Stroke Flashcards
0
Q
Wallenberg ipsilateral (6)
A
Horner Nystagmus Ataxia Hoarse No facial pain
1
Q
Wallenberg aka.
A
Lateral medullary syndrome
2
Q
Wallenberg contra lateral
A
No limb pain appreciation
No limb temp spinal thalamus
3
Q
Anton aka….
A
Top basilar syndrome
4
Q
Patho of Anton
A
Occipital and deep
5
Q
Mortality rate of basilar
A
80 percent
50 with intervention
6
Q
Symptoms of Anton
A
Learning and menmory hippo Sleepy Mutism Can't see Can look to side Can look up
Dumb jock Anton
7
Q
What is the difference between a stroke screen and a stroke evaluation?
A
Stroke evaluation by speech therapist
8
Q
Why is everyone npo who is a stroke?
A
Aspiration pneumonia is a common complication
9
Q
What do you order for embolic stroke
A
Cardio consult
Heart monitor
Tee
Xeralto
10
Q
Order for low blood sugar
A
Glucose chewable 12g Dextrose 40% gel 15 g Glucagon inj 1 mg Insulin lispo Saline
11
Q
Starting Dose of Lipitor for stroke?
A
20mg
Can work at 10
Give provastatin 40
12
Q
Why no long term atypical antipsychotics
A
Increase risk for stroke
13
Q
How do you treat an acute ischemic stroke without TPA.
A
Into rectal aspirin 300 mg or Plavix 300 mg which is a loading dose.
14
Q
What is the dose of Lipitor for stroke.
A
20 limiter was a prudent 10 mg 80 mg is contraindicated. You don’t want to go to high with her because their limits might be too low.
15
Q
Why shouldn’t you get a CTA with a patient and INO
A
Doesn’t affect treatment. Get an MRI
16
Q
What is a good sign for prognosis of stroke.
A
Show recovery in 2 weeks good sign.
17
Q
Thalamus and motor deficit
A
4/5 real gets better
18
Q
What happens to reflex overtime with stroke
A
Starts upper motor goes away over time.
19
Q
Dose of Asa suppository. Order info for Asa
A
300 Asa suppository
Chew able 81
20
Q
Pupil problem with syphylis
A
Argyle Robertson.
21
Q
What did they do before ct for head aches.
A
Pneumocephalogram. Take out csf. Pump in air. X-ray
22
Q
How much csf do you make
A
150 cc every 8 hr 270 ml per day
23
Q
How much csf do you make per day
Per shift
Total volume
A
600 to 700/ day
125/shift
150 to 270 ml total
24
How often does an echo show anything in stroke
3%
| That is why it is on the care plan
25
How can you tell if edema is stroke or tumor
Tumors have fingers projections.
| Vasogenic
26
90 day risk with a Tia
17%
27
What percentage of of Tia have an intact
1/3rd
28
What are the two goals of imaging
1. Rule out bleed with ct or MRI
2. Assess risk factors stenosis and afib
Pump an pipes.
29
How helpful is lowering you blood pressure in preventing stroke
Reduces by 30 to 40 percent
30
Best treatment for blood pressure
Fruits
Vegetables
Weight loss
Clean living
31
Best med for blood pressure
Diuretic Ace i
32
How to approach someone with bp issue with stroke
Wait. 1 day and 120/80
33
What happens when you give statins with someone with low cholesterol
Bleed
34
When would be the only time that you go in with intervention with a basilar stroke
If it's a thrombus or in it within 24 hours- and it's miraculous
35
When can you start prophylaxis for ICH pt? What is tx
48 hr
| 5000 bid
36
What blood sugar should you
240
37
What do you see with SAH lumbar puncture
Rbc. 1000, does wash out
38
What do you see if you look at a SAH after 2 hrs.
ISO density
| So do lp
39
How do u categorizes SAH
Hunt and Hess 1- 5
40
On hunt Hess what signifies bad prognosis.
Grade 3 w/ mild focal paresis
41
What do you order with dx SAH
Angiogram is more sensitivity
MRI
Tox screen
Saline 80 to 100
42
How many people have more than 1 aneurysm?
