Stroke and Cerebrovascular Disorders Flashcards Preview

Pathophysiology - Neurology > Stroke and Cerebrovascular Disorders > Flashcards

Flashcards in Stroke and Cerebrovascular Disorders Deck (23)
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1
Q

What is it called if you have an infarct block your retinal artery?

A

Retinal stroke

2
Q

What causes a lacunar stroke?

A

Small artery thrombosis with two main causes:

  1. Atherosclerosis
  2. Lipohyalinosis - fibrinoid necrosis + lipid
3
Q

How do cardiac emboli show up on CT scan?

A

Usually with multiple emboli all over the brain -> embolization from Afib or mural thrombosis can affect multiple brain areas

4
Q

What are the nonmodifiable risk factors for stroke?

A
  1. Age > 55
  2. Male sex
  3. Hispanic and blacks
  4. Family history
5
Q

What are the modifiable risk factors for stroke?

A

Atherosclerosis risk factors:

  1. Hypertension
  2. Diabetes
  3. Dyslipidemia
  4. Smoking
  5. Elevated homocysteine
  6. Alcohol
  7. Obesity
  8. Sedentary lifestyle
6
Q

What will a stroke of the left cerebral hemisphere do to gaze preference?

A

Makes gaze preference go to left -> left frontal eyefield will be knocked out, so right becomes dominant in turning gaze to left

7
Q

What is one sign which really points more towards brainstem lesion than cerebral lesion?

A

Decreased consciousness

8
Q

Where will blood easily be seen in CT of a subarachnoid hemorrhage?

A

The perimesencephalic cisterns of the brain, i.e. prepontine cistern

9
Q

What happens in the ischemic areas of the brain which makes them more susceptible to loss of blood flow? What is another cause of this

A

There is a loss of cerebral autoregulation -> S-shaped curve which maintains cerebral blood flow at varying perfusion pressures is lost, making areas much more susceptible to hypoperfusion or hyperperfusion

Also occurs in chronic hypertension

10
Q

What scale standardizes measures of severity of stroke?

A

NIH stroke scale -> can be used between providers

11
Q

How do you tell the difference between an ischemic and a hemorrhage stroke?

A

Via a CT of head without contrast -> cannot tell the difference between the two clinically

-if ischemic stroke is obvious, it’s probably an old stroke because it will not appear for a few hours

12
Q

What other labs should you order on a patient with a stroke?

A

CBC, PT/PTT, troponins, SaO2, EKG

-> testing for cardiac origin or other problems

13
Q

What is the door to treatment goal for the ER, and what is the latest you should administer tPA? Why?

A

ER - door to treatment = 60 minutes

tPA - 3 hours, 4.5 hours in select patients
-> odds ratio for improvement is not better after 3 hours

14
Q

What are the absolute contraindications to tPA?

A

Head trauma / stroke in past 3 months
Previous history of hemorrhage
BP > 185 systolic or 110 diastolic
Elevated aPTT or PT, current anticoagulation
Low blood glucose
CT suggests multilobar infarction
Tumor or intracranial / intraspinal surgery in last 3 months

15
Q

What are the relative contraindications of tPA?

A

Pregnancy
Recent GI hemorrhage
Recent MI
Only minor symptoms

16
Q

What drugs are used to rapidly achieve the blood pressure goals of tPA therapy? Why is this important?

A

Labetalol (pregnant organist), nicardipine (nice card), clevidipine (clover)

-> hydralazine should be avoided because it may cause vasodilation and worsen cerebral edema

Important because high blood pressure predisposes to bleeding

17
Q

How should you treat high blood pressure following stroke?

A

Usually recovered on its own, can just observe for 1-2 weeks to see if it comes down

18
Q

What is standard of care for treatment of ischemic infarct now?

A

tPA + stentriever -> little piece of mesh to pull out the clot

19
Q

What is a very common persistent symptom following a stroke?

A

Depression (40% of people)

20
Q

What drugs should be started for secondary prevention following a stroke?

A
  1. Antihypertensive agents - ACE inhibitor / diuretic
  2. Statin therapy - regardless of LDL
  3. Antiplatelet agents - aspirin, clopidogrel, or aspirin / dipyridamole (phosphodiesterase inhibitor) -> annotate this
21
Q

Where do embolic clots normally form in atrial fibrillation and how is it treated to prevent stroke? Is aspirin effective?

A

Normally in left auricle - antiplatelet agents like aspirin are not sufficient, need anticoagulants

  • > Warfarin to increase INR to 2-3
  • > direct oral anticoagulants like: Dabigatran, Rivoroxaban, Apixaban, etc
22
Q

What condition accounts for a major percentage of anterior circulation strokes and TIAs, and how is it treated?

A

Carotid artery stenosis -> treat via carotid endarterectomy

23
Q

What is the part of the brain where the infarct starts and is already dead called? The part that can be saved?

A

Starts - “core”
Can be saved - “penumbra”

Time is brain