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Stroke > Stroke > Flashcards

Stroke Flashcards

1
Q

Contraindications for tPA

A

6 months
-ICH

3 months

  • severe head trauma
  • ischemic stroke
  • intracranial or spinal surgery
  • acute MI

21 days
-active bleeding or GIB

2 weeks

  • major surgery
  • major trauma

7 days
-arterial puncture, non compressible site

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2
Q

Other tPA contraindications

A
  • BP 185/110
  • Glucose <2.8 mmol/l or >22 mmol/L
  • INR >1.7
  • Neoplasm
  • AVM
  • Aneurysm
  • plt <100,000/mm
  • use of NOAC within 48hrs
  • CT hypodensity >1/3 hemisphere
  • minor stroke (NIHSS<5)
  • rapidly improving symptoms
  • seizure
  • pregnancy (case to case)
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3
Q

Candidates for Acute Endovascular Stroke Therapy

A
  • Age >18
  • NIHSS >_ 6
  • Time from symptom onset to groin puncture <6 hours
  • Good prestroke Functional status (mRS equal to 2 or less) and life expectancy of >3 months
  • ASPECTS >_6 on baseline CT
  • Presence of proximal intracranial artery occlusion
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4
Q

Percentage of complications with IVtpa

A
  • symptomatic intracranial hemorrhage: 6%
  • Major systemic hemorrhage: 2%
  • angioedema: 5%
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5
Q

KGH EVT RAPID imaging interpretation

A
  1. ) CBF <30% volume if 70ml or less (shown on the first panel titled CBF/Tmax Mismatch)
  2. ) Mismatch volume is 15ml or greater
  3. ) Mismatch ratio is 1.8 or greater
  4. ) proximal MCA thrombus (M1 or proximal M2 and some mid-M2 clots)
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6
Q

Hypercoaguable state (primary)

A 
Factor V Leiden 
Prothrombin (factor II) G20210A 
Protein C deficiency 
Protein S deficiency 
Anti-thrombin deficiency
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7
Q

Hypercoaguable state (secondary)

A

Cancer
Pregnancy
Oral contraceptives
Antiphospholipid antibody syndrome

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8
Q

Antiphospholipid antibody syndrome bloodwork

A

Lupus anticoagulant
Anti-B2 glycoprotein (Ig G and IgM)
Anti cardio lipin

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9
Q

CADASIL

A 
MRI: extreme capsule, anterior temporal lobe, corpus callosum,   cerebral microbleeds 
NOTCH3 gene
Clinical: 
1. Migraine
2. Sub cortical infarcts/TIA 
3. Cognitive dysfunction 
4. Depression
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10
Q

CARASIL

A 
Recessive disorder—-> HTRA1 gene
Premature aloplecia 
Cervical or lumbar spondylosis 
Stroke
No migraine
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11
Q

MELAS (mitochondrial encephalopathy, lactic acidosis, stroke-like episodes)

A

A3243G mutation on gene encoding tRNA

  • early psychomotor delay, learning disability
  • stroke like episodes
  • peripheral neuropathy
  • dementia
  • short stature
  • seizures—> avoid VPA
  • migraine like headache
  • cardiac features
  • T2DM—> avoid metformin
  • nephropathy
  • hearing loss—> cochlear implant

Others:

  • GI symptoms (dysmotility)
  • ophthalmic features: optic atrophy, pigmentary retinopathy, CPEO (chronic progressive external opthalmoplegia)

MRI:

  • BG calcifications
  • SPARING subcortical fibers
  • parietal occipital and parietal temporal
  • *increase DWI but no change in ADC
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12
Q

INTERACT2

A
  • acute ICH patients sBP<140 vs. sBP<180
  • -No difference in 90 day mortality, disability or hematoma growth
  • -look up in stroke trials
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13
Q

ATACH2

A
  • acute ICH sBP 110-139 vs. 140-179
  • -no difference in 90 day mortality or disability
  • look up stroke trials
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14
Q

Anticoagulation reversal

A

Canadian stroke best practive guidelines

  • stop anti-platelet or anti-coagulation
  • warfarin with increased INR–> PCC 50u/kg + IV Vitamin K 10mg
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15
Q

Hyperacute stroke

A
  • Last well seen
  • ABC’s and NIHSS
  • B/W: CBC, lytes, Cr, INR, PTT, Trop
  • Imaging: CT/CTA
  • ECG

IVtpa: catalyze plasminogen–> plasmin (clot breakdown)
-small to moderate ischemic core (ASPECTS > 6)

Complications:

  • angioedema (1%)–> IV cortisone 100mg, IV benadryl 50mg, IV Ranitidine 50mg
  • tPA-associated bleeding–> 10u cryoprecipitate

NOTE: tPA can not recanalize clots >8mm; distal M1/M2 is sweet spot

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16
Q

Stroke Mimics

A
  • Seizure
  • Metabolic/toxic/infectious encephalopathy
  • Neoplasm
  • Meuromuscular
  • Migraine with aura
  • Psychogenic
17
Q

ASPECTS

A

Normal=10

  • caudate
  • putamen
  • internal capsule
  • insular cortex
  • M1-M6
18
Q

Secondary stroke prevention

A
  1. ) Very high risk stroke recurrence
    - within 48hrs
    - unilateral weakness
    - speech disturbance
    - other stroke-like symptoms
    - see IMMEDIATELY
  2. ) High risk stroke recurrence
    - 48hrs-2wk
    - unilateral weakness
    - speech disturbance
    - see 24HRS
  3. ) Moderate risk stroke recurrence
    - 48hrs-2wk
    - WITHOUT motor weakness
    - WITHOUT speech disturbance
    - other symptoms: sensory loss, monocular vision loss, ataxia, etc.)
    - see within 2 weeks
  4. ) Lower risk stroke recurrence
    - >2wks
    - see within one Month
19
Q

Secondary Stroke prevention: PFO

A

PFO device closure + long-term antiplatelet is recommended if ALL of criteria are met:

  1. 18-60 year
  2. ) index stroke non-lacunar stroke OR TIA with DWI or cortical symptoms
    - alternate etiologies been excluded

**benefit greater if atrial septal aneurysm, larger shunt

20
Q

Fabry disease

A

X-linked, lyosomal storage disease

  1. )Cutaneous: angiokeratomas (trunk and lips), hypohidrosis
  2. )Renal: renal impairment
  3. )Corneal: corneal dystrophy
  4. )Cardiac: cardiomyopathy, cardiac conduction disturbances
  5. )Neurological: stroke in posterior circulation, dolioachoectasia (extensive dilatation of vessels), leukoaraiosis (calcifications in pulviinar, GP, crebellar-corticomedullary junction, cerebral subcortical-cortical junction), acroparaesthesia, PNS manifestations: small fiber neuropathy, sympathetic skin responses (abnormality), intestinal dysmotility, hearing loss

Deficient activity of lysosomal alpha-galactosidase A–> accumulation of glycophingolipids in vascular endothelium, smooth muscle, autonomic and dorsal root ganglia

Treatment: Galasidase alpha or galasidase beta

Stroke (1 decks)

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