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CMT > TIAs, Strokes, Intracerebral AVM, Aneurysms > Flashcards

TIAs, Strokes, Intracerebral AVM, Aneurysms Flashcards

1
Q

how to differentiate stroke from TIA

A
  • stroke: deficity > 24 hrs, infarction present on imaging
  • TIA: deficity is only minutes to hrs; no infarction on imaging
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2
Q

what is RIND?

A

reversible ischemic neurologic deficit

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3
Q

what causes RIND

A

due to occlusion of blood supply to the brain leading to ischemia which recovers from 1d to a few wks

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4
Q

what 2 things keep the brain happy?

A

oxygen & glucose

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5
Q

what does the frontal lobe control?

7

A
  • planning
  • reasoning
  • personality
  • personality
  • emotions
  • motor functions
  • motor speech area (Broca)
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6
Q

what does the parietal lobe control?

6

A
  • sensory info/processing
  • taste/temp/pain
  • understanding language
  • memory
  • reading/writing
  • spatial awareness
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7
Q

what does the temporal lobe control?

7

A
  • memory functions
  • speaking/understanding written/verbal material
  • hearing
  • facial recognition
  • learning
  • Wernicke’s area
  • seizures
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8
Q

what does the occipital lobe control?

A
  • primary visual cortex is at the rear of this lobe
  • controls vision and visual processing
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9
Q

what is involved with anterior circulation

A
  • anterior cerebral artery and middle cerebral artery
  • they branch off of the internal carotid arteries
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10
Q

what is involved w/ posterior plumbing

A
  • posterior cerebral artery branches from the vertebral/basilar arteries
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11
Q

how do pts w/ stroke or TIA usually present

6

A
  • abrupt sx onset
  • hemiparesis
  • speech disturbance
  • sensory loss
  • visual field defect
  • ataxia/coordination
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12
Q

ACA stroke sx

3

A
  • usually occurs with MCA stroke
  • contralateral motor and sensory
  • leg more affected than the arm
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13
Q

MCA stroke sx

3

A
  • contralateral weakness to the face and arm
  • contralateral sensory loss
  • aphasia if dominant hemisphere
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14
Q

PCA stroke sx

9

A
  • contralateral visual field defect
  • MILD contralateral motor/sensory deficit
  • dysarthria
  • diplopia
  • dizziness
  • dysphagia
  • decreased LOC
  • ataxia
  • disturbed hearing
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15
Q

what is in the brainstem

A

midbrain, pons, medulla

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16
Q

what does the brainstem control?

7

A
  • breathing
  • heart rate
  • temperature
  • swallowing
  • weakness
  • paralysis
  • consciousness
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17
Q

Brain Stem Events

non modifiable risk factors

4

A
  • age
  • male gender
  • race
  • family hx
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18
Q

Brain Stem Events

modifiable risk factors

5

A
  1. HTN
  2. dyslipidemia
  3. CAD
  4. hypercoagulability
  5. diabetes
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19
Q

Brain Stem Events

behavioral risk factors

6

A
  1. smoking
  2. alcohol
  3. obesity
  4. physical inactivity
  5. illicit drug use
  6. OCPs ONLY if also smoker
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20
Q

what should you always order first?

A

CT

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21
Q

What will CT show?

A

subtle indicators of infarction within 6 hrs of stroke onset

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22
Q

Ischemic Stroke

what % of strokes are this kind?

A

~85%

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23
Q

Ischemic Stroke

how did the stroke occur if it is thrombotic?

A

produces stroke by reduced blood flow or by fragment carotid arteries, plaque build up and rupture. Usually a unilateral pattern

24
Q

Ischemic Stroke

what causes small vessel strokes?

A
  • HTN
  • DM
  • atherosclerosis
25
Q

Ischemic Stroke

how did the stroke occur if it is embolic?

A
  • most likely a cardiac source (a. fib, PFO, valvular disease, artery to artery embolism)
  • bilateral appearance
26
Q

Ischemic Stroke

how did the stroke occur if it was in a large vessel?

A

atherothrombosis most common pathology

27
Q

Hemorrhagic Strokes

what to order?

A
  • CT without contrast
  • Blood will “light up” on CT
28
Q

Intracerebral Hemorrhage

Risk Factors

6

A
  1. HTN
  2. Arteriovenous Malformation
  3. Ruptured Aneurym
  4. Coagulopathy
  5. Eclampsia
  6. Trauma
29
Q

Subarachnoid Hemorrhage

Sx

6

A
  1. thunder clap headache
  2. “worst headache of my life”
  3. nausea/vomiting
  4. decreased LOC
  5. nuchal ridigity
  6. seizures
30
Q

