Stroke Flashcards
1
Q
what is the leading cause of permanent disability in adults
A
stroke
2
Q
what is the 3rd leading cause of death in North America
A
stroke!
3
Q
what time do strokes normally occur
A
in the morning between 8AM and 10AM
4
Q
age group most affected by strokes
A
over the age of 65
5
Q
which sex is more affected by strokes
A
males
6
Q
what race is affected more by strokes
A
African Americans more than Caucasians
7
Q
Reson why strokes often occur in the morning
A
due to blood pressure
8
Q
risk factors fro stroke
A
hypertension heart disease previous stroke or TIA carotid bruit diabetes mellitus smoking age
9
Q
number for risk of stroke in hyptertension
A
6 X
10
Q
number for risk of stroke in heart disease
A
2-6X
11
Q
number for risk of stroke in previous stroke/TIA
A
10X
12
Q
risk for stroke if carotid bruit
A
3x
13
Q
risk of stroke for smoking
A
2x
14
Q
age for stroke risk
A
doubles every 10 years after 55
15
Q
number one risk factor for stroke
A
hypertension
16
Q
examples of potential genetic risks factors for stroke
A
apolipoprotein e4
elevated homocysteine levels
factor V mutation
17
Q
hemorrhagic stroke types
A
intracerebral and subarachnoid
18
Q
types of ischemic strokes
A
atherothrombotic/embolic
cardioembolic
small vesel disease
19
Q
cardiogenic emboli strokes are commonly caused by
A
atrial fibrillation
20
Q
what type of emboli are usually larger, longer, lasting and MORE DAMAGING than other sources
A
atrial fibrillation emboli
21
Q
what is nonbacterial thrombotic endocarditis
A
condition where you develop clots in the heart because you have cancer somewhere else
22
Q
if both hemispheres are involved what should you look for
A
atrial fibrillation emboli
23
Q
what is a transient ischemic attack
A
last less than 24 hours, a sudden FOCAL neurlogical deficit that is confined to an area of brain or eye perfused bya SPECIFIC artery
24
Q
what is a RIND
A
reversible ischemic neurological decifit that lasts up to a week
25
Carotid TIA symptoms
unilateral weakness and numbness, aphasia, and monocular ision loss!
26
vertebrobasilar TIA symptoms
bilateral weakness, numbness and vision loss with a combination of diplopia, vertigo, ataxia, and dysphagia
27
partial or complete vision loss in one eye
amaurosis fugas
28
like a shade covered by eye
amaurosis fugax
29
how long does amaurosis fugas last
less than 5 minutes
30
embolic infract
seizure
focal deficit
sudden onset
hemorrhagic transformation
31
thrombotic infract
slowly progressive
| preceded by TIA
32
symptoms of internal carotid occlusion
usually asymptomatic if circcle of willis is well developed
33
hemiplegia, hemianesthesia (leg more affected than face and arm, urinary symptoms, apathy)
ACA occlusion
34
apathy associated with
ACA occlusion
35
urinary symptoms associated more with
ACA occlusoin
36
homonomous hemianopia indicative of
MCA occlusion
37
aphasia if dominant hemispher affected
MCA occlusion
38
hemiplegia and hemianesthesia of face and arm more than leg
MCA occlusion
39
PCA occlusoin
homonomous hemianopia, hemiplegia, hemiparesis, affects the peduncles and brainstem
40
also known as nonfluent, expressive or anterior aphasia
brocas aphasia
41
characterized by broken difficulties producing speech but understanding is intact
brocas aphasia
42
also known as fluent, receptive or posterior aphasia
wernicke aphasia
43
characterized by impaired comprehension, paraphasia, neoglisms and gibberish
wenicke aphasia
44
lesion of posterior perisylvian region produces what type of aphasia
wernicke aphasia
45
lesion of the arcuate fasciculus leads to
conduction aphasia
46
common symptom of conduction aphasia
difficulty with reptition
47
type occlusion resulting in global aphasia
MCA occlusion
48
small vessel disease is also known as
lacunar infracts
49
presentation of lacunar infarcts
```
pure motor
pure sensory
pseudobulbar palsy
clumbsy hand
hemitaxic-hemiplegic
```
50
how are lacunar infarcts diagnosed
clinical syndrome
51
what are risk factors for small vessel disease
hypertension and diabetes
52
recurrence rate of lacunar infarcts is high if what
if blood pressure is NOT controlled
53
what is used to diagnose lacunar infarcts
MRI's NOT CT SCAN!!!
