STROKE Flashcards
(125 cards)
1
Q
score to determine hospital admission in TIA
A
TIA ABCD2 score
2
Q
TIA score to warrant admission
A
more than 3
3
Q
T or F: Medication is more important than BP lowering in primary stroke prevention
A
F
4
Q
SBP reduction in stroke
2mmHg
3mmHg
5mmHg
A
6,8, 14%
5
Q
First major trial to see effect of anit-HPN in stroke
(indapamide vs pla, 30% RRR
A
PATS (post stroke anti-HPN study)
6
Q
PRoGRESS
A
ACE inhibitor-based management in BP lowering for secondary stroke prevention
7
Q
No difference in SBP of 130 or 150 in composite outcome of stroke, MI and vascular death
A
SPS3
8
Q
Which is associated with higher risk of stroke?
Pre-DM or DM
A
Pre DM
9
Q
RR of stroke among pts with DM
A
1.6x higher
10
Q
in rTPA treated pts, OR of ICH in DM vs non-DM
A
6.73
11
Q
BP target for primary prevention of stroke among DM pts
A
<140/90
12
Q
elderly + ischemic stroke + secondary prevention stroke: increased risk
A
60%
13
Q
Lipid index associated with inc rsik of stroke
A
LDL
14
Q
Mechanisms of statins for stroke prevention
A
- dec inflammation
- promote angiogenesis/neurogenesis
- upregulate tPA
15
Q
risk reduction of 80 mg/day of atorvastatin vs pla in SPARCL
A
16%
16
Q
risk of stroke within 2 weeks from recent MI
A
5%
17
Q
stroke highest in MI of whot myocardial wall
A
anetro apical, by 20%
18
Q
risk of stroke in pts with MI and thrombus
A
10-20%
19
Q
risk reduction of stroke for pts with thrombus on ASA vs ASA+Warfarain
A
19% vs 29%
20
Q
duration of treatment of pts with CVD and mural thrombus
A
3 mos
21
Q
indications of anti-coagulation in pts with MI
A
AF, EF less than 28%, LV thrombi
22
Q
associated with inc risk of stroke and arterial emobolization with LA appendage thrombus or LV mural thrombus
A
restrictive CM
23
Q
risk of stroke in vlavular heart dse
A
no ASA: 4x
on ASA: 2x
on VKA: 1x
24
Q
kind of stroke associated with MVP
A
TE (2%)
25
risk of CVD among pts with prosthetic heart valve without AF
20%
26
INR for diff generation of valves accdg to ESC
```
1st gen 3-4.5
2nd gen: 3-3.5
2nd gen in the aortic position: 2.5-3
mechanical prosthetic valves: 2.5-3.5
bio-prosthetic: 2-3
```
27
stroke reduction in pts with asymptomatic carotid artery stenosis (more than 60%)
11.8% in medical vs 6.4% in CEA+medical
28
ARR of pts >70% CAS with Sx
5.6 for 2 years if surgery done in 2weeks
29
CEA vs stenting+ angioplasty on periprocedural stroke and MI
MI less in: ______
stroke greater in _______
angioplasty
CEA
30
CREST:
risk for stroke >> ______
risk for MI>>>________
CAS
CEA
31
Incidence of ICAD in asians
37%
32
trial showing that 3.5% risk of stroke among asymptomatic pts with ICAD
WASID
33
Findings of WASID trial:
ASA is more effective vs Warf in stroke prevention (19.7 vs 17.2%)
34
Antiplateletet trials with outcomes relating tp neuroimaging and TCD in ICAD
TOSS
TOSS2
CLAIR
35
ASA + Cilos (100BID) >>>ASA in prevention of ICAD as seen in MRA at 6 mos
TOSS
36
ASA+ Cilos=== Clopid (non-significant trend)
TOSS II
37
risk of stroke among pts with PAOD
40%
38
trial that men with PAOD have 4 to 5 times higher risk of stroke than without PAOD
Atherosclerosis risk in Communities
| ARIC
39
_________ indicated for pts with asymptomatic LE PAD to reduce cardiovascular ischemic events
ASA
40
_______ improve walking distance in pts with LE PAD
Cilost 100 BID
41
TRIAL
Acute ischemic stroke within 48hrs
ASA: 300
Hep: 5000u BID
Hep: 12,500 BID
ASA+HEP
ASA: fewer strokes
HEP: fewer deaths/recurrent stroke
IST
42
TRIAL
AIS within 48hrs
ASA vs PLA for 4 weeks
ASA: reduced stroke and vascular death
CAST
| Chinese Acute stroke Trial
43
TRIAL
AIS within 24 hrs minor ischemic stroke
Clopid 300 LD then Clopid 75mg OD+ ASA 75mg OD for 21d then Clopid for 90d
vs ASA for 90d
recurrent stroke
Clopid-ASA: 8.2%
ASA:11.7%
CHANCE
44
TRIAL
AIS of less than NIHSS 15
ASA 300 vs Cilos 200 for 90d
non-inferiority outcome
CAIST
45
