Stroke / CVA

Question 1

Types of stroke

Answer 1

Iscemic

Transient Ischemic Attack

Hemorrhagic (traumatic vs spontaneous)

Question 2

Types of Hemorrhagic stroke

Answer 2

Traumatic

• Epidural Hematoma
• Subdural Hematoma

Spontaneous

• Subarachnoid Hemorrhage > Berry Aneurysm
• Spontaneous Intracerebral Hemorrhage

Question 3

Most common type of stroke

Answer 3

Ischemic (87%)

Question 4

Stroke, higher incidence for men or women?

Answer 4

Men, until age 75+ then women

Question 5

3 pathologic processes that lead to ischemic stroke

Answer 5

1. Thrombosis (2/3)
   (Common/Internal Carotids or Circle of Willis + branches)
2. Embolism (1/3)
   (cardiac, artery-artery)
3. Systemic Hypotension

Question 6

Blood disorders associated w Ischemic stroke

Answer 6

Prothrombin gene mutation

Factor V Leiden

Sickle Cell

Infection / Inflammatory States (HIV, Cancer, Crohns)

Question 7

Patient presenting w aphasia, agraphia, memory/behavior, gaze, motor/sensory might be what kind o stroke

Answer 7

Cortical Stroke (ischemic)

Question 8

Patient presenting w predominantly motor deficits on opposite side (face, arm, leg) might be what kind of stroke

Answer 8

Subcortical Stroke (ischemic)

Question 9

Patient presenting w occulomotor impairment, CN findings (facial, disphagia, nystagmus) might be what kind of stroke

Answer 9

Subcortical Brainstem Stroke (ischemic)

Question 10

Patient presenting w profound nausea, vomiting, headache, double vision, imbalance, eye movements. OR COMATOSED.

Answer 10

Brainstem Stroke

Question 11

Stroke that shows non-focal symptoms beyond 1 vascular territory, autonomic symptoms: tachy, sweaty, pallor

Answer 11

Hypoperfusion

Question 12

Routine blood work for stroke

Answer 12

CMP
CBC + Platelet
PTT / PT / INR
ESR

Lipids
Glucose

Urinalysis

Drug Screen

Question 13

3 infectious processes to be considered/ruled out w stroke

Answer 13

Syphilus
HIV
Lymes

Question 14

Diagnostic imagine for stroke

Answer 14

1. CT, acute phase. Differentiates ischemic from hemorrhagic
2. MRI : better for acute ischemic

Question 15

Gold Standard Angiography for stroke

Answer 15

Digital Subtraction Angiography

Question 16

Angiography to order in stroke code if pt is intervention candidate

Answer 16

CTA - Computer Tomography Angiography

if kidney function is ok

Question 17

Angiography to order in stroke if pt has poor kidney function

Answer 17

MRA - Magnetic Resonance Angiography`

Question 18

Acute management of stroke

Answer 18

ABCs (Airway, Breathing, Circulation)

STAT CT +/- CTA

IV Access

Check Anticoag status and Glucose

Manage BP, < 220 / < 110

(get timeline from pt / family)

Question 19

tPA for stroke?

Answer 19

Approved for use within first 3 hours of acute stroke

pts > 18yrs

stroke causing clinically significant neuro deficit

Question 20

Tx Stroke

Answer 20

tPA (if candidate, 3 hrs etc)

Thrombectomy / lysis if large vessel anterior

Antiplatelet therapy: ASA 325mg (or anticoag, if indicated)

Statin: Atorvastatin

Question 21

Antiplatelet vs Anticoag Tx stroke

Answer 21

Anitplatelet for Iscemic / TIA

Anticoag for Cardiac Emboli

Question 22

Hemorrhagic stroke Tx

Answer 22

control BP, determine cause, c/s NSU (ABCs, CT/A, LP, pain mgmt., rainbow labs,
ECG, C Enzymes, CXR,
TTE (transthoracic echo)

Question 23

Which cranial artery is known to cause epidural hematoma -hemorrhagic stroke

Answer 23

Middle Meningeal Artery

Question 24

CT shows lens shaped, convex bleed

Answer 24

Epidural Hematoma

Question 25

Lucid Intervals often seen in what kind of stroke

Answer 25

Epidural Hematoma

Question 26

Epidural Hematomas often caused by

Answer 26

Trauma

Question 27

Subdural hematomas are arterial or venous?

Answer 27

VENOUS

Question 28

CT shows Crescent shaped, concave, slow growing

Answer 28

Subdural Hematoma

Question 29

Subdural hematoma often caused by

Answer 29

Trauma

Question 30

Majority of Subaracnoid Hemorrhage due to

Answer 30

Ruptured saccular aneurysm

Question 31

TIA's typically relate directly to which vessels

Answer 31

Carotid or Vertebral vascular distribution

Question 32

Stroke symptoms which resolve completely and result in no infarction of tissue

Answer 32

TIA

Question 33

Cardioembolic vs Non-cardioembolic TIA Tx

Answer 33

Cardioembolic: Anticoagulants Non-cardioembolic: Antplatelet (Aspirin, Plavix)

Question 34

Accumulation of blood in potential space between dura and bone (intracranial or spinal)

Answer 34

Epidural Hematoma

Question 35

Accumulation of blood below inner dura but external to brain

Answer 35

Subdural Hematoma

Question 36

Most common type of traumatic intracranial lesion

Answer 36

Subdural Hematoma

Question 37

Often secondary to trauma or tearing of bridging veins

Answer 37

Subdural Hematoma

Question 38

Epidural and Subdural Hematoma Tx

Answer 38

Reverse coag (Vitamin K, FFP, clotting factors) Hyperosmolar therapy if high ICP SURGERY

Question 39

Sudden onset of "worst headache of life" with N/V, seizure, altered mental status

Answer 39

Subarachnoid Hemorrhage (ruptured saccular aneurysm)

Question 40

Prodrome of sudden head pain may precede rupture by days to months (average is 2 weeks)

Answer 40

Sentinal Leaks - SAH

Question 41

CSF in SAH

Answer 41

markedly elevated opening pressures grossly bloody fluid