15
43
Non aneurysm causes for SAH
Avm
Venous thrombosis
Vasculitis
44
% that rupture in 2 week SAH
20%
45
Peak for vasospasm with SAH
7 days
46
% of adults with aneurysm
2%
47
Risk of stroke with coil or clipping SAH
| Risk of rupture per year
2%
0. 7%
- big is bad
48
When do you treat SAH conservatively
Less than 10 mm
| Serial imaging
49
Most important precaution to tell a SAH
Don't smoke.
50
What doesn't SAH have compared to ICH and ischemic
No focal sign
51
Uncommonly found in ischemic.
Head ache
52
Define Tia.
No infarct
53
How long does it take to cause infarct
1 to 2 hrs
54
Why are Tia a term that is falling out of favor
Imaging is becoming more sensitive
55
5y risk with Tia
50 %
56
90 day risk for Tia
17%
57
Most important management step in Tia
Duplex ica
58
% of stroke that are cardio embolic.
15 to 30
59
Tell tail sign with cardio embolic cause
Sudden
| Maximum at onset
60
Syndromes associated with cardio embolic
Hemianopsia with out paresis
Wernicks
Apraxia
61
Large stroke causes eyes to..
Large. Stroke away
62
The mgt of algorithm depends on
Stroke mechanism
63
Eyes with brain stem
Eyes look toward brainstem lesion
64
Transient eye loss
Amaris fugus
65
Large vessel stenosis percentage
15 %
66
LOC is associated w brain region
brain stem
67
Tips for embolic stroke
Single branch territory
68
What do you call a atherosclerotic plaque
Atheroma
69
Atheroma rarely extends into.
Surface vessels
70
Causes of mainstream branch
Embolic vs. Atherostenosis
71
Term for narrowing of arteries d/t plaques
Local Artherostenosis
72
Mult. Lenticulaostriate branches. Licensure cz by
Embolic not Lucian
73
How to dx foramen ovale
Bubble test - 10 ml saline agitates
74
How to look at atria wall for pfo
Contrast Transophageal echocardiography
75
Large vessel stenosis dx w
Duplex Doppler
| Mra
76
Symptoms of large vessel stenosis
Shoulder is different than the hand
77
How to differentiate between inter arterial embolism and cardio embolic.
Intra arterial is smaller cortical than cardio embolic.
Cardio embolic decreases concious.
-cardio more likely to have an abnormal initial ct bc the clots from embolic are brighter.
78
What do u call it when fat breaks off and clogs an artery.
Embolic fragments arise from atherosclerotic plaques
79
Lacuna strokes account for %
15 to 20
80
Where do lacunae strokes occur
White matter in the subcortical area.
81
What brain region do lacuners occur in
Thalamus
Basal ganglia
Pons
82
Patho of lacunar
Lipohyalinosis on arteriolar wall
| -fibrinoid necrosis
83
Small fat clot and small blood clot
MicroatheromaMicroemboli
84
Percent of people over 65 with a silent lacunar
20 %
85
Associates with lacunar
Hypertension
86
How many small deep infarct syndromes
70
87
% of strokes that have an undetermined after workup
```
40 %
Aortic arch
Ct to early
Angio too late
Hyperagulation
Meds
```
88
Hyper coagulation states
```
Protein c
Protein s
Fibrinogen levels
Factor 5
Lupus
Anti cardio lipin
```
89
Symptoms of dissection vertebral and carotid
```
Neck trauma
Neck
Side of face
Teeth
Jaw
Retro orbital
```
90
"Beaded look"
Granulomatous angitis of the brain
91
What is granulomarous angitis
Mult. Small infarcts in cx deep structures
92
Csf and granulomarous anagitis
100 protein
| 500 mononuclear
93
Images for vasculitis
Arterial narrowing on angiography
94
Intravenous heparin indication
Large vessel Stenosis
Cardio embolic or large 6h out
Cud
| Vertebra basilar
95
If you don't do an endarterectomy what can you do.
