Stroke Flashcards Preview

Clin Med: Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (100):
1

small vessel lacunar infarct

can cause ischemic stroke
small infarcts in deeper part of the brain (basal ganglia, thalamus, white matter) and in brain stem

responsible for about 20% of all strokes

2

racial risk for stroke

blacks and Hispanics

3

ischemic stroke def

Stroke is acute neurological injury that occurs as a result of one of many pathologic processes
primarily brain ischemia (lack of oxygen) secondary to thrombosis (clotting), embolism or systemic hypoperfusion or brain hemorrhage secondary to ICH or SAH

4

3 main ways ischemia occurs

thrombosis
embolism
systemic hypotension

5

clotting occurs more often at

branching points in cervicocranial vasculature

6

common extracranial ischemic location

common / internal carotids

7

common intracranial area for ischemic

circle of willis and proximal branches

8

mian intracranial pathologies that lead to stroke risk

atherosclerosis
artery dissection
arteritis/ vasculitis
noninflammatory vasculopathy
moyamoya syndrome in younger pts
vasoconsctriction

9

moyamoya syndrome looks like __ on angiogram

puff of smoke
causes HA, TIA, migraines

10

extra cranial vessel pathologies

atherosclerosis
cervical artery dissection
takaysau Arteritis - inflammed BV
Giant Cell Arteritis
Fibromuscular dysplasia - rare

11

takayasu arteritis definition

seen in young/middle aged women of Asian descent
- vasuculitis that affects aorta and pulmonary arteries often pulses extremeities

12

Fibromuscular dysplsia is ___

non atherosclerotic non inflammatory which causes abnormal growth in arterial wall

13

lipohyalinosis

causes necrosis and decrease lumen diameter due to HTN or inflammation / dysfunction - common small vessel disease that affects intracerebral arterial system

14

common sites of lacunar infarcts

basal ganglia
internal capsule
thalamus
ons

15

embolisum causes __ sx

abrupt and maximal sx

16

high primary risk for ischemic stroke

left atrial thrombus
LV thrombus
A fib
Paroxysmal atrial fib
Mechanical valves/ Recent CABG
Infective endocarditis
dilated cardiomyopathy with poor EF (under 40%)

17

lower risk or uncertain risk ischemic stroke

cardiac source of embolism
aortic source of embolism
wall motion abnormalities
mitral annular calcification

18

watershed ischemia can lead to __ infarct

boarder zone infarction - occurs at a border line that shares with 2 others etc

19

___ and ___ are associated with venous thrombosis which can lead to DVT and cerebral venous thrombosis

factor 5 leiden
Prothrombin gene mutation

also associated with arterial causes of ischemic stroke
along with antiphsopholipid syndrome

20

examples of hypercoaguable states

HIV
Cancer
Chrons

21

where are cortical strokes located

frontal, parietal, temporal or occipital lobe

22

prevost sign

conjugate deviation of eyes and head / neck

23

subcortical stroke affects what 3 areas of brain

thalamus
basal ganglia
internal capsule - main highway sensory and motor info

24

subcortical strokes often caused by

lacunar infarcts

25

thalamic pain syndrome

caused by thalamic stroke that leads to hemibody sensory deficit often painful after recovery

VERY painful on one side of the body - contralateral to lesion site

26

sx of a subcortical brainstem stroke

EOM impairments
CN findings
diplopia
dysphagia
dysarthria
nystagmus

27

brainstem strokes often involve ___ circulation

posterior:
basilar artery, vertebral arteries and cerebellar arteries

28

3 examples of things that can trigger brainstem strokes

trauma
chiropractic manipulation
hyperextension maneuvers
"painters neck" - dissection of artery

29

cerebellar stroke sx

often gait/ imbalance/ ataxia/ nausea/ vomiting/ vertgo / tremor/ nystagmus

30

what sx provide evidence of circulatory problems?

