Mcphs Mmd Ii Brain Attacks

Front 1

What are the different types of Stroke?

Back 1

Lacunar Infarction
Cerebral Infarction
Intracerebral Hemorrhage
Subarachnoid Hemorrhage

Front 2

Focal Ischemic cerebral neurological deficit.

Last < 24 hours (usually < 1-2 hours)

Often precedes stroke

Back 2

Transient Ischemic Attack (TIA)

Front 3

The risk of this is highest in the month after a TIA (particularly in the first 48 hours).

Back 3

Stroke

Front 4

TIA are caused by an embolization secondary to what two things?

Back 4

Cardiac causes: Afib, rheumatic heart dz, Mitral valve dz, infective endocarditis.

Hematologic causes: Polycythemia, sickle cell dz, or hyperviscosity syndromes.

Front 5

This can let a venous thrombus travel to the cerebral arteries?

Back 5

A patent foramen ovale.

Front 6

This is the only way that a DVT can cause a stroke?

Back 6

If there is a patent foramen ovale.

Front 7

This has an abrupt onset without warning, recovery occurs rapidly, can be within a few minutes. SX depend on extent and location of the lesion.

Back 7

TIA

Front 8

If a TIA occurs here a carotid bruit or cardiac abnormality will be appreciated. Motor or sensory deficits will be present either singular or in combination.

Motor deficits: Weakness, heaviness of contralateral arm or leg. Slowness of movement, dysphagia or monocular vision loss in ipsilateral eye.

Sensory: Numbness or paresthesias, hyperreflexia.

Back 8

Carotid Territory TIA

Front 9

Motor or sensory deficits either combined or singular.

Vertigo, ataxia, diplopia, dysarthria, dimness or blurry vision, perioral numbness or paresthesias can be seen with this.

Back 9

Vertebrobasilar Territory TIA

Front 10

Stroke risk is greatest in patients with a TIA who show what characteristics?

Back 10

After TIA lasting > 10 minutes

After TIA with weakness, speech impairment or gait disturbance

Front 11

Which type of TIA, Carotid or Vertebrobasilar TIA, is more likely to be followed by a stroke?

Back 11

Carotid TIA

Front 12

What test can you do to rule out a patent foramen ovale?

Back 12

Echo with bubble contrast

Front 13

What situations give rise to hospitalization due to a TIA? (five of them)

Back 13

1. Pt presents within 48 hours of first attack

2. Pt has crescendo attacks

3. Sx lasting > 1 hour

4. Pt has symptomatic carotid stenosis

5. Pt has known cardiac source of emboli or hypercoagulable state.

Front 14

This is the treatment of choice for a TIA if there is a 70-99% carotid stenosis + relatively little atherosclerosis elsewhere. This is done to decrease the risk of ipsilateral carotid stroke.

Back 14

Carotid Thromboendarterectomy

Front 15

If a TIA is vertebrobasilar having a cardioembolic source, what is the TX plan?

Back 15

Immediate anticoagulation

Heparin IV, then bridge to Coumadin

If coumadin is contraindicated give ASA daily 325mg to reduce stroke risk.

Front 16

If a TIA is vertebrobasilar, having a non-cardioembolic source, what is the TX plan?

Back 16

ASA 325mg daily to reduce frequency of TIAs, stroke and MIs

If ASA not tolerated, give clopidogrel 75mg daily

Coumadin is not recommended.

Front 17

This is also known as a stroke?

Back 17

Cerebrovascular accident

Front 18

What are the four types of stroke?

Back 18

Infarcts:
Lacunar and Cerebral

Hemorrhagic:
Intracerebral, Subarachnoid

Front 19

Lesions less than 5mm in diameter

Occur in arterioles in the basal ganglia, pons, crebellum and deep cerebral white matter.

Associated with uncontrolled HTN and DM

SX: Contralateral pure motor or pure sensory deficits. Ipsilateral ataxia w/muscle weakness with clumsiness of the hand and dysarthria.

SX may progress over 24-36 hours before stabilizing.

Back 19

Stroke - Lacunar Infarct

Front 20

Thrombotic or embolic occlusion of major vessel leading to a cerebral infarct. Atherosclerosis of the cerebral arteries are a risk factor.

Back 20

Stroke - Cerebral Infarct

Front 21

Abrupt onset, then little progression except secondary to brain swelling. On physical exam you will perform cardiac exam and auscultation of subclavian and carotid vessels for bruits.