54
how are lacunar infarcts treated
control blood pressure
antiplatelet agents
carotid endartectectomy
55
what are some common causes of a carotid dissection
migraines
oral contraceptive in smokers
cocaine and vasoactive agents
56
third nerve palsy and contralateral hemiplegia from midrain stroke
weber syndrome
57
occlusion of verteral or PICA resulting in ipsilateral facial numbness, ataxia, horners, dysphagia, hoarseness, loss of taste, numbness, and CONTRALATERAL pain and temperature
wallenberg syndrome
58
what should you do to prevent ischemic penumbra from growing
relative hypotention
hypoxia
hyperglycemia (over 200)
hyponaturemia
59
what are neuroprotetive agents for ischemic penumbra
NMDA, NO, GABA, calcium, and free radicals
60
examples of antiplatelet agents
aspirin
ticlopidine
clopidogrel
dipyridamole (modofied release)
61
which antiplatelt drug requires monitoring
ticlopidine (neutropenia and thrombocytopenia)
62
what drug is used to lower cholesterol
pravastatin
63
anticoagulative drugs
heparin
64
lowering cholesterol drugs
pravastatin (normal LDL<70)
65
patients with asymptomatic carotid stenosis
60% stenosis did better with surgery
66
symptomatic carottid stenosis
greater than 70% stenosis did beter with surgery
67
asymptomatic carotid stenosis approach
control risk factors
educate about TIA symptoms
cardiac workup
surgery if indicated
68
what are the indications for anticoagulation
progressive TIA
known source of emboli
Afib
hypercoagulable states
69
what are some contraindications of for haparin
sensitivity to heparin
bleeding
uncontrolled hypertension
large infracts
70
what are some complications of heparin therapy
```
hemorrhage
excessive anticoagulation
hypertension
large infracts
embolic infarcts
thrombocytopenia
```
71
what is TPA
converts plasminogen to plasmin resulting in fibrinolysis and must be used within the first
72
what drug do you use first to control someones blood pressure before administrating TPA
labetalol
73
what are the features hypertensive encephalopathy
headache, confusion, seizure, and focal deficit
74
what is transient global amnesia
sudden loss of memory that occurs in middle age to elderly that's cause ins most likely vascular in nature with a benign prognosis
75
what decades are associated with giant cell arteritis
6-8th decades
76
features of temporla arteritis
headache, fever, anorexia, blidness and tender artery and aching stuf muscles
77
treatment of temporal arteritis
self limited, steroids
78
what are the causes of idiopathic intracranial hypertension
pregnancy
sinus thrombosis
obesity
vitmain A, old tetracycline and steroids
79
features of IIH
headache, papiledema, Cranial Nerve 6 Palsy
80
spinal tap pressure greater than 250 indicates
increased pressure
81
how do you treat idiopathic intracranial hypertension
self limited, diruetics, surgerym succcessive spinal taps
82
venous thrombosis caused by
idiopathic, pregnancy, trauma, infection, tumors, oral contraceptives, malnutrition, hematological
83
features of venous thrombosis
papilledema, seizures, cranial nerve deficits, proptosis, chemosis, and focal deficits
84
located in the white matter and is associated with a tumor or hematoma
vasogenic edema
85
result of cellular swelling and involves both the gray and white matter and is associated with hypoxia and infraction
cytotoxic edema
86
how do you treat cerebral edema
hyperventilation
mannitol/glycerol
steroids
diruetics--pee off the fluid
87
what is the most common cause of intraparenchymal hemorrhage
hypertension due to rupture of small penetrating arteries
88
location of intraparenchymal hemorrhage
putamen, thalamus, pons cerebellar lobar
89
blood in CSF is indicative of
subarachnoid hemorrhage
90
95% of subarachnoid hemorrhages are located in the
anterior circulation
91
what two diseases are associated with subarachnoid hemorrhage
polycystic kidney disease and coarctation of the aorta
92
clinical features of subarachnoid hemorrhage
sudden worst headache of life, nuchal rigidity, alert to coma, focal deficits, and may have warning leak
93
Hess and Hunt grading scale type 1
asymptomatic, slight headache
94
Hess and Hunt grading scale type 2
moderate to severe headache; nuchal rigidity
95
Hess and Hunt grading scale type 3
drowsy, mild focal deficits
96
hess and hunt graiding type IV
semicomatose, posturing
97
hess and hunt grading type V
deep coma, decerebrate rigidity
98
complications to subarachnoid hemorrage
vasopasm
rebleeding
hydrocephalus
99
diagnosis of subarachnoid hemorrhage
H and P
CT scan
lumbar puncture
angiogram
100
nimodipine
calcium channel blocker that has been shown to prevent vasospasm from happening due to subarachnoid hemorage
101
treatment of subarachnoid hemaorrhage
nimodipine, bed rest, sedation, control bp, stool softener, pain, surgery, coiling
102
caused by septic emboli which lodges and weakens the blood vessel walls and is associated with bacterial endocarditis
mycotic aneurysms
103
what should you NOT DO WITH mycotic aneurysms
do NOT anticoagulate
104
features of areteriovenous malformation
headache, seizure, bruit, and hemorrhage
105
lucid interval
epidural hematoma
106
laceration of middle meningeal artery
epidurla hematoma
107
type of hemorrhage where are most often comatose from the start
acute subdural hematoma
108
tearing of briding veins
acuete subdural hematoma
109
signs of subdural hematoma
blown pupil, hemiplegia, cushingg's reflex, and altered respirations