hypotension pallor
sweating brady or tachycardia, hypotension

31

watershed ischemia results

cortical blindness/ bilateral vision loss/ coma
weakness of shoulders/thighs spare face hands and feet
"man in a barrel"

32

how often do ischemic stroke pts need neuro checks?

q2hours, vitals 2-4 hours
continuous pulse ox
continuous telemetry

33

when is CT used

acutely to rule out blood presence
- can use for subactue infarcts or those CI to MRI
* will not show ischemia acutely, radation, and not good for intracranial patho without contrast

34

MRI

can id ischemia acutely or subacute lesions
expensive, gadolinium deposits, not metal compatable

35

what 3 tests can be used for dissection?

CTA/MRA/DSA

36

what test is gold standard for dissection/aneurysms

DSA: digital subtraction angiography
- gives best viualization of vessels

cons; time, interventionalist, radiation

37

MRA is the __-

gold standard for seeing strokes

38

inpatient stroke heart tests

baseline EKG
cardiac markers if CP history
telemetry - look for arrhythmia
echo or TEE

39

outpatient stroke management if you don't know what caused the stroke

24 H holter monitor
Prolonged heart monitor 30 D loop or implant - look for a fib rhythm

40

out pt labs

check lipid panel yearly
if made an antiplatelet changes check PFA or P@\2Y12

41

inpatient lab evaluation

Baseline CBC
Baseline CMP
PT/INR, aPTT
Lipid Panel
HGA1C
Thyroid Profile
Blood glucose checks
UA
Possible serum drug screen
if fever infectious work up!

42

if put pt on asapirin run a

PFA

43

if on Plavix run a

P2Y2

44

if a young pt has a stroke ( less than 45) or history or hypercoaguability what are some labs you might want to run?

PRO C and PRO S
antithrombin III
Activated Pro C Resistance
Facotr 5 leiden
Prothrombin Gene mutation
Antiphsopholiipid AB testing
Homocysteine
Sickle cell hemoglobin electrophoresis

45

goal time for anterior circulation mechanical thrombectomy or intraarterial thrombolysis

less than 6 hours

46

goal time for posterior circulation for mechanical thrombectomy

less than 18 hours sometimes 24HRs

47

post thrombectomy

must go to NICU

48

large territory ischemic stroke may benefit from ..

hemicraniectomy to prvt swelling

49

overall mortality rate for stroke post 30 days is

23%

50

Transient Ischemic attack defintion

A transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction (2009)

51

TIA incidence is ...

higher with age risk
higher in males
higher in African americans

52

what causes a TIA

atherosclerosis, cocaine - other sympathomimetics, hypercoaguable states, dissections, etc

53

what is causing a TIA pathophys?

temporary reduction or cessation of cerebral blood flow in a specific neurovascular distribution

54

initial image for TIA

CT noncontrasted - have to rule out stroke/ bleed

55

imaging once realize its probably TIA

MRI
MRA/CTA
Carotid Doppler if MRA/CTA not avaiable

56

cardiac workup for TIA

baseline EKG
2D ECHO with bubble study
Holermonitor

57

treatment for noncardioembolic TIA

antiplatelet: ASA, Aggrenox (ASA + Dipyridamole) or Plavix

58

for cardioembolic TIA

antigoag within first 14 days get INR to 2-3

59

if find intracranial atherosclerosis post TIA or incidental

ASA 50-325 mg per day
keep bp under 140/90

60

epidural hematoma blood location

between bone and dura

61

gender spread for epidural hematoma

males: females 4 to 1 probability

62

what artery and shape is epidural hematoma

MMA
convex - football or lens shape

63

___ has a lucid interval

epidural hematoma
- period after loss of consciousness in which person seems fine prior to more decompensation

64

subdural hematoma blood location

beneath arachnoid but superior to brain

65

ratio male to female subdural hematoma

males to females
3"1

66

highest incidence for chronic subdural hematoma is ____

5th -7th decade of life

67

______ pts present with parenchymal contusions

subdural hematoma

68

when you see subdural hematoma

get the BP and call the neurosurgeon

69

subdural bleed is ___

shearing of bridging veins
concave and crescent

70

dural bleed treatments

If GCS lower than 8 - intubate
Reverse coag: vita K/FFP/clot factor
Consider AED
Normalize sugar and temp
If high ICP - do hyperosmolar therapy - shrinks cells

Surgery!

