stroke

Question 1

def. acute stroke

Answer 1

• sudden loss of brain function
• interuption of blood flow
• loss of O2 and glucose to brain
• ischemic of hemmoragic

Question 2

def. TIA

Answer 2

self-limited episode of neuro dysfunction

- not associated with cerebral infarction

Question 3

biggest risk for stroke

Answer 3

age

- stroke rate doubles each decade after 55

Question 4

how has aging and deaths due to strokes changed over time

Answer 4

age of pop going up, but deaths going down (better care)

Question 5

how will this change in future

Answer 5

interventions will plateau and deaths up again

Question 6

impact of stroke

Answer 6

1% of canadians

3% of heath $

Question 7

how are stroke and TIA localized

Answer 7

to a single vascular territory

Question 8

2 keys to understanding stroke localization

Answer 8

1. 4 major arterial territories

2. understanding underlying anatomy

Question 9

what is origin of all cerebral blood supply

Answer 9

A arch

Question 10

2 main branches

Answer 10

1. internal carotid

2. vertebral

Question 11

3 main vascular territories and the supply vessels

Answer 11

1. brainstem
   - basilar and vert. arts.
2. cerebellum
   - PICA
   - AICA
   - SCA
3. main cerebral
   - MCA
   - ACA
   - PCA

Question 12

2 deep brain structures and what supplies them

Answer 12

1. basal ganglia - MCA and perf.

2. thalamus - top of basilar and PCA perforating

Question 13

what is ACA territory and effect of ischemia

Answer 13

• medial frontal and parietal lobes

- contralateral hemiparesis and anathesia- leg more

Question 14

what is MCA territory and effect of ischemia

Answer 14

supply: lateral frontal and parietal + superior temporal
ischemia:
- contralateral hemiparersia and anasthesia face, arm>leg
- contra homonymous hemianopsia
- conta hemineglect and ipsi gazw deviation
- lagnuage impairment if on dominant side

Question 15

what is PCA territory and effect of ischemia

Answer 15

supply - inferior temporal and occipital
ischemia
- contraleteral homonymous hemianopsia

Question 16

what is basilar territory and effect of ischemia

Answer 16

supply - pons and midbrain
ischemia
- tracts to contrlateral
- nuclei to ipsilateral

Question 17

what is brainstem territory and effect of ischemia

Answer 17

• both tracts and nuclei - crossed face/body deficits

Question 18

what are 2 cerebellar syndromes

Answer 18

1. vermis (central) - gait ataxia and truncal instability

2. lateral - ipis limb ataxia

Question 19

what is effect of small vessel

Answer 19

• perfuse deeper structures

- result in small discrete lesions causing classic syndromes

Question 20

lacunar affects of internal capsule, basal ganglia

Answer 20

all contra

• pure hemi-motor
• pure hemi- sense
• hemi sensimotor
• ataxic hemiparesis
• dysarthia/clumsy hand syndrome

Question 21

lacunar thalmic effects

Answer 21

contra sensory loss

Question 22

mech of ischemia

Answer 22

insufficient blood flow leading to irreversible damage

Question 23

4 main etiologlies of ischemia

Answer 23

1. thrmobosis
2. embolism
3. hemmorage
4. hypoperfusion

Question 24

def. thrombosis

Answer 24

formation of clot or throbus in artery - triggered by pathological endothelium

Question 25

most common location of atherscleosis causing stroke

Answer 25

internal carotid

Question 26

def. embolsim

Answer 26

formation of clot in another area that breaks off and travels to brain

Question 27

2 common sources of embolism

Answer 27

1. artery-to- artery - atherosclerosis | 2. cadiac to artery - A fib, valvular disease

Question 28

2 common causes of hemm

Answer 28

1. uncontrolled or spike in HT | 2. amyloid angiopathy - weakens vessel walls

Question 29

proportion of stroke etiology

Answer 29

hemm 12-15% , rest is ischemia

Question 30

2 main ischemia etiologies

Answer 30

1. atheroscleoris - 45% | 2. cardiogenic - 20%

Question 31

modifable risk factors

Answer 31

- HT - diabetes - hyperlipid - smoking - obesity - sedentary diet CAD - heart disease

Question 32

non-modifiable risk factors

Answer 32

- ages - male - fam Hx - genes

Question 33

most important modifiable risk factor

Answer 33

HT

Question 34

what are HT targets

Answer 34

140/90 or 130/80 for diabetes

Question 35

what is blood target in diabetes

Answer 35

A1C

Question 36

2 treatments of lipids and their effects

Answer 36

fibrate - reduce chol, but no effect on stroke | statins - reduce LDL and most effective

Question 37

what is effect of statins

Answer 37

- 25% RRR | - each 10% redcuction in LDL = 13% reduction in stroke

Question 38

what are primary and secondary targets for stroke prevention

Answer 38

primary - framingham | secondary - LDL

Question 39

what is major cardiac risk factor

Answer 39

A fib - more severe strokes

Question 40

what is use of anticoag

Answer 40

reduces stroke risk in A fib

Question 41

what to use for anticoag

Answer 41

warfarin - 66% RRR | ASA - 19%

Question 42

what is doing of warfarin

Answer 42

keep INR @ 2-3

Question 43

what is advantages to new anticoags

Answer 43

- no INR to monitor - standard dosing - need good renal funct

Question 44

what is risk of TIA

Answer 44

high risk for stroke in next 90 days

Question 45

5 things to do after TIA

Answer 45

1. treat HT 2. start statin 3. screen for diabetes 4. antocoag 5. lifestyle mods

Question 46

what to do to prevent thrombus formation

Answer 46

antiplatelets - ASA - absolute benefit small - but cheap and minimal adverse effects

Question 47

what is standard dose of ASA

Answer 47

anything over 30mgis good - standard is 81

Question 48

2 other options

Answer 48

1. aggrenox | 2. plavix

Question 49

what is first and second line anitplatelet therapy

Answer 49

1st - ASA 2nd - plavix daily or aggrenox BID - used if had stroke or TIA on ASA

Question 50

2 treatments for carotid disease

Answer 50

1. endartectomy | 2. stent

Question 51

when to do endartectomy

Answer 51

stenosis > 70% - any time will benefit | 50--59% - need to do in 2 weeks

Question 52

what is diff. between endartectomy and stent

Answer 52

no diff up to age 70, then end is better

Question 53

what is time for thrombolysis

Answer 53

4.5H of stroke onset