Strokes/CVDs

Question 1

Strokes are characterized by sudden neurologic deficits resulting from?

Answer 1

• ischemia (88% of cases)
• hemorrhage (12% of cases)

Question 2

What are the clinical features of an anterior cerebral artery stroke?

Answer 2

Contralateral leg weakness.

S34

Question 3

What are the clinical features of a middle cerebral artery stroke?

Answer 3

• Contralateral hemiparesis and hemisensory deficit (face and arm more than leg)
• Aphasia
  (if it affects the dominant hemisphere)
• Contralateral visual field defect

S34

Question 4

What are the clinical features of a posterior cerebral artery stroke?

Answer 4

Contralateral visual field defect and contralateral hemiparesis.

S34

Question 5

What are the clinical features when penetrating arteries are occluded?

Answer 5

Contralateral hemiparesis and contralateral hemisensory deficits.

S34

Question 6

What are the clinical features of a basilar artery stroke?

Answer 6

Oculomotor deficits and/or ataxia with crossed sensory and motor deficits.

S34

Question 7

What are the clinical features of a vertebral artery stroke?

Answer 7

Lower cranial nerve deficits and/or ataxia with crossed sensory deficits.

S34

Question 8

What is Ischemic stroke?

Answer 8

occlusion of a vessel that supplies a region of brain resulting in cellular ischemia

S35

Question 9

What are causes of Ischemic stroke that are categorized according to the TOAST classification :

Answer 9

1. Large artery atherosclerosis (e.g., carotid stenosis)
2. Small vessel occlusion (e.g., lacunar stroke)
3. Cardioaortic embolic (e.g., emboli from atrial fibrillation)
4. Other etiology (e.g., stroke due to hypercoagulable states or vasculopathies)
5. Undetermined etiology

S35

Question 10

What is Transient ischemic attack?

Answer 10

sudden focal vascular neurologic deficit that resolves within 24 hrs

S35

Question 11

What happens to 1/3 of patients who experience a TIA?

Answer 11

subsequently suffer a stroke

S35

Question 12

What to do if a stroke is suspected and why?

Answer 12

a STAT non-contrast CT is needed todistinguish ischemia strokefrom intracerebral hemorrhage BECAUSE treatments differ for each

S35

Question 13

What is treatment of Ischemic CVA?

Answer 13

• PO Aspirin (initial treatment)
• IV orintra-arterial recombinant Tissue Plasminogen Activator (if criteria met and must be initiated w/n a time window)
• Thrombectomy devices (used to stent vessels and remove clots)
• Revascularization

S36

Question 14

What is treatment of Hemorraghic CVA?

Answer 14

• Tx depends on severity
• Conservative txis centered on
  the reduction of ICP
  blood pressure control
  seizure precautions
  vigilant monitoring
• Evacuation of hematoma
  may remain intubated
  ICU monitoring required

S37

Question 15

What is the guideline for elective cases in patients on new anticoagulants for cardiac thrombus?

Answer 15

No elective cases should be scheduled within 3 months for patients on new anticoagulants for cardiac thrombus.

S38

Question 16

What should be done pre-operatively for patients on anticoagulants for cerebrovascular accident (CVA) prophylaxis?

Answer 16

Consult the prescriber to establish a protocol for managing anticoagulants pre-operatively.

S38

Question 17

What is the management strategy for high-risk CVA patients who pause long-acting anticoagulants?

Answer 17

will need SA anticoags (LMWH, IV unfractionated heparin) to bridge the gap

S38

Question 18

What is required when managing cerebrovascular disease patients who are pausing anticoagulants for surgery?

Answer 18

Close monitoring of coagulation status is required for patients who are pausing anticoagulants for surgery.

S38

Question 19

What is the protocol for discontinuing anticoagulants in relation to regional anesthesia?

Answer 19

Regional Anesthesia requires discontinuing anticoagulants for a sufficient time to safely perform the block.

S38

Question 20

What should be reviewed pre-operatively in patients with cerebrovascular disease?

Answer 20

Review the patient’s history, deficits, imaging, treatments, and co-existing diseases carefully.

S39

Question 21

What physical assessments should be done for pre-op cerebrovascular disease patients?

Answer 21

• orientation
• pupils
• bilateral grip strength
• lower extremity (LE) strength.

S39

Question 22

What symptoms should be asked about in patients with cerebrovascular disease?

Answer 22

• headaches
• tinnitus
• vision/memory loss
• bathroom issues

S39

Question 23

What are the causes of a cerebrovascular accident (CVA) that should be considered?

Answer 23

Look at the root cause of CVA, including vascular disease, embolic causes (such as atrial fibrillation, prosthetic valve, right to left shunt/Patent Foramen Ovale).

S39

Question 24

What imaging is recommended for preoperative assessment in cerebrovascular disease?

Answer 24

• Carotid Ultrasound
• CT/MRI of head & neck
• echocardiogram.

S39

Question 25

What are the routine preoperative investigations for cerebrovascular disease?

Answer 25

include an EKG and a CBC, BMP including glucose.

S39

Question 26

What monitoring device to use for Cerebrovascular Disease?

Answer 26

Cerebral oximetry

S39