Stroke Flashcards
(44 cards)
What is the 3rd most common cause of death in the US?
Stroke
What is a stroke?
Sudden onset neurological deficit from the death of brain tissue
What are common causes of stroke?
sudden blockage in the flow of blood to the brain
Bleeding
Where do Emboli commonly originate in Strokes?
Carotid stenosis
Heart: A-Fib, Valvule disease, DVT through PFO
What are the common risk factors for stroke?
Hypertension, Diabetes, Hyperlipidemia, tobacco smoking
What artery is most commonly involved in stroke?
Middle Cerebral Artery (MCA)
How does a Middle Cerebral Artery (MCA) stroke present?
Weakness of sensory loss: Contralateral
Homonymous Hemianopsia: Loss of visual field opposite of stroke
-L MCA stoke causes loss or R visual fields
Aphasia: If ipsilateral to speech center (usually left)
How does an Anterior Cerebral Artery (ACA) stroke present?
Personality/cognitive defects: Confusion
Urinary Incontinence
Leg weakness
How does a Posterior Cerebral Artery (PCA) Stroke present?
Ipsilateral loss of the face, 9th and 10th CN
Contralateral sensory loss of limbs
Limb ataxia
What is the best initial test in suspected stroke?
CT Head W/o contrast
What is the most accurate test in suspected stroke?
MRI
Why is CT W/o Contrast done first in suspected stroke?
To exclude hemorrhage
What tests are used to help determine the cause and treatment for stroke?
Echocardiogram
EKG
Holte Monitor
Carotid Duplex Ultrasound
What is an Echocardiogram used to detect in stroke?
Surgical Replacement or repair of damaged valves
Patent Foramen Ovale (PFO)
Thrombi: anticoagulation
What is EKG used to detect in stroke?
A-Fib or A-Flutter: treat with DOAC or warfarin as long as the arrhythmia is present
Stroke or TIA means CHADS-VASc of 2 or more
What is a Holter monitor used to detect in stroke?
Atrial Arrhythmias if EKF is normal
if (-) long term monitor with loop recorder to find arrhythmia
What is Carotid Duplex US used to detect in stroke?
Carotid stenosis: Endarterectomy is superior
-if 100% stenotic: no intervention surgically
How do you treat a Hemorrhagic Stroke?
No treatment: surgical draining does not help the outside posterior fossa
How do you treat a Nonhemorrhagic stroke <3 hours since onset?
thrombolytics
How do you treat a nonhemorrhagic stroke >3 hours since onset?
Some get thrombolytics up to 4.5 hours
Aspirin
Dipyridamole or Clopidogrel: if already on aspirin at time of stroke
What patients can receive Thrombolytics up to 4.5 hours after a stroke?
Age <80
NIH stroke scale <25
No hx of DM with previous stroke
No current use of anticoagulants
What is the best treatment if it has been >4.5 hours since the onset of stroke?
Clot removal via catheter: useful for up to 24 hours
What drug should be given to all stroke patients?
Statin: regardless of LDL to goal of <70
What is Closure of a Patent Foramen Ovale (PFO) indicated in stroke patients?
Right to Left shunt detectable by bubble study
Embolic-appearing cryptogenic ischemic stroke
