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Flashcards in Stroke Management Deck (9)
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Stroke Presentation

-abrupt onset of focal neurologic symptoms & signs
-evaluate & stabilize vital signs (BP, HR, Vent, T)


Stroke History

-HxPI - time of symptom onset, progression, headache - formulate anatomic Dx
-PMHx - stroke risk factors, medications
-FHx - vascular disease, HTN, hyperlipideia
-SHx - tabacco, EtOH, illicit drugs


Stroke Exam

-medical examination - provides info on pathogenesis or etiology, heart rate & rhythm, BP in both arms, listen for carotid bruits, peripheral vascular exam
-Neuro: info on lesion location
-Working diagnosis: stroke or other cause, ischemic vs. hemorrhagic, vascular territory, etiology


Stroke Labs

-EKG with rhythm strip
-Chest x-ray to evaluate heart size
-CBC with differential & platelet count
-Chemistry profile (glucose, BUN, electrolytes)
-Lipid profile
-Clotting times (INR, aPTT)
-Head CT without contrast


Other Stroke lab Values

-Coag (lupus, anticardiolipin Ab, protein C & S activity, factor V leiden)
-Viscosity tests: blood viscosity, protein electrophoresis
-Vascultis: ESR especially in elderly, FANA, etc.
-Homocysteine levels
-Urine drug screen


Radiologic Evaluation of Stroke

-Carotid artery ultrasound
-Head MRI
-Head & Neck MRA
-CT arteriogram
-Digital subtraction arteriogram


Digital Subtraction Arteriography

-interventiaonal neuroradiographic methods for catheter placement via the femoral artery and injection contract dye to create digital subtraction images of extra and intracranial blood vessels


Acute Treatment of Stroke

-treat with IV tPA if <8 hr from symptom onset & patient meets other strict criteria


Stroke Prophylactic Treatment

-vascular stenting or endarterectomy for stenosis >70% of lumen diameter
-anti-hypertensive Rx
-Anti-lipid Rx
-Anti-platelets Rx for atherothrombotic stroke
-Anti-coagulants only for cardioembolic stroke
-Anti-diabetic Rx
-Stop smoking
-Physical exercise