging

linear pattern

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2 Causes of ischemic stroke

cardio (clots from heart or emobli from sepsis)
atherosclerosis

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What is an important reference for determining where the acute ischemic stroke is in the brain?

Motor homunculus

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ACA territory stroke: symptoms (5)

Contralateral leg weakness
Urinary incontinence
Akinetic Mutism
Tactile agnosia
Gait impairment

(supplies frontal lobe & parietal lobe)

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MC LVO’s

MCA territory stroke

(usually dominant (left) hemisphere)

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PCA territory stroke: presentation

Contralateral homonymous hemianopia
Hemisensory loss

(occipital lobes

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MCA territory stroke: symptoms

Contralateral hemiparesis
Contralateral hemisensory loss
Hemianopia
Aphasia: depends on location/size
Hemispatial neglect (cannot preceive one half of the world around them)

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Thalamic stroke (aka Lacunar Strokes (means “little lake”)) is a _____ etiology.

hypertensive

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Pure motor stroke (lacunar stroke syndrome): deficit

Contralateral hemiparesis: weak face, arm, leg

(pure sensory is numb face, arm, leg)

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Thalamic stroke sensory deficits (aka Pure sensory stroke or lacunar stroke syndrome) & nuclei involved.

VPL of thalamus (L for Limb)
VPM nucleas for face (M for mask, meaning face)

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Pure sensory stroke (lacunar stroke syndrome): presentation

Contralateral hemisensory loss: numb face, arm, leg

(pure motor is contralateral hemiparesis: weak face, arm, leg)

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Thalamocapsular stroke (aka sensorimotor stroke or lacunar stroke syndrome) is combined ____ deficits. Damage to the ____ (2).

Contralateral paresis and sensory loss
Internal capsule + thalamus

(mix between pure motor & pure sensory)

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Dysarthria-Clumsy Hand (lacunar stroke syndrome): presentation (2)

Slurred speech
Weakness of contralateral hand; decreased fine motor skills

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Dysarthria-Clumsy Hand (lacunar stroke syndrome): damage to \_\_\_\_\_

pons (CN V-VII) (it can localize anywhere outside the CNS)

Ataxia-Hemiparesis (lacunar stroke syndrome): presentation

1. Weak leg 2. incoordination of ipsilateral arm & leg (Contralateral hemiparesis and ataxia)

CADASIL is due to a ______ mutation

notch 3 | (AD)

Fabry's Disease genetic inheritance

X-linked

Fabry's disease causes stroke and is due to \_\_\_\_\_\_\_.

lysosomal alpha-galactosidase A deficiency

CADASIL patients have recurrent \_\_\_\_\_\_

small vessel strokes

Initial evaluation: Stroke code

1. Straight to the scanner! ("time is brain"~ 2 million neurons die/min) 2. CT head 3. MRI 4. CBC, PT/INR, CMP, glucose 5. TTE (don't need contrast for CT or MRI, only w/angio)

What is one of the most important questions when working up a patient with a possible stroke?

"When was the patient last known well?" (we need to know when the symptoms started)

What is evaluated in an NIHSS score?

Define ischemic penumbra

Potential irreversible brain tissue injury caused by hypoperfusion after a stroke (can be calculated and mapped)

What is this (image to the right)?

* this identifies the ischemic penumbra * green = penumbra * red = ischemic core

Acute stroke therapy: 2 options

1. Thrombolysis: TPA, tenecteplase 2. Endovascular

Thrombolysis (TPA): inclusion criteria (2)

NIH\>2 or ***_disabling_*** sx

tPA relative contraindications

glucose \< 40 (make sure the sx aren't due to hypoglycemia)

Thrombolysis: exclusion criteria (5)

1. Intracranial ***_hemorrhage_*** (last 3 mo.) 2. Hypertensive (SBP must be \<185/110) 3. Active internal bleeding 4. Bleeding at non-compressible site 5. symptoms for \>4.5 hrs

Endovascular therapy (mechanical thrombectomy) indications (2)