71

Outpatient treatment

if chronic can watch with follow up CT scans
**epidural bleeds cant watch outpt
BP management etc.. all lifestyle precautions

72

average age of SAH onset

50 yrs ..slightly higher incidence in females

73

subarachnoid hemorrhages commonly associated with __

cerebral aneurysm

74

crab of death CT

subarachnoid hemorrhage
*due to ruptured aneurysm

75

sentinel leak

a prodrome of sudden head pain the may preceed a subarachnoid hemorrhage days to months prior to rupture
average is 2 wks

76

when is surgical coiling of aneurysm appropriate

advanced age, poor clinical grade, comorbidities, top of basilar aneurysm, high surgical risk

77

clipping when..

aneurysm with wide neck to body ratio, normal arterial branches arise from dome or body of aneurysm, MCA associated with large parenchymal hematoma

78

cerebral aneurysms often are..

clinically silent

79

how to manage aneurysm

less than 5 mm watch
5+ refer to neuro surg
surgery at 7+
Management: HTN, Seizure prvt, CCB

80

if less than 50 and have unruptured aneurysm less than 10 mm what do you do?

surgical treatment

81

risk factors for aneurysm

cigarette smoking, family history of aneurysms, polycystic kidney dz etc

82

all aneurysms over ___ should be considerd for treatment

10mm

83

___ is second most common form of stroke

non traumatic intracerebral hemorrhage

84

higher incidence of ICH in...

Asian countries
higher in African American
slight male predominance

85

in young ppl with ICH what is most common cause?

AVM: arteriovenous malformations

86

___ is most common area of brain bleeds

basal ganglia

87

amyloid angiopathy is ____

lobar for ICH

88

HTN for ICH is...

90 degress to parent vessel
penetrates arteries of brain stem, basal ganglia, and cerebellum

89

"coke stroke"

cocaine causing ICH

90

when would do surgery for ICH

when look like crap!
hemorrhage less than 12 hours ago
ongoing clinical deterioration etc..
cortically based lesion

*reserve surgery for obtunded or deeply comatose pts

91

outpt ICH tx

monitor BP as an outpatient
Risk factor modification
Continuation of rehab
generally re-start antiplatelet if medically indicated within 5-14 days

92

syncope

Transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery

93

noncardiac causes of syncope

Vasovagal syncope
Autonomic insufficiency
Situational
Orthostatic

94

vasovagal syncope

Usually in standing position. Precipitated by fear, emotional stress, pain .

Presentation: Nausea, diaphoresis, fading out, epigastric discomfort, light-headedness precede syncope by minutes

Mechanism: Efferent vasodepressor reflexes results in decreased PVR = hypotension = faint

95

situational syncope

Known precipitant, reproducible

Causes: micturition, defecation, deglutition, tussive, carotid sinus syncope (seatbelt)

Mechanism: precipitants cause autonomic vasodepression which lead to transient cerebral hypoperfusion

96

orthostatic syncope definition

due to: Drop of systolic BP of 20mmHg or Diastolic BP of 10mmHG when going from lying to standing position within 3 minutes. Often with pulse increase of >10-20

97

what must be done prior to fluid resuscitation for syncope?

orthostatic vital signs

98

outpatient syncope steps

prolonged cardiac monitor
tilt table test
cardiac stress test
EEG

99

atropine is given for

syncope if you have bradycardia and consider pacemaker placement for 2nd degree heart block or 3rd degree heart block

100

if syncope from neurogenic problem

usually due to some degenerative process