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Clin Med - Neuro > Stroke > Flashcards

Flashcards in Stroke Deck (26)
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1
Q

Ischemic Stroke

A

Loss of blood supply/perfusion to an area of the brain
Can be the result of hypoperfusion/hypotension
AKA “blockage stroke”

2
Q

Medical Risk Factors for Stroke

A
Hypertension
Atrial Fibrilation
Hyperlipidemia/Hypercholerestemia
Diabetes
Carotid Stenosis
3
Q

Behavior Risk Factors

A

Cigarette smoking
Physical Inactivity
Illicit Drugs
Heavy Alcohol Consumption

4
Q

What are the three subtypes of ischemic strokes?

A

Large Artery Atherosclerosis
Cardioembolism
Lacunar Infarctions (Small Vessel)

5
Q

What is the significance of getting a Head CT for an ischemic stroke?

A

You want to rule out a hemorrhagic stroke. CT are good for viewing blood, but are not good at determining blockages.

6
Q

What diagnostic method is sensitive and specific for detecting an ischemic stroke?

A

Diffusion Weighted Imaging MRI

7
Q

What is a TIA

A

Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction.

8
Q

Where in the arteries is atherosclerosis most commonly found?

A

In the bifurcations because there is a lot of turbulent flow.

9
Q

A 68-year old patient comes into the ER with CC of right-side facial weakness and slurred speech. You order a CT scan first, which shows no sign of a hemorrhagic stroke. What would you do next and how long do you have to act?

A

Order for the patient to have tPa and you have 3 hrs from the onset of the stroke. Giving tPa increases the likelihood of recovery at 90 days.

10
Q

What is the purpose of tPa?

A

It helps to break up clots and fibrin products

11
Q

A 72-year old patient comes in with stroke symptoms. You are doing your H&P and learn that he suffers from thrombocytopenia. Can he receive tPa?

A

NO. This is one of the exclusion criteria

12
Q

What is the most common cause of intraparenchymal hemorrage (IPH)?

A

HYPERTENSION

13
Q

What is an intraparenchymal hemorrhage (IPH)?

A

Bleeding into the parenchyma of the brain which may extend into the ventricular system.

14
Q

Where does IPH most commonly occur?

A

Basal ganglia, pons, cerebellum, thalamus

15
Q

Clinical presentation of IPH?

A
  • Rapidly progressive focal neurological deficits
  • Vomiting, systolic BP >200 mmHg, severe headache, depressed mental status (not specific though)
  • Hard to distinguish from ischemic strokes
16
Q

Definition of Subarachnoid Hemorrhage?

A

Bleeding into the space between the arachnoid membrane and and the pia mater surrounding the brain.

17
Q

Common cause of subarachnoid hemorrhage?

A

Trauma

18
Q

Common cause of non-traumatic subarachnoid hemorrhage?

A

Rupture of cerebral aneurysm

19
Q

What are the symptoms of subarachnoid hemorrhage?

A

“Worst headache of my life”

Nausea/vomiting, depressed mental status, meningeal irritation/neck stiffness

20
Q

What are the signs of subarachnoid hemorrhage?

A

The patient is often hypertensive and drowsy and exam is NON-FOCAL

21
Q

What is the common site of cerebral aneurysm?

A

Anterior communication artery

22
Q

The patient you are seeing has a CT scan that comes back negative. You highly suspect a cerebral aneurysm based on your exam findings. What do you do next?

A

Lumbar puncture

23
Q

Gold standard for diagnosing cerebral aneurysm?

A

Conventional Cerebral Angiogram

24
Q

After doing that lumbar puncture, you see that they are positive for subarachnoid hemorrhage (not due to trauma). What are two surgical options that you do for this patient

A

Coiling (endovascular approach)

Clipping (surgical approach)

25
Q

This complication of SAH occurs in 25% of patients and results in ischemic stroke. What is it?

A

Vasospasm

26
Q

What drug is given to reduce the morbidity and possible mortality associated with vasospasm?

A

Prophylactic Nimodipine