Back 21

Stroke - Cerebral infarct

Front 22

With this type of stroke you will see the following:

Unilateral blindness

Severe contralateral hemiplegia and hemianesthesia

Profound aphasia

Back 22

Stroke at the Internal Carotid Artery

Front 23

With this type of stroke you will see the following:

Emotional lability

Confusion, amnesia, personality changes

Urinary incontinence

Impaired mobility w/sensation in LE>UE

Contralateral hemiplegia or hemiparesis

Back 23

Stroke at the Anterior Cerebral Artery

Front 24

With this type of stroke you will see the following:

Alternation in communications, cognition, mobility and sensation

Homonymous hemianopia

Contralateral hemiplegia or hemiparesis

Back 24

Stroke at the Middle Cerebral Artery

Front 25

With this type of stroke you will see the following:

Hemianesthesia

Contralateral hemiplegia in face, UE > LE

Homonymous hemianopia

Receptive aphasia

Cortical blindness

Memory deficits

Back 25

Stroke at the posterior cerebral artery

Front 26

With this type of stroke you will see the following:

Unilateral or bilateral weakness of extremities

Diplopia, homonymous hemianopia

Nausea, vertigo, tinnitus and syncope

Dysphagia

Dysarthria

"Locked In" syndrome

Respiratory and circulatory abnormalities

Back 26

Stroke at the vertibrobasilar artery

Front 27

With this type of stroke you will see the following:

Vertigo, nausea, vomiting

Nystagmus

Ipsilateral limb ataxia

Contralateral spinothalamic loss

Back 27

Stroke at the cerebellar artery

Front 28

When performing imaging for cerebral infarct, why do you perform a CXR?

Back 28

To detect cardiomegaly or valvular calcifications

Front 29

When performing imaging for cerebral infarct, why do you perform a Head CT?

Back 29

You perform this first, before any other tests. It is fater than an MRI in acute situationand better capable of visualizing a cerebral hemorrhage, but may not distinguish cerebral infarct from tumor. It is used to exclude cerebral hemorrhage.

Front 30

What is the TX for a stroke-cerebral infarction?

Back 30

IV thrombolytic therapy with recombinant tissue plasminogen activator.

Effective if given within 3 hours of onset of ischemic stroke, not later.

Front 31

The following are contraindications for what?

Recent hemorrhage

Increased risk of hemorrhage (ie. pt on anticoagulation)

Arterial puncture at a noncompressable site

SBP>185 or DBP > 100

Back 31

Contraindication for TPA

Front 32

It is important to avoid reducing this in a patient with HTN during the acute phase of a stroke due to the fact that it may further compromise ischemic areas.

Back 32

BP

Front 33

If the source of the embolization is cardiac, then you should anticoagulate with?

Back 33

Heparin to a coumadin bridge

Front 34

HTN is a major risk factor for this, probably secondary to microaneurysms.

Sudden onset, usually during strenuous activity.

Most likely location is the Basal Ganglia.

Back 34

Inracerebral Hemorrhage

Front 35

The following symptoms are signs of what?

Consciousness is initially lost or impaired in 50% of patients.

Vomiting

Headache

Focal deficit depending on the location.

Back 35

Intracerebral Hemorrhage

Front 36

This has N/V, disequilibrium, headache, loss of consciousness which may progress to death within 48 hours

Back 36

Inracerebral hemorrhage - Cerebellar hemorrhage

Front 37

This usually presents with a loss of conjugate lateral gaze.

Back 37

Intracerebral hemorrhage - Putaminal hemorrhage

Front 38

This presents with a loss of upward gaze, downward or skew deviation of the eyes, lateral gaze palsies and pupillary inequality.

Back 38

Intracerebral hemorrhage -
Thalamic hemorrhage

Front 39

This diagnostic is contraindicated in intracerebral hemorrhage.

Back 39

Lumbar puncture (due to possible herniation syndrome)

Front 40

What is the conservative support ant TX for an intracerebral hemorrhage?

Back 40

Ventilatory support
BP regulation
Sz ppx
Fever Control
Osmotherapy (with mannitol)

Surgical evacuation of hematoma especially in cerebellar lesions to prevent spontaneous unpredictable deterioration.

Front 41

This is 6% of strokes. Usually secondary to ruptured aneurysm or AV malformation.

Sudden onset of worst HA of life.

N/V

Loss/Impairment of consiousness

Nuchal rigidity and other signs of meningeal irritation.

Back 41

Subarachnoid hemorrhage

Front 42

What Imaging do you use for a subarachnoid hemorrhage?

Back 42

Head CT - Faster and more sensitive than MRI in the first 48 hours.

Front 43

What do you look for in the lumbar puncture of someone who has a subarachnoid hemorrhage?

Back 43

Look for presence of blood or xanthochromia.

Front 44

What is the TX for subarachnoid hemorrhage?

Back 44

Admission to hospital, consult Neuro

Conscious pts: bedrest, no exertion or straining

Laxatives and stool softener

Tx for HA and anxiety

If severe HTN, gradually lower BP

Sz PPX

Front 45

These types of intracranial aneurysms occur at arterial bifurcations.

Back 45

Saccular (berry) aneurysms occur at arterial bifurcations.

Front 46

This is when a small amount of blood leaks from the aneurysm. Precedes major hemorrhage by a few hours to days. Sx: Headache, sometimes nausea and neck stiffness.

Back 46

Intracranial aneurysm - Warning Leak

Front 47

How do the following labs come back with an intracranial hemorrhage?

1. CSF
2. EEG
3. EKG
4. CBC
5. UA

Back 47

1. Bloodstained
2. Usually diffuse abnormalities
3. Arrythmias or myocardial ischemia 2/2 excessive sympathetic activity.
4. Increased WBC
5. Transient glucosuria