Stent
| Monitor 3 to 12 mo
96
Risk with endarterectomy
| Improvement of stroke
3 percent
50 percent in 5 yr
9 vs 26% in 2 yr
97
What if some fails Asa
Aggrenox unless migraines
25 do pu rid a mole
200 mg bid
98
Why use clopidogrel
No headache 1 time per day
99
% of. ICH
15%
100
ICH volume that is fatal
80
101
ICH with good prog
20 ml
102
Cost of aggrenox
115/ mo
| Asa few dollors
103
Risk of bleeding on Asa
1.5%| yr/ gi dose dependent
104
What study showed plavix and Asa was not benificial.
Match
| Mgt of antherothrombosis clop in high risk
105
Is Asa plus dipy rid a mol
Yes twice as effective
| Esps2
106
What do you need to know about ticlopidine
Blood problems labs
| Less bleeding
107
If someone is allergic to a sprain with stroke
Clopidogrel
108
Reason for plavix with comorvidities
CAD
Peripheral artery disease
Smoking
Mi
109
If they fail on Asa 81 mg
Go 162 Asa or platelets
110
Study that compared warfarin and Asa were similar in afib
Warss
| But the pt were pretty sick
111
How does Asa work
Blocks cyclo oxygenate
Prevent prostaglandin
Thromboxane a2
From arachnid omit
112
M1 of mca supplies
Basal ganglia and internal capsule
113
Symptoms of aortic dissection
Neck pain
| Head pain
114
Cause of vertebral dissection leading
Vertebral artery dissection
115
Reason for plavix and Asa combo
Afib
116
Diagnosis carotid dissection
CTA can't if creatine high
Mra - can't if stim
Carotid last resort
117
Reason for plavix and Asa combo
Afib
118
Who has intra vs extra artherosclerosia
White are extra
| Hisp are intra
119
Do we give someone tpa who has a 10 that goes to a 5
Yes.
120
If you have an nih 1 or 2 what type of stroke
It is goig to be a lacunar
121
Problem synthesis of SAH
Man w/ severe headache, AMS, stiff neck, photophobia, cn 3
122
Why is previcol better than Lipitor
More lipophilic
123
Percentage who wake up with stroke
20 percent
124
How long does it take to get tpa if you call 911
84 min
125
How long does it take if you drive yourself.
270
| 3.5 hrs
126
When did tpa get approved by FDA
95
127
Why do some get worse after tpa.
Reocclusion
| 1/3 rd reocclusion early
128
Risk factor for bleed
```
Elevated fibrin
Baseline hyperglycemia
Nih score over 20
Major arteries
Severe neurological impairment
Violating thrombo lytic protocol
Fall
Not Asa
```
129
What happens if you give thrombotic after 12 hr
Cardiac rupture
130
Drug that is related to tongue edema anaphylaxis.
Ace inhibitor
131
What is heparin
Glucos amino glycans mixture
132
How does heparin work
Inactivated thrombin
By binding to anti thrombin 3
Inhibits factor 10 but activates 11
133
How does heparin affect platelet function
Platelet factor 4
134
What do you have to know about heparin and its anti inflation effects
Only in the infractionated form
135
How do you test heparin efficacy
APTT 1.5 times control
| Factor 10 .3 units/ml to .5
136
What reverses heparine
Prot amine sulfate
| 1mg counteracts 100 units of heparin
137
Why is heparin bad to use
Too variable hard to dose accurately. Weight bases.
138
How would you dose heparin
Weight based nomogram
139
Trick with administering prot amine
| What happens?
