Stroke and Movement Disorders Flashcards
(53 cards)
What is the definition of a stroke?
Interruption of blood supply to an area of the brain, causing signs and symptoms of intracranial neurologic compromise.
What is a TIA?
Transient interruption of blood supply to an area of the brain causing symptoms lasting for under 24 hours
What % of strokes are ischemic and hemorrhagic?
85% ischemic
15% hemorrhagic
What is the most important nonmodifabile risk factor for strokes?
Age
What is the most important modifable risk factor for strokes?
HTN
What are some major risk factors for stroke?
HTN, smoking T2DM, HLD, CAD/CHF, Afib, carotid stenosis
What are the three types of ischemic strokes?
- embolic- sudden onset deficits
- thrombosis- gradual onset deficits, MC type of ischemic stroke
- lacunar (putamen, thalamus, internal capsule), variable onset, related to HTN
What is the most common type of ischemic stroke?
Thrombotic
Where is the classic location for SAH?
Berry aneurysm bursts at the anterior communicating artery (next most common Pcomm)
What is the classic presentation for SAH?
Sudden onset during exertion
“Worst headache of my life”
How does a posterior communicating artery aneurysm present?
CN III compression –> blown pupil, ptosis, down and out
What is the Hunt and Hess Scale?
Used to grade SAH 1 = roughly asymptomatic 2 = headache, neck stiffness 3 = headache, neck stiffness, confused 4 = completely unintelligible as if they are very drunk 5 = coma
higher score = increased acute mortality, but generally more favorable functional prognosis if they survive the acute period.
When do SAH occur vs intracerebral hemorrhages?
SAH = exertion intracerebral = at rest
What is the most common site of an intracerebral hemorrhage?
Putamen (contralateral hemiplegia)
What is the goal BP in ischemic strokes?
SBP <220
What is the goal BP in hemorrhagic strokes?
SBP <180
What is the goal ICP in the setting of a stroke?
Keep ICP < 20 mmHg
(Remember we want CPP to be >60mmHg)
CPP = MAP - ICP
What techniques can be used to lower ICP in patients with strokes?
Forced hyperventilation IV mannitol Elevate HOB Hypothermia (last resort) Neurosurgical Burr hole decompression
What are the considerations for tPA? (timeline, age, additional labs and imaging?)
Presenting within 3 hours of stroke onset
Adult (not elderly)
Negative CT head for blood
SBP <185
INR <1.7
Platelets <100k
Stroke territory involves <1/3 MCA territory
What are considerations for SAH and intracerebral hemorrhage management? (blood pressure, ICP, medications, treatment)
Keep SBP <180
Stool soft –> docusate, miralax
Keep ICP <20
Nimodipine x21 days to prevent secondary intracranial vasospasm due to blood irritating vessels
Perform clipping/coiling of aneurysm or removing the AVM
How long does an infarction typically take to show up on a CTH? What color is blood on CT? What color is infarction?
1-2 days usually
Blood = white
Infarction = dark area
(Opposite of T2 MRI)
What color is blood on T2 MRI? What color is infarction?
Blood = dark
Infarction = bright white on T2 MRI (T2 = H2O)
(Opposite of CT)
What is the purpose of getting an echo for a stroke workup?
Look for:
Cardiac embolus source
Wall motion abnormalities
PFO
What is the purpose of getting an LP in the setting of possibles troke?
Helpful when CT head is not informative but you still suspect SAH
Xanthochromia (blood breakdown products) can be detected indicating SAH
