Stroke

Question 1

what is ischemia?

Answer 1

decreased blood flow
reversible

Question 2

what is infarction?

Answer 2

death of tissue due to lack of blood flow

Question 3

a stroke results in a change in mental function for over ____ hours and evidence of ___ on imaging

Answer 3

24 hours
cerebral ischemia

Question 4

T/F: there is evidence of ischemia/acute infarction on MRI after a TIA

Answer 4

F

Question 5

how long does a TIA last?

Answer 5

usually <1 hours (15-20 mins)
can be up to <24 hours

Question 6

after ____ hours of a TIA, there will be permanent damage

Answer 6

3

Question 7

when is the risk of stroke highest after a TIA?

Answer 7

1st 30 days

Question 8

what is the ABCD2 used for?

Answer 8

assess the risk of a stroke in the next 2 days after a TIA

Question 9

components of the ABCD2

Answer 9

Age ≥ 60
Blood pressure ≥140 SBP or ≥90 DBP
Clinical features unilateral weakness or speech impairment w/o weakness
Duration: ≥ 60 mins (2 pts), 10-59 mins (1)
Diabetes

Question 10

ABCD2 score:
high risk
moderate
low

Answer 10

high risk = 6-7
moderate = 4-5
low = 0-3

Question 11

T/F: a sudden loss of consciousness should not happen during a stroke

Answer 11

T

Question 12

what pattern of numbness is not indicative of a stroke?

Answer 12

both feet
one hand or one foot

Question 13

stroke is the ___ leading cause of death in US and ____ globally

Answer 13

5th US
2nd global

Question 14

what is one of the leading causes of serious disability in the US?

Answer 14

stroke

Question 15

what is the most common ischemic stroke subtype?

Answer 15

undetermined etiology

Question 16

how does paralysis of conjugate gaze present in an MCA stroke?

Answer 16

look towards lesion (away from weak side)

Question 17

anterior MCA supplies _____’s area
posterior MCA supplies ____’s area

Answer 17

anterior = Broca’s
posterior = Wernicke’s

Question 18

ACA stroke sx

Answer 18

LE hemiparesis & hemisensory loss
if bilateral = incontinence
slowness, lack of spontaneity
akinetic mutism (lack motivation)

Question 19

what does an MCA stroke effect more?

Answer 19

UE and face
language areas

Question 20

PCA stroke sx

Answer 20

cortical blindness
some contra sensory loss
inability to read

Question 21

what is the most common cause of cardioembolic infarction?

Answer 21

atrial fibrillation

Question 22

what are lacunar infarcts?

Answer 22

small infarcts of small penetrating vessels of the putamen, caudate, IC, pons, thalamus, corona radiata

Question 23

lacunar infarcts are usually related to

Answer 23

diabetes and HTN

Question 24

T/F: the face, arms, and legs are all effected equally with lacunar infarcts

Answer 24

T

Question 25

where is the infarct in a pure motor stroke?

Answer 25

IC or base of pons

Question 26

where is the infarct in pure sensory stroke?

Answer 26

posterolateral thalamus

Question 27

where is the infarct in a sensorimotor lacunar stroke?

Answer 27

thalamus & IC

Question 28

where is the infarct when a lacunar stroke causes dysarthria and clumsy hand syndrome?

Answer 28

base of pons

Question 29

where is the infarct when lacunar stroke causes ataxia?

Answer 29

pons & IC or subcortex

Question 30

sx of thalamus stroke

Answer 30

contra sensory loss to ALL modalities spontaneous pain and dysesthesias mild hemiparesis

Question 31

lateral medullary syndrome (Wallenberg) is caused by what artery having ischemia?

Answer 31

PICA/vertebral

Question 32

AICA stroke sx

Answer 32

hearing loss facial weakness ataxia Horner's

Question 33

SCA stroke sx

Answer 33

ipsi ataxia scanning speech

Question 34

for every 30 min delay after stroke onset, there is a ___% decline in probability of good outcome

Answer 34

10%

Question 35

the window for administering tPA is

Answer 35

4.5 hours

Question 36

the window for an endovascular intervention is

Answer 36

24 hours

Question 37

PT w/i ____ of tPA administration is contraindicated

Answer 37

24 hours

Question 38

T/F: BP should be high after a stroke if no tPA is given

Answer 38

T

Question 39

swelling up to _____ hours after stroke is normal

Answer 39

72 hours

Question 40

if a stroke pt is worsening, how should the bed be positioned?

Answer 40

head of bed down/supine

Question 41

when is the highest rate of recovery from a stroke?

Answer 41

1st 3-6 months aggressive PT important

Question 42

recovery from stroke begins ____ (proximal or distal)

Answer 42

proximally

Question 43

if a pt was unresponsive, what type of stroke is suspected?

Answer 43

hemorrhagic

Question 44

hemorrhagic strokes are usually due to

Answer 44

HTN

Question 45

what must be done in order to differentiate ischemic vs hemorrhagic stroke?

Answer 45

CT

Question 46

what are sx of increased intracranial pressure?

Answer 46

HA vomit decreased consciousness

Question 47

common areas for intracerebral hemorrhage due to HTN

Answer 47

putamen thalamus cerebellum (also hemisphere and pons)

Question 48

what stroke is more deadly but has a better prognosis after 2 weeks?

Answer 48

intracerebral hemorrhage

Question 49

what are most subarachnoid hemorrhages caused by?

Answer 49

rupture of intracranial aneurysm

Question 50

how can a hemorrhage lead to an ischemic stroke?

Answer 50

vasospasms due to irritant of blood in areas not supposed to be

Question 51

venous strokes are common with what conditions?

Answer 51

pregnancy/post-partum OCP lupus

Question 52

stroke? R hand weakness mixing up words loss of left eye vision

Answer 52

L carotid artery

Question 53

stroke? balance changes veering towards right when walking

Answer 53

cerebellar