Give slowly bc it causes hypotension
140
Why is low molecular weight heparin better than unfractionated 5
1. Small - less bleed
2. More stable
3. Longer half life
4. No affect aPTT
5. Neuroprotective effects
No anti inflammatory effects
141
How to treat high blood pressure with stroke
Lab 10mg Iv over 2 min, doub q 10 min , max 300mg, can inf .5-2ng/min
Nicardapine. 5mg/ hr, inc by 2.5/hr q 5 min (max 15mg)
Nitroprusside .5 to 10 micron/kg/min
142
Plasma dose
10 to 20 ml
143
How do you fix fibrinogen levels
200 mg/dl of cryo
144
If tpa cause bleed! Oh shit
```
Stop tpa
Ct
Labs
Cryo and plasma
Neuro consult and heme
```
145
Percent of seizures after stroke
5 to 10
146
Percent of stroke complicates by dysphagia
45 percent
147
How long does dysphagia last
About a week
148
Image for arterial dissection
Axial t1 weighted image w fat suppression of neck
149
Do you need an echo if you know they have a fib
No. You are going to treat anyway.
150
How long after a stroke do you see central pain syndrome.
A month
151
Thalamic lesion cause what symptoms
Pure sensory hemi anesthesia
152
Name for loss of pin prick
Hemianalgesia
153
Name for no touch
Hemianesthesia
154
Anatomy of pseudo bulbar dementia
Subcortical dementia
155
What is weber syndrome
Contralateral weakness face, arm leg
| Ipsilateral cn3
156
Where is weber located anatomically
Midbrain
157
Where is foville's located
Pons
158
What is foville's symptoms
Contralateral weakness
Ipsilateral cn 7
Small pupils
159
Spinal cord lesions described as line
Sensory level
160
Browns sequard
Hemi cord syndrome
161
Symptoms of anterior horn ALS
```
Fasciculations
Upper extremity wasting
Spastic legs
Huperreflexia
Wasted uppers and hyper legs
```
162
Stocking glove distribution suggests what type of neuropathy
Poly neuropathy
163
How can you differentiate spinal level, acute cord and transverse myelitis
Traverse myelitis has hyper decreased ste and then later hyper reflex is
164
Can. Stroke cause Parkinsonism
Yes it is call vascular Parkinson's
165
Most telling sign of Parkinson's
One sided asymmetric.
166
Summary of Parkinson's
Asymmetric symptoms without cognitive, hallucinations pyramidal
167
Early signs of Parkinson's
Decrease blinking
Arm swing
Trouble with make up
Rolling over in bed
168
Early complains of pd
```
Hypophonia
Micrographia
Handling utensils
Shaving
Fine motor problems
```
169
Signs of diffuse Lewy body
Delirium
Hallucinations
Early dementia
170
Signs of supra nuclear palsy
Downward gaze palsy
Balance problems
Prominent neck rigidity
171
Signs of multisystem atrophy
Incontinence
Dysphagia
Orthostatic hyptension
172
Signs of corticobaasal ganglionic degredation
Asymmetric
Myoclonus
Apraxia
Alien limb
173
Test to differentiate Parkinson's
Pet shows hyper metabolism in the striatum of a true pet scan.
174
Which drugs neuroprotective for pd
Q10
Agilect
Perhaps senimet
175
Agilect aka
Ra SAg iline
176
What age is consided old that would receive sine my first line
75
177
Starting dose of sine met
25 bid
| Work up to three time a day
178
How does sinemet compare in efficacy to sinemet cr
70 percent
| So 70 short acting - 100 long acting
179
What happens if someone on sinemet cr get gi issue
Pretty common when old
| Switch to short acting
180
What if someone has Parkinson's who can't swallow.