for every 1C inc in temp, RR of death increases by____-
2
46
hypothermia reduces infarct size by
44%
47
mechanisms of Citicoline
for membrane repair
inhibits PLA2
reduces cytokines and free radicals
48
TRIAL
AIS within 12 hrs
IV Cerebrolysin 30cc for 10d vs pla
no diff in functional outcome
Post hoc: favorable trend in NIHSS more than 12
CAISTA
cerobrolysin in AIS in Asia
49
TRIAL
mod to severe stroke within 24hrs
Citicoline 1g IVq12 for 6 weeks
ICTUS
50
TRIAL
AIS, intermediate severity
NeuroAID 4x TID for 90d
no diff in MRS
Trend of benefit: if given more than 48hrs
51
Dose of Heparin in AIS, CE_____
aPTT levels
600-800 u/hr
1.5x to 2.5x the control
52
Contraindications for RTPA in stroke
Contraindications to Tissue Plasminogen Activator in Stroke SHIP BLAST
```
S: Stroke in last 3 months
H: Head injury in last 3 months
I : Intracranial hemorrhage
P: PT > 15 sec
B: BP > 185/110
L: Lumbar puncture in last 7 days
A: Anticoagulants use / Arterial puncture in last 7 days
S: Surgery within last 14 days
T: Thrombocytopenia < 100,000
```
53
during RTPA, SBP of >230 or DBP >121-140, give _______
LAbetalol 20 mg IV for 1 hr
Nicard 5 mg/hr
Nitroprusside
54
What to give in ICH post thrombolysis
cryoppt: 6-8u
Platelet: 6-8u
55
exclusion criteria for rtpa at 4.5 hrs
>80 y/o
on OACs
NIHSS >25
hx of ischemic stroke and DM
56
TRIAL
AIS <3 hrs
RTPA vs PLA
outcome: RTPA group are 30% more likely than controls to have min disability at 3 mos
NINDS
57
TRIALS
AIS <6 HRS
TPA: 1.1mg/kg vs PLA
109 protocol violations
ECASS
58
TRIALS
AIS <6 HRS
TPA: 0.9 mg/kg vs PLA
no diff in outcome at 3 mos
ECASS II
59
ATLANTIS A
AIS <6 HRS
TPA: 0.9 mg/kg vs PLA
no diff in outcome at 1 and 3 mos.
Inc ICH to those treated in 5-6 hrs
60
TRIALS
ATLANTIS B
AIS <6 HRS
TPA: 0.9 mg/kg vs PLA
no diff in outcome at 3 mos.
risk of ICH higher in rtpa
61
TRIALS
AIS in 3 hrs
RTPA 0.6 mg/kg
36.9 achieved MRS of 0-1 in 3 months
J-ACT
62
TRIALS
AIS in 3-4.5 hrs
TPA: 0.9 mg/kg vs PLA
TPA group had favorable outcome in 3 mos
no sign diff in ICH in both groups
ECASS III
63
TrIals for BP control in ICH
INTERACT
| ATACH
64
TRIAL
rend to less hematoma growth in 24 hrs with BP goal of less than 140
INTERACT
65
TRIAL
Early BP lowering in ICH with Nicardipine is safe
ATACH
66
TRIAL
SBP lowering to <140 vs <180 within 6 hrs
no difference in primary outcome bet two groups
67
In hemicraniectomy, when should the flap be replaced
12 weeks
68
In hemicraniectomy, decrease in ICP from
removal of flap:
removal of dura:
15%
70%
69
improvement of MR in decompressive vs medical
67-84%
20-30%
70
TRIALS FOR HEMICRANIECT
DESTINY, DECIMAL, HAMLET, HEADFIRST, HEMMI, DESTINY II
71
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: symptomatic atherosclerosis on ASA 50-1500 mg/day
O: 23% odds reduction in stroke, MI, death
ATC
| antiplatelet trialist collaboration
72
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: pts with TE stroke
I: Ticlodipine 250mg BID vs PLA
O: Tic reduced MI, stroke, death by 30%
CATS
| Canadian American Ticlodipine Study
73
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: pts with recent TIA/stroke
I: Ticl 250 BOD vs ASA 1300 mg/d
O: Tic reduced risk of stroke by 12% vs ASA
TASS
| Tic ASA stroke study
74
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: pts with atherosclerotic dse
I: ASA 325 vs Clopid 75
O: Clopid reduced ischemic stroke vs ASA by 8.7%
CAPRIE
| Clopid vs ASA at Risk for Ischemic events
75
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: pts with TIA or stroke + RF
I: ASA-Clopid vs Clopid
O: no diff in outcome, worst bleeding in combu
MATCH
76
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: pts with clinical events or RF
I: ASA-Clopid vs ASA
O: No sig diff in outcome but trend to benefit in symptomatic pts
CHARISMA
77
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: pts with symptomatic lacunar infarction
I: ASA 325+ Clopid75 vs ASA 325
