Stroke

Question 1

2/3 of all ischemic stroked affect the _____ circulation.

Answer 1

Anterior

Question 2

What is the most commonly affected vessel?

Answer 2

Middle cerebral artery (MCA)

Question 3

S/S of MCA Occlusion

Answer 3

Contralateral hemiplegia in face/arm/leg
Homonymous hemianopsia
Aphasia
Confusion
Apraxia (can't follow instructions)

Question 4

Do posterior strokes have good outcomes?

Answer 4

No

Question 5

Posterior circulation stroke S/S

Answer 5

Vertigo
Diploplia, ocular palsy
Ipsilateral face and contralateral limbs
Dysarthria
Ataxia

Question 6

5 D’s of posterior stroke circulation

Answer 6

Dizziess
Diploplia
Dysarthria
Dysphagia
Dystaxia

Question 7

2 Types of ischemic stroke?

Answer 7

Embolic and Thrombotic

Question 8

Hemorrhagic stroke

Answer 8

Bleeding occurs from blood vessels within the brain
HTN or rupture
Generally more acute patients, deteriorate faster

Question 9

Wernike’s Aphasia

Answer 9

Receptive Aphasia
Posterior
Have trouble understanding language
Fluent, meaningless words
Unaware of language errors

Question 10

Broca’s Aphasia

Answer 10

Expressive aphasia
Anterior
Can understand, but cannot talk

Question 11

AVM

Answer 11

Atriovenus malformation

Can rupture and result in intracerebral hemorrhage

Question 12

Subarachnoid Hemorrhage (SAH)

Answer 12

RUpture of an artery with bleeding into the surface of the brain
#1 cause in aneurysm
AVM
10% idiopathic

Question 13

SAH S/S

Answer 13

Worst HA in life, radiates to face and neck
Progresses to maximal intensity immediately after onset
Phonophobia and photophobia
Papillary edema

Question 14

Intracerebral Hemorrhage

Answer 14

Rupture of an artery with bleeding into the brain parenchyma.
#1 cause = HTN
Can present similarly to ischemic stroke

Question 15

Transient Ischemic Attack (TIA)

Answer 15

Stroke like event lasting minutes to hours
The effects wear off completely when blood flow returns
Does not result in permanent damage

Question 16

More than ___% of pt’s that have TIA will go on to stroke.

Answer 16

33%

Question 17

Amphetamines and cocaine are associated with what type of stroke?

Answer 17

Hemorrhagic stroke

Question 18

What is the most common cause of aphasia?

Answer 18

Stroke

25 - 40% of stroke survivors acquire aphasia

Question 19

Global aphasia

Answer 19

Most severe form
Produce few recognizable words
Understand little or no speech
Can neither read nor write

Question 20

Anomic Aphasia

Answer 20

Persons left with persistent inability to supply words for things they want to talk about.
Understand speech, can read
Poor writing ability

Question 21

Is Broca’s Aphasia Anterior or Posterior?

Answer 21

Anterior

Question 22

What is the most frequent presenting problem for stroke survivors?

Answer 22

Hemiplegia

Question 23

Best INITIAL imaging for stroke pt.

Answer 23

Noncontrast CT

Later: MRI

Question 24

Left hemisphere controls?

Answer 24

Speech and language

Question 25

Right hemisphere controls?

Answer 25

Analytical and perceptual tasks

Question 26

What is the window of opportunity to treat stroke

Answer 26

4.5 hours | Pt must get to hospital in one for eval

Question 27

tPA

Answer 27

Tissue Plasminogen Activator Clot busting drug Treats ischemic strokes Must be given within 4.5 hrs of onset

Question 28

tPA exclusion criteria

Answer 28

Significant stroke/trauma in last 3 months Previous intracranial hemorrhage Intracranial neoplasm Recent intracranial/spinal surgery Arterial puncture at non-compressible site within last week

Question 29

What is the cut off BP for tPA?

Answer 29

>185 systolic or 115 diastolic

Question 30

What must platelet count be for tPA?

Answer 30

>100,000

Question 31

Discharge meds?

Answer 31

ASA Statin Anticoagulation? Plavix? AntiHTN