Stroke I Flashcards Preview

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Flashcards in Stroke I Deck (58)
1

What is the definition of stroke?

Sudden change in neurological function d/t a disruption of blood flow to a region of brain tissue resulting in cell death

2

What is the definition of a TIA?

Stroke process without cell death

3

True or false: Time is not an element of the definition of a TIA or stroke

True

4

What percent of strokes are hemorrhagic? Ischemic?

15% = hemorrhagic
85% = ischemic

5

True or false: a lot of medicine is consensus based

True

6

What percent of strokes are SAH? ICH?

ICH = 10%
SAH= 5%

7

What is the most common cause of ischemic strokes?

Idiopathic / cryptogenic

8

What percent of strokes are 2/2 a.fib?

15%

9

What are the three components of Virchow's triad?

1. Stasis/turbulence
2. Hypercoagulability
3. Endothelial damage

10

Are lacunar strokes 2/2 small or large vessels?

Small

11

What is moyamoya disease?

Gradual occlusion of the internal carotid artery, causing formation of collateral vessels, that looks like a puff of smoke. Usually results in multiple CVAs or TIAs

12

What is the association between migraines and strokes?

May be related to migraines with auras

13

What are lacunar strokes?

Subcortical strokes from deep penetrating blood vessels in the brain

14

What are the lenticulostriate arteries?

Branches from the middle cerebral artery that feed the caudate, internal capsule, thalamus, and lentiform nucleus

15

What comprises the lentiform nucleus?

Putamen and the globus pallidus

16

The vertebral arteries come together to form what vessel?

Basilar

17

What are the three vessels that feed the thalamus?

-Lenticulostriate
-Thalamoperforating
-Pontine paramedian

18

What are the types of lacunar strokes? (5)

-Pure motor
-Pure sensory
-Mixed
-Clumsy hand dysarthria
-Ataxia hemiparesis

19

True or false: ataxia is independent of weakness

True--weakness = dyssynergia

20

Most of the time, strokes are not stereotypical. What does this mean?

Strokes do recur with the same s/sx

21

When do stuttering strokes occur?

When the same vessel is occluded

22

What is lipohyalinosis?

Small vessel disease of the brain d/t endothelial dysfunction and necrosis of the vessels, and eventual occlusion

23

What are the three risk factors for lipohyalinosis?

-Age
-HTN
-DM

24

What is the biggest risk factor for developing a stroke?

Age

25

Where in the brain do most hemorrhagic strokes occur?

Subcortical

26

What is Dejerine-Roussy syndrome?

(aka thalamic pain syndrome)--Where a stroke to the thalamus causes a allodynia or dysesthesias

27

What is the general s/sx of a stroke?

*Sudden* change in neurological function

28

Why is LOC not common with strokes?

Have to either hit both cortices, or posterior pons

29

Is memory loss a typical stroke symptom?

No

30

What are the components of the anterior circulation? What are the functions that lesions to this interrupt?

Carotid and its branches
Motor, cognition, speech, language, vision

31

What are the components of the posterior circulation? What are the functions that lesions to this interrupt?

Vertebrobasilar and its branches

Motor, sensory, speech, vision, *cranial nerves*

32

What is intraparenchymal hemorrhage?

Deep hemorrhages in the BG, internal capsule, pons, thalamus, and deep cerebellum

33

How do you diagnose intraparenchymal hemorrhage? Why?

CT--very sensitive for blood

34

What is the sensitivity of CT in detecting subarachnoid hemorrhages?

95%

35

What are the features of subarachnoid hemorrhage?

-Sudden, severe HA
-LOC, focal neuro s/sx
-Meningeal sign variable

36

What is a sentinel hemorrhage?

Little bleeds before the big bleed, that causes s/sx that precede SAH

37

How do you dx SAH? (2)

-Head CT within the first 12 hours
-Xanthochromia

38

What is the sensitivity of CSF xanthochromia with SAH in the first 12 hours?

100%

39

What is the sensitivity of head CTs with SAH in the first 12 hours?

95%

40

What is the sensitivity of angiograms for aneurysms in diagnosing SAH?

80%

41

What type of blood is found with xanthochromia (old or new)?

Old blood

42

What percent of SAH pts have more than one aneurysm?

20%

43

What percent of patients with a negative angiogram will have one on repeat testing?

2%

44

What is the treatment for a SAH?

ICU admission
Nimodipine
BP management

45

Why is Nimodipine given post SAH?

Prevent vasospasm, which can cause ischemic strokes

46

What are the complications that can result from SAH? (6)

-Intraparenchymal hemorrhage
-Brain edema
-Hydrocephalus
-Recurrent hemorrhage
-Vasospasm
-Szs

47

What is the leading cause of death or neurological morbidity within the first two weeks post SAH? Treatment?

-Rebleed
-Bed rest + antifibrinolytics

48

What is a paradoxical embolus?

Embolus that goes through a PFO and into the brain vasculature

49

Are most strokes venous or arterial in origin?

Arterial

50

What is the artery that is given off of the Vertebral arteries, just before they converge to form the basilar?

PICA

51

What are the arteries that come off of the basilar (5, from posterior to anterior)?

-AICA
-Pontine
-Superior cerebellar
-posterior cerebral
-Posterior communicating

52

What are Charcot-Bouchard aneurysms?

Aneurysms of the brain vasculature which occur in small blood vessels. They are most often located in the lenticulostriate vessels of the basal ganglia and are associated with chronic hypertension

53

How do you monitor for vasospasms?

Transcranial doppler will look for vasospasms

54

What days post stroke carry the greatest risk for vasospasms?

4-21

55

What is the medication that can help prevent vasospasms?

Nimodipine

56

What are the components of the triple H therapy for SAHs?

HTN
Hemodilution
Hypervolemia

57

What is the cause of hyponatremia post SAH?

Cerebral salt wasting--idiopathic

58

What days post SAH carry the greatest risk of hyponatremia? What is the treatment?

3-7

3% NS