TIAs, Strokes, Intracerebral AVM, Aneurysms Flashcards
(55 cards)
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
2
Q
what is RIND?
A
reversible ischemic neurologic deficit
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
4
Q
what 2 things keep the brain happy?
A
oxygen & glucose
5
Q
what does the frontal lobe control?
7
A
- planning
- reasoning
- personality
- personality
- emotions
- motor functions
- motor speech area (Broca)
6
Q
what does the parietal lobe control?
6
A
- sensory info/processing
- taste/temp/pain
- understanding language
- memory
- reading/writing
- spatial awareness
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
8
Q
what does the occipital lobe control?
A
- primary visual cortex is at the rear of this lobe
- controls vision and visual processing
9
Q
what is involved with anterior circulation
A
- anterior cerebral artery and middle cerebral artery
- they branch off of the internal carotid arteries
10
Q
what is involved w/ posterior plumbing
A
- posterior cerebral artery branches from the vertebral/basilar arteries
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
12
Q
ACA stroke sx
3
A
- usually occurs with MCA stroke
- contralateral motor and sensory
- leg more affected than the arm
13
Q
MCA stroke sx
3
A
- contralateral weakness to the face and arm
- contralateral sensory loss
- aphasia if dominant hemisphere
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
15
Q
what is in the brainstem
A
midbrain, pons, medulla
16
Q
what does the brainstem control?
7
A
- breathing
- heart rate
- temperature
- swallowing
- weakness
- paralysis
- consciousness
17
Q
Brain Stem Events
non modifiable risk factors
4
A
- age
- male gender
- race
- family hx
18
Q
Brain Stem Events
modifiable risk factors
5
A
- HTN
- dyslipidemia
- CAD
- hypercoagulability
- diabetes
19
Q
Brain Stem Events
behavioral risk factors
6
A
- smoking
- alcohol
- obesity
- physical inactivity
- illicit drug use
- OCPs ONLY if also smoker
20
Q
what should you always order first?
A
CT
21
Q
What will CT show?
A
subtle indicators of infarction within 6 hrs of stroke onset
22
Q
Ischemic Stroke
what % of strokes are this kind?
A
~85%
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
# Ischemic Stroke
how did the stroke occur if it is embolic?
* most likely a cardiac source (a. fib, PFO, valvular disease, artery to artery embolism)
* bilateral appearance
26
# Ischemic Stroke
how did the stroke occur if it was in a large vessel?
atherothrombosis most common pathology
27
# Hemorrhagic Strokes
what to order?
* CT without contrast
* Blood will "light up" on CT
28
# Intracerebral Hemorrhage
Risk Factors
| 6
1. HTN
2. Arteriovenous Malformation
3. Ruptured Aneurym
4. Coagulopathy
5. Eclampsia
6. Trauma
29
# Subarachnoid Hemorrhage
Sx
| 6
1. thunder clap headache
2. "worst headache of my life"
3. nausea/vomiting
4. decreased LOC
5. nuchal ridigity
6. seizures
30
# Subarachnoid Hemorrhage
Primary Cause
arterial aneurysm
31
# Subarachnoid Hemorrhage
Other Risk Factors
| 4
1. AVM
2. bleeding disorders
3. trauma
4. illicit drug use
32
# Subarachnoid Hemorrhage
Risk factors for arterial aneurysm
| 5
1. HTN
2. EtOH
3. Family Hx of SAH
4. Family Hx of connective tissue disorder
4. personal previous SAH
33
# Subarachnoid Hemorrhage
FAST acronym
* F: facial drooping
* A: arm has pronator drift
* S: speech is slurred, abnormal, dysarthric, or absent
* T: time is "last known well"
34
# Subarachnoid Hemorrhage
Immediate Management
* 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
# Subarachnoid Hemorrhage
Monitoring
* closely monitor vitals
* monitor mental status, speech changes
* fundoscopic, cardiac, and neurologic exams
36
# Subarachnoid Hemorrhage
imaging to consider?
| 6
* brain CT w/out contrast
* CTA of head/neck
* MRI of the brain (once admitted)
* EKG
* echo w/ bubble study
* carotid US
37
# Subarachnoid Hemorrhage
lab testing to order
| 5
* cardiac enzymes
* CBC w/ diff
* coag studies
* blood type & screen
* metabolic panel
38
# Subarachnoid Hemorrhage
inclusion criteria for IV tPA
| 3
* clinical dx w/ measureable deficit
* age > 18 y/o
* sx since < 4.5 hrs
39
# Subarachnoid Hemorrhage
pmhx exclusion criteria for IV tPA
| 4
* stroke/head trauma in last 3 mo
* recent head/spine surgery
* prior IC hemorrhage, malignancy, AVM, aneurysm
* incompressible arterial puncture last 7d
40
# Subarachnoid Hemorrhage
clinical exclusion criteria for IV tPA
* SAH
* BP > 185 / > 110
* blood glucose < 50
* active internal bleeding
41
# Subarachnoid Hemorrhage
heme exclusion criteria for IV tPA
* 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
what is a thrombectomy
a procedure to remove a blood clot from a blood vessel using a catheter and a clot retriever
43
how many brain cells die each minute a strok goes untreated?
2 million
44
# Subarachnoid Hemorrhage
surgical options
* carotid endarterectomy
* carotid stents per vascular surgeon
45
# Subarachnoid Hemorrhage
if embolic, when are warfarin or apixaban indicated?
* a. fib
* mitral stenosis
* prosthetic cardiac valve
* LV thrombi
* atrial myxoma
46
# Subarachnoid Hemorrhage
what can you use as adjunct w/ warfarin? until what?
* heparin
* INR therapeutic (2.0 to 3.0)
47
# Subarachnoid Hemorrhage
what meds don't require bridging or monitoring?
NOACs
48
# Subarachnoid Hemorrhage
if event was thrombotic or lacunar and the pt was not on anti-platelet meds at presentation what are they discharged on?
ASA 81mg PO QD
49
# Subarachnoid Hemorrhage
if the pt was on ASA and had a stroke then what are they discharged on?
* overlap 21d with ASA 81 mg PO QD and Plavix 75 mg PO QD
* Plavix only after 21d
50
# Subarachnoid Hemorrhage
how long to delay ASA if pt received tPA? what does CT need to confirm?
* hold ASA for 24 hr
* CT confirms no hemorrhagic transformation
51
# Subarachnoid Hemorrhage
Hypertensive Tx- when to treat?
* all tPA candidates if BP > 185/110
* everyone if BP > 220/120
* HTN w/ end organ damage
52
# Subarachnoid Hemorrhage
hypertensive in patient tx
* labetolol
* nicardipine
53
# Subarachnoid Hemorrhage
Post stroke therapies
| not meds....
* physical therapy
* occupational therapy
* speech therapy
54
# Subarachnoid Hemorrhage
secondary prevention
| 6
1. control risk factors
2. comply w/ treatment
3. lifestyle modifications
4. statins
5. DM control
6. HTN control
55
# Subarachnoid Hemorrhage
what lifestyle mods should be performed for secondary prevention?
* exercise
* mediterranean diet
* smoking cessation
* EtOH cessation