Parcopa sublingal
| Disintegration tablet
181
What is stalevo
Carbidopa/levodopa/comt
182
Doses of stalevo
50 100 150
183
How is com pt inhibitor improve stalevo 2
Makes levodopa 1.3 time more effective
| Lasts longer
184
Starting dose of stalevo
50 tid
185
What is the max comt dose
1600 or 8 tabs bc all stalevo has 200 mg of comt
186
Side effect and percentage of stalevo
1 in 20 get diarrhea
187
Most common side effect of levodopa
Nausea and hypotension
188
What is the minimum dose of carbidopa pa per day
75/day
189
What if pt gets nausea with sinemet
Take with meals
Or add lodsyn or carbidopa
Take with ginger preparation
190
Tx for urinary problems hyperactive with Parkinson's
Detail la has fewer cognitive problems
Ditropan has more confusion
Check uti
191
Parkinson's hypo active bladder
Flowmax
192
What must you check before you give Detrol
Orthostatic
193
Treatment for orthostatic changes
```
Stockings
Dec dopamine drugs
Dec hypertension drugs
Fludrocortisone .1mg
Midrodrine 2.5 mg
```
194
Surgery for of tremor
Thalam otomy
-Ventral is intermediis thalamus
-part of thalamus that receives cerebellar afferent
-
195
Problems associated with bilateral thalmotomy
Dysarthria
| Speech issues 50%
196
Problem with unilateral pallidotomy
Only lasts 6mo to 2 year
197
Side effect of pallidotomy
Hypophonia
198
Problems with palli do tiny
Only works for Parkinson's with cardinal feature
They miss the gpi
199
The average improvement with deep brain stimuli
40 to 60 bilateral
200
Why can't crazy people get DBS
Your depression must be well controlled
201
Side effects of DBS bilateral
Confusion
202
Why would you only implant 1 DBS at a time
1 side might be all it takes
203
Treatment for essential tremor
Thalamic
204
Tx for DBS and Parkinson location
STM or gpi
205
What do you call it when we over treat high blood pressure
I at tro genic hypotension
206
How long does Todd paralysis last
20 min to 24 hr
207
How long does a seizure take to march
2 min
208
How long does a migraine take to march
10 to 30 min
209
Evidence for lacuna stroke
```
Stutter
Classic pattern
Straight forward
All sensory
All motor
All speech
```
210
When do you order a tee
When you are suspecting afib
| If you already know there in afib what is the point just anticoagulate
211
Small stroke is caused by
Lipohylinosis with clot formation
212
Most important part of treating small vessel
Cholesterol and plavix
213
Why is cea better than stent ing
Because stent ing has more risk of death
214
When to do stenting 2
Large stenosis w recurrent symptoms
| Or if on plavix cea not a candidate
215
Treatment with atherosclerotic aortic with mobility component
Warfarin
216
Cardiac sources of stroke
Afib
Ef 25
Wall motion
Pfo
217
What does pfo risk for
Atrial septal aneuysm
| Not a risk of stroke
218
How does statin work
Decrease inflammation assiciated with arherosclerotic
219
Enzyme assoc with statin
Hmg co at reductase inhibitor
220
Optimum bp after stroke
140
221
Three things to tell pt after tia
Stop smoking
Get bp down
Get cholesterol down
B
C
S
222
Treatment of high bp with stroke sys 180
Monitor
223
Bp control w tpa sys 231
Iv labetolol 20
224
Iv labetolol diastolic over 140
Nitroprusside
225
Bp and tpa dia 105
Lab 10
226
Systolic 180 bp and tpa
Lab 10
227
When does edema peak
3 to 5 days
228
After you give tpa what are you looking for
Any reason stop tpa, drop, and tpa roll
229
How do treat copd desat
Keep them at the baseline
230
Most deviates toon complication of stroke
Icp dt edema
231
Things that worsen icp with stroke
Heat co2 hypercapnia
232
Reversing edema with stroke to Prev uncle
Hypertonic saline
| Hypervent
233
When do you order an EEG to check for non convulsive status
Fluctuating consciousness
234
What do you call it when they have secret seizures
Non convulsants status epileptics
235
How common is a seizure after stroke
4 to 40; recurrent up to 80
236
When and how to prevent dvt
Start sq heparin 5000 bid
237
How to prevent bed sore
turn pt every 2 hr
238
How to treat bed sores
Wet to dry
239
How long do you delay using warfarin for cardioembolic
5 day asparin then start warfarin after ct
240