1. Can be performed up to 24 hours after onset of symptoms 2. NIH \> 5

Endovascular (mechanical thrombectomy): inclusion criteria

* Evidence of large vessel occlusion on CT angio / perfusion * Sizable ischemic penumbra relative to ischemic core

Post-acute stroke therapy management (after thrombectomy) (2)

1. CTP 2. CTA

Post-acute stroke therapy management (after tPA) (4)

1. Close neurologic monitoring in ICU for 24 hours 2. BP control between 160-185 mmHg 3. no anti-platelet or anti-coagulation for 24 hours 4. repeat CT

Post-acute stroke therapy: blood pressure must be \_\_\_\_\_\_\_\_.

between 140-185 (can reduce by 20 mmHg over the next 24 hours)

Define young stroke

Strokes in patients less than 50 years old

Workup for patients who present with a stroke who are less than 50 years old (3).

1. Hypercoagulable panel 2. Transesophageal echocardiogram (Patent foramen ovale) 3. Long-term cardiac monitoring (A fib)

Hypercoagulable panel includes (5)

1. factor deficiency 2. protein deficiency 3. mutations 4. antiphospholipid Ab syndrome 5. lipoprotein

Gold standard for ischemic stroke evaluation

MRI (more detail of brain tissue, stroke territory, edema)

Left: Right:

* Diffusion-weighted: white = ischemia * Paired diffusion co-efficient map: black = ischemia (confirms stroke: if white on diffusion-weighted and dark or "drop out" on co-efficient map)

Acute stroke management after TPA or thrombectomy (3)

1. PT/TOT 2. speech therapy 3. screen for depression

Stroke complications (3)

1. cerebral edema 2. epilepsy 3. depression

Stroke: prevention recommendations

1. Diet (Mediterranean diet: fruit, veggie, lean meat, nuts) 2. Exercise: 150 min moderate/week or 30 min x 5 days 3. Blood pressure control 4. Blood glucose control 5. Weight control

hyperhomocysteinuria can cause stroke and is due to \_\_\_\_\_\_\_.

impaired cystathionine B-synthase | (AR)

Fibromuscular dysplasia can have a stroke due to \_\_\_\_\_\_\_.

arterial dissection

polycystic kidney disease is associated with ______ & \_\_\_\_\_.

* berry aneurysms * SAH

Marfan's orr Ehlers-Danlos type IV is associated with stroke due to \_\_\_\_\_.

dissection

MELAS can cause stroke and is due to \_\_\_\_\_\_\_\_.

mitochondrial disease w/metaboic stroke-like brain lesions

FAST

* Face : can they smile * Arms : can they raise arms * Speech * Time

Right-hemisphere stroke deficits (2)

1. left side movement & sensation 2. analytical & perception tasks

Left-hemisphere stroke deficits (2)

1. right-sided movement/sensation 2. speech/language ability

Gaze preference

they look toward the side of the stroke

cerebellar stroke patients will present with \_\_\_\_\_\_.

balance & coordination deficits

Brain stem strokes will present with ______ (4) deficits.

1. eye movement 2. hearing 3. speech 4. swallowing

Dominant hemisphere stroke sx (2)

1. aphasia 2. contralateral hemiplegia: arm/face\>leg

Non-dominant hemisphere stroke sx (2)

1. contralateral hemi-neglect 2. contralateral hemiplegia arm/face\>leg

Parietal-occiptal stroke deficit (3)

1. visual 2. sensory 3. language

Stroke/lesion location: facial numbness, weak jaw, lateral rectus palsy, facial weakness

* CN V – facial numbness, weak jaw movement * CN VI – lateral rectus palsy * CN VII – facial weakness

Stroke/lesion location: vertigo/hearing loss, dysphagia, weak palate or tongue weakness

* CN VIII – vertigo, hearing loss * CN IX, X – dysphagia, weak palate * CN XII – tongue weakness

metabolic workup for stroke patient (5)

1. lipid panel 2. HbA1C 3. TSH 4. Blood glucose 5. T/PTT/INR

Stroke Flashcards

(69 cards)