Subarachnoid Hemorrhage

Primary Cause

A

arterial aneurysm

31
Q

Subarachnoid Hemorrhage

Other Risk Factors

4

A
  1. AVM
  2. bleeding disorders
  3. trauma
  4. illicit drug use
32
Q

Subarachnoid Hemorrhage

Risk factors for arterial aneurysm

5

A
  1. HTN
  2. EtOH
  3. Family Hx of SAH
  4. Family Hx of connective tissue disorder
  5. personal previous SAH
33
Q

Subarachnoid Hemorrhage

FAST acronym

A
  • F: facial drooping
  • A: arm has pronator drift
  • S: speech is slurred, abnormal, dysarthric, or absent
  • T: time is “last known well”
34
Q

Subarachnoid Hemorrhage

Immediate Management

A
  • CT brain stroke protocol ASAP
  • if bleeding: control BP, OACs, seizure prophylaxis, neurosurgery consult
  • if no bleed: tPA? thrombectomy? ASA, VTE prophylaxis? further work up
35
Q

Subarachnoid Hemorrhage

Monitoring

A
  • closely monitor vitals
  • monitor mental status, speech changes
  • fundoscopic, cardiac, and neurologic exams
36
Q

Subarachnoid Hemorrhage

imaging to consider?

6

A
  • brain CT w/out contrast
  • CTA of head/neck
  • MRI of the brain (once admitted)
  • EKG
  • echo w/ bubble study
  • carotid US
37
Q

Subarachnoid Hemorrhage

lab testing to order

5

A
  • cardiac enzymes
  • CBC w/ diff
  • coag studies
  • blood type & screen
  • metabolic panel
38
Q

Subarachnoid Hemorrhage

inclusion criteria for IV tPA

3

A
  • clinical dx w/ measureable deficit
  • age > 18 y/o
  • sx since < 4.5 hrs
39
Q

Subarachnoid Hemorrhage

pmhx exclusion criteria for IV tPA

4

A
  • stroke/head trauma in last 3 mo
  • recent head/spine surgery
  • prior IC hemorrhage, malignancy, AVM, aneurysm
  • incompressible arterial puncture last 7d
40
Q

Subarachnoid Hemorrhage

clinical exclusion criteria for IV tPA

A
  • SAH
  • BP > 185 / > 110
  • blood glucose < 50
  • active internal bleeding
41
Q

Subarachnoid Hemorrhage

heme exclusion criteria for IV tPA

A
  • Plt < 100 K
  • current A/C (coumadin with INR > 1.7)
  • therapetic heparin w/ in 48 hrs w/ elevated PTT
  • DOACs within 48 hrs
42
Q

what is a thrombectomy

A

a procedure to remove a blood clot from a blood vessel using a catheter and a clot retriever

43
Q

how many brain cells die each minute a strok goes untreated?

A

2 million

44
Q

Subarachnoid Hemorrhage

surgical options

A
  • carotid endarterectomy
  • carotid stents per vascular surgeon
45
Q

Subarachnoid Hemorrhage

if embolic, when are warfarin or apixaban indicated?

A
  • a. fib
  • mitral stenosis
  • prosthetic cardiac valve
  • LV thrombi
  • atrial myxoma
46
Q

Subarachnoid Hemorrhage

what can you use as adjunct w/ warfarin? until what?

A
  • heparin
  • INR therapeutic (2.0 to 3.0)
47
Q

Subarachnoid Hemorrhage

what meds don’t require bridging or monitoring?

A

NOACs

48
Q

Subarachnoid Hemorrhage

if event was thrombotic or lacunar and the pt was not on anti-platelet meds at presentation what are they discharged on?

A

ASA 81mg PO QD

49
Q

Subarachnoid Hemorrhage

if the pt was on ASA and had a stroke then what are they discharged on?

A
  • overlap 21d with ASA 81 mg PO QD and Plavix 75 mg PO QD
  • Plavix only after 21d
50
Q

Subarachnoid Hemorrhage

how long to delay ASA if pt received tPA? what does CT need to confirm?

A
  • hold ASA for 24 hr
  • CT confirms no hemorrhagic transformation
51
Q

Subarachnoid Hemorrhage

Hypertensive Tx- when to treat?

A
  • all tPA candidates if BP > 185/110
  • everyone if BP > 220/120
  • HTN w/ end organ damage
52
Q

Subarachnoid Hemorrhage

hypertensive in patient tx

A
  • labetolol
  • nicardipine
53
Q

Subarachnoid Hemorrhage

Post stroke therapies

not meds….

A
  • physical therapy
  • occupational therapy
  • speech therapy
54
Q

Subarachnoid Hemorrhage

secondary prevention

6

A
  1. control risk factors
  2. comply w/ treatment
  3. lifestyle modifications
  4. statins
  5. DM control
  6. HTN control
55
Q

Subarachnoid Hemorrhage

what lifestyle mods should be performed for secondary prevention?

A
  • exercise
  • mediterranean diet
  • smoking cessation
  • EtOH cessation

CMT (72 decks)

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