Explain hemorrhagic stroke transformation
If recanulization occurs
| Blood now can enter infect tissue. Which can lead tonic bleeding
241
When do we treat htn in pt patient wo tpa
Not for days unless over 220 or 120
242
Do we tx bp fast or slow
Slow use drip 10 percent
243
When so we treat glucose low
Below 80
244
Knowing temp can make stroke worse what do you do with stroke and fever
Tylenol
245
What percent of population US has a stroke
2.5%
246
What percent of pt w ischemic stroke get tpa
3 to 5 percent
247
What do you call it when you give tpa and the recover immediately
Lazarus effect
248
How many neurologists believe a stroke is worse than death
70%
249
How many die of stroke each year
160000
250
Hemorrhage explain
Bursting pipes
251
What is the differential for echolalia
```
Autism
dementia
schizo
Tourette's
Caratonia
```
252
Vertebrobasilar ischemic symptoms 4
Diplopia
Dysarthria
Dysphagia
Drop attacks
253
Defining meunière 3
Recurrent
Hearing loss
Tinnitus
254
What suggests brainstem issues
Slurred speech
Vestibular nuclei
Bilateral weakness
255
How often is stroke misdiagnosed in Ed
10 percent
256
What does a stroke scale emphasize
Lateralized motor findings
257
Ed misdiagnosed Tia
36 percent
258
What thiings distract you from making Tia diagnoses
Headache
Involuntary movements
Dizzy
259
Is syncope or seizure more common
Syncope
260
What percent o ischemic stroke are missed by MRI
2 perc
261
Occipital stroke treatment
CTA
Formal visual test ophthalmology test
OT
262
Having a stroke puts at what risk
5 fold more likely
263
Pure sensory stroke in lower face
Ventroposteromedial nucleus
Vpm nucleus
Pure sensory
264
What does gaze prefernce suggest
Large vessel
265
What does dysarthria plus arm weakness but alert and reaponding appropriate mean
Lacunar
266
If you can do an MRI after tpa what do you do
Repeat ct in 2 days
267
Pt e stroke and headache over 50
Esr
| Stroke
268
If you see episodic aphasia or visual issues
Think Tia
Think migraine
Think Tia
269
Who wrote and when did Alice in wonderland come out
Lewis Carroll
| 1865
270
What is Alice and wonderland syndrome
Migraine with Lilliputian hallucinations
| They believe their body parts are larger or smaller then they actually are
271
6 treatable risk factors
```
Htn
Heart
Alcohol
Smoking
Sugar
Fat
C
```
272
Where do aneurysm occur.
Bifurcation
273
Rupture means. Aka
App plebiscite
274
3 aspects of time course
Speed - sudden chronic
Subsequent - spread parts, modality
Multiplicity - frequency: recurrence
275
Value of multiplicity in Neuro
```
Spells - migraine. Seizure ms
Are the always the same seizure migraine
Per day - seizure
Per week - migraine
Per year - ms
```
276
What percent of lacunars have a tight carotid
8%
277
What cancer can mimic a stroke
Wedge shape Gliomas can mimic a small infarct
278
Vermis atrophy suggests
Alcohol
| Heel to shin is fine laying down but ataxic gate
279
Parietal stroke and arm drift
Arm drifts up
280
Cerebellar lesion and arm drift
Arm drifts lateral
281
What if there tremor during finger to nose gets better with eye closed
Proproception problem not cerebellar
282
Active study and a fib
Asa and plavix w small stroke for three weeks
Not someone going to nurse home
W small stroke
You need a compliant
283
How long does plavix take work
3 to 11 days
284
Percent who wake up with stroke
40 to 50 schoonover
285
Study regarding vertibrobasilar studying mortality
Ucla
286
How long is the plavix take to clear from the body
5 days
287
Regions involved in ataxia
Pons
| Cerebellar
288
How does Asa compare to warfarin
Asa reduces stroke by 20 percent
| Warfarin reduces by 60 percent
289
How long does it take for eliquis to clear enough for surgery
2 days
290
Percent of people with myopathy w statin
1%
291
Indication for Asa and plavix
Small stroke or Tia who is a good pt
| Afib with fall
292
Relative risk reduction of Asa for stroke
22% ischemic atc antirhromcotic trial it's collaboration
293
How sensitive is a tee
Very. Need an MRI to test it. If not on tee don't treat with warfarin
294
Do we put pt on Asa and Lipitor who has avm
No just put them on a statin, unless Neurosx says they coiled and say it is stable.