O: 3.4 yrs, recurrent stroke no diff bet groups
SPS3
78
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: Hx of cerebral infraction
I: PLA vs Cilos 100BID
O: Cilos reduced stroke by 41.7%
CSPS
79
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: Hx of CVS in 26 weeks
I: Cilos vs ASA in 1-5 yrs
O: non-inferior, headache tachycardia and diarrhea more in Cilos
CSPS2
80
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: stroke, TIA
I: ASA+ Dypiridamole 225mg/d vs PLA
O: ASA+DYP reduced stroke by 33%
ESPS1
81
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: stroke, TIA
I: ASA 25 BID vs ER-DP 200BID vs PLA
O: ASA+DYP:37% ASA 18% DYP: 16%
ESPS2
82
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: recent stroke, TIA
I: ASA 30-325 mg/d +DYP vs ASA
O: Stroke, MI, death dec by 20% in ASA_DYP
ESPRIT
83
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: CVD in the past 120 days
I: ASA+DYP vs CLOPD
O: similar recurrent rate of stroke
PROFESS
84
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: stroke TIA in the past 6 mos
I: ASA 325 vs Triflusal 600 for 30 mos
O: similar efficacy, Triflusal lesser bleeding
TACIP
85
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: stroke TIA in the past 6 mos
I: ASA 325 vs Triflusal 600 for 28 mos
O: no diff in outcome
TAPIRSS
86
TRIALS FOR ANTI-PLATELET IN SECONDARY STROKE PREVENTION
P: isch stroke, non-CE
I: Warf INR (1.4-2.8) vs ASA 325
O: no diff in outcomes
WARSS
87
Reduction of stroke in NVAF CE CVD
ASA:______
Warf:______
24 vs 64%
88
Time on Ther range for Warf to be effective: _______
>60%
89
Mechanism of NOAC
Dabig:
Rivarox
Apix
DTI
Xa Inh
Xa Inh
90
Half life
Dabig:
Rivarox
Apix
14-17 hrs
5-9hrs
8-15 hrs
91
Studies of NOAC
Dabig:
Rivarox
Apix
RELY
ROCKET-AF
ARISTOTLE
92
for HR AF, CHADSVASC >2, alternative if VKA not available
ASA+CLOPID
93
Crea clearance for which NOACs not indicated
<30
94
Correlates with serum levels of NOACS
aPTT
PT
Dabig, Rivarox
95
for ICH
score that predicts hospital admission
FUNC
96
Sn of CT in SAH
12 hrs
24 hrs
6 days
98-100
93
57-85
97
if angiography negative for aneurysm, repeat in_____
7-14d
98
May be reasonable to reduce vasospasm
MgSO4
99
MR for AVM per bleed
10%
100
bleeding risk for unruptured AVM
2-4%
101
ICH lifetime risk in pt with AVM
105-pt's age
102
DWI signal can be seen as early as________
30 mins
103
ADC map continues to decrease in intensity upto _____ from stroke
3-5 days
104
Types of CRPS
Type 1:
Type 2
after illness/injury without overt damage
after distal nerve damage
105
% of stroke pts who develop post stroke pain
10.6%
106
First line of Tx for CSPS
LTG, AMitryptyline
107
First line of Tx for CSPS in elderly
Nortriptyline
108
treatment of CRPS post stroke
Bisposphanates
| Short course of prednisolone 30mg/d upto 12 weeks
109
post stroke epilepsy is highest in what subtypes of stroke?
multiple stroke: 7.7%
ICH:4.3
SAH: 4.2
110
which has a higher onset of SE and mortality, early vs late onset Sz
early
111
recurrence rate of late onset Sz in 5 yrs
50%
112
Prevalence of post stroke dementia
p 1 yr:
every yr after:
at 25 yrs:
30%
inc by 7%
48%
113
Imaging findings assctd with edema
silent infarcts
WMIC
Global and medial temp lobe atrophy
114
Imaging to detect multiple lobal hemorrhages characteristic of CAA
MRI with GRE
115
Incidence of SITY-STROKE
10-14%
116
MC cause of SITY
Arteriopathies
117
SITY after prolonged immobilization/ Valsalva
PFO
118
MC cause of thrombophilia associated with SITY
APAS
119
MC cause of ICH-SITY
AVM, cavernous angioma
120
MC cause of ICH-SITY
AVM, cavernous angioma
| others: HPN, CVT, MAP
121
duration of Tx of carotid artery dissection
3-6 mos
122
OCP if with RF for stroke
PO contraceptives
123
secondary stroke prevention for pts with APAS
ASA
124
Targery HbS for patients with sickle cell dse.
If BT cant be done, may give ____
<30%
HU
125
recent stroke + hyperhomocysteinemia
folate