295
When do you use t2
Blood, not used often
296
What lights up in dw MRI
Stroke
Ms
Cancer
Seizure
297
How long do you let permissive htn
24 to 48. 48 is better
| 140 to.160 perfect
298
Left posterior cerebral artery distribution
```
No read, yea write
Alexia w/o agraphia
Poor color naming
Right sensory
Hemisensory bad
Motor strip is fine
```
299
RPCA issues
Neglect - parietal
Left sensory deficit
Visual neglect
300
Limitation of nih score
Light on cerebellar and cranial nerve
301
When/who nih scale
Brott 89
| Luden 99
302
How many items on nih scale
15
303
Max scale on MOHs
42
304
Indication for spinal tap w head
Sudden and severe
| Sucks to suck
305
How often do you see stroke mimics
30 percent of time
306
Can't read term
Alexia
307
What percent of cancer pt say there symptoms started 1 day ago
6
308
How does a tumor cz sudden symptoms 3
Seizure
Bleed into itself
Obstructive hydrocephalus - mass effect
309
How common are stroke mimics %
19 to 31%
310
Most common stroke mimic is
Postfix yak 21 %
311
What do u call it when a stroke mimics something else
Stroke chameleon
312
Define encephalopathy
Diffuse hemispheric dysfx
313
What type of stroke mimics encephalopathy
Strokes hitting the limb ic cortex
| Orbitofrontal
314
Def pseudo encephalopathy
Focal ischemic injury to the temporal or orbital that look like confusion
315
What strokes cz chest pain4
Thalamic
Coronia radiata
Lateraledullary
316
What peripheral nerve can be involved in strokes
Radial
| Ulnar
317
What gives you high suspicion in stroke
Sudden
| Risk of cv issues
318
Can a stroke cause distal weakness
Yes, focal cerebral ischemia
319
What is dot sign
Hypersensitive in sylvian fissure
320
How long do you wait for a large hemorrhagic stroke before you start an anticoag like eliquis
10 to 14 days
321
Explain smile and basal ganglia and cx stroke
```
BG = involuntary
Cx = voluntary
```
322
If you think you see a little bleed on ct but aren't sure
MRI gradient echo
| Pain to order
323
What is the difference bw brain arteries vs cardio blood vessels
Brain has fewer laminar more fragile
324
Explain expressive aphasia w a rmca stroke in a right hander
Mechanical
| Speech association center
325
What are the odds of havin a bleed in a healthy brain, say a psych stroke pt
Less than 1%
326
How do cancer cells cause strokes
They release pro coagulation factors
327
Causes of thrombosis 6
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Artherosclerosia mcc
Dissection
Fibromyscular
Vasospasm
Inflammation
Infection
Radiation
Moyamoya
```
328
What is responsible for large subcortical infarcts
Microatheroma which is a plaque that clots the entire penetrating artery
329
Fibroid necrosis assoc w
Htn
| Granulated eosinophilia
330
Focal dilation in small vessel wall
Charcot Bouchard aneurysm
331
Local tissue pressure is influenced by what in a stroke
Collaterals and blood pressure increase
| -edema lowers local tissue pressure
332
How much do you have clamp you artery to see neurological signs
50 suddenly
333
How much do you have to clamp the ica to see permanent neurological effects
30% acutely
334
How low does cbf have to drop to street slow down
23ml per min
335
Mehta data suggest cea are effective
Synonym 77
336
What are we hoping the cbf maintains at during a 3 hr mca occlusion
More than. 5ml per minutes
337
What is the minimum amount of cbp nesssary to maintain the brain for three hours
Over 18 ml per 100 mg per min
338
What is term for ischemic intolerance
Blood flow thresholds
339
Does white or gray matter have lower ischemic threshold
Gray has lower ischemic threshold
| Die quicker
340
Define penumbra
Hypo perfumed but viable
| Like a fetus has potential
341
What does ischemic penumrum represent
Functional impairment but structurally intact
342
Easy way to explain the penumbrum
Salvageable tissue
343
What term is for mild hypoperfused tissue effective below 22 ml mg min
Oli gemia
344
Importants of oligemia
If you drop blood pressure oligemia tissue dies or fever acidosis
345
Why does penumbra shrink over time
Over time the penumbrum turns into the core
346
What state is the penembrum
Transitional state life or death
347
What happens to the penumbra electro physiologically
Continuous firing making it metabolically unstable
348
How do you measure penumbra
You need an MRI. Subtract dwi minus perfusion weighted
Dwi vs pwi
At risk tissue
But is not accurate dt dwi not able to dis derm what is reversible
349
How large is the penumbrum
40 percent
350
Does the size of the core or penumbrum affect out come
Core is the real problem
351
Term for frequency
Poll aquaria
352
Can you get loc with Tia
Not likely
353
What protease plays a bug role in destroying the bbb
Metalloprotease 9
354
What protease increases the risk of transformation after tpa
Mettaloproteinase 9
| Mergenthaler 2004
355
What comprises neurovascular unit
Neuron
Astrocytes
Endothelium
356
When did tpa first get approved by FDA
1996
357
What 2 studies randomized studies provide evidence for tpa
NINDS study (nat institute of Neuro dz)
Stroke rt pa stroke study
Phase 3
358
What study support intra arterial tpa delivery
Furlan. 99
359
What thrombo lytic came out in 99
Prourrokinase
| But thee was only 1 study
360
When was intra artery delivery become approved
99 furlan
361
When was merci retriever approved
2005
362
What evidence supports the merci retriever
Single arm phase 2 trial
363
What is Iv tpa in acute ischemic stroke
Cornerstone of evidence based
364
What percentage of ischemic stroke pt are disabled after a stroke
50 percent
365
How many patient do you need to treat to save 1 from disability
1 in 8. Ninds 95
366
How many pt do you need to treat to see any improvement.
1 in. 3
367
What the ninds study only study that looked at stroke
No, graham 2003
368
What evidence suggests faster administration works better
Hacke 2004
| Marler 2000
369
How does ssri help stroke patients
Decreases inflammation associated w glia
| More hopeful
370
Why don't we give anticoags in stroke
Risk of stroke to high
371
Mnemonic for modifying risk factors for stroke
```
Abc old
Age
Bp
Cigs
Obesity
Lipids
Dm
```
372
What can infarct the basal ganglia bilaterally
Leigh's disease
Prop ionic academia
Carbon monoxide
Cyanide
373
What is delta sign and what does it suggest
Thrombus at occipital at intersection of transverse and Sagittal and strait
374
How often is htn related to hemorragic
50
375
How doe a angio pathy lead to hemorrhage
Amyloid deposit along vessel wall in lobes
Weakens the vessel
Requires biopsy
376
How accurate can cus be?
Off by 20%
377
What percentage of syncope is cause by stroke
5 to 10
| Reticular activating
378
Classifying strokes
Location
Ischemic vs hemmorrhage
Thrombotic vs. embolic
Large vs small
379
What does lacunar mean
Lakes small
380
Example of artery to artery embolic
Stenosis segmented if ica
381
What is danger of patent foramen ovals
Venous clots can skip lung and go straight to the brain.
382
Do thrombotics affect large vessels
Yes. Only proximal
383
Stroke risk factors 6
```
Prior stroke
Htn
Dm
Family
Hx
Hypercholesterolemia
```
384
Young stroke differential
Dissection
| Pfo
385
TIA aka
Brain attack
386
Class of drugs of tpa
Thrombolitic
387
What did they used to give stroke pt's That didn't get tpa
Heparin drip
388
What do you call lacune that knocks out sensory and motor
Sensorimotor
| Tha lam o capsular
389
Sensory stroke
Ventral posterior lateral
| Vpl thalamus
390
Of people give tpa how many were mimics
3% experienced
21 percent- cher ny shev nonexperienced
Seizure
Migraine
Conversion
391
Percent of strokes with troponins elevated
Up to 1/3rd
392
If you dont know if seizure or stroke
Ct perfusion
393
How sensitive is the cincinnati stroke scale
78 percent
