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33 Cards in this Set
- Front
- Back
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what is a stroke? |
sudden onset of neurological deficit resulting from death/ischemia of brain tissue |
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4 risk factors for stroke |
hypertension hyperlipidemia diabetes smoking
the same exact risk factors for MI |
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2 types of strokes |
ischemic (85% of them) and hemorrhagic (15%) |
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two reasons for ischemic stroe |
thrombus in the artery itself
emboli from other places like the left atrium |
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3 things that would cause emboli infarcts in the brain |
a fib valvular diseases DVTs resulting in paradoxical emboli across a PFO |
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what other vessel flicks off a lot of emboli? |
carotid artery stenosis |
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what vessel is the cause of 90% of strokes |
MCA infarction |
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it it's left MCA what should you see? |
aphasia
contralateral motor weakness and sensory losses |
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What visual field loss is common with MCA strokes? |
homonymous hemianopsias |
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what side is the hemianopsia on? |
if it's a left MCA then you have a right homonymous hemianopsia |
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it's because of a lesion in the optic |
radiations |
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right MCA classic sign |
neglect |
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if a patient has a stroke that also manifests with personality and cognitive deficits what vessel would you suspect? |
ACA stroke |
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In the homunculus, what is medial and what is lateral? |
legs= medial
arms and face= lateral |
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so with ACA infarctions, what should be affected most? |
legs |
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What does a PCA stroke show? |
i think this is super rare but wll show:
ipsilateral sensory loss of the face, ninth and 10th cranial nerves |
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best initial test in any kind of stroke is... |
CT without contrast |
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the most accurate test for any kind of stroke however is... |
MRi |
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what is the reason we do CT scan first? |
because it excludes an acute hemorrhage |
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Which is more sensitive for stroke however? |
MRI is a lot more sensitive and only takes 24 to 48 hours to be abnormal usually
CT can take up to 5 days to really show the stroke (at 95% sens) |
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what is the time cutoff for giving tPA? |
3 or 4.5 hours depending on who you ask |
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After you've reached the 4.5 hour mark what should you give? |
aspirin instead |
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what do you give for a hemorrhagic stroke? |
nothing |
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What do you give to a stroke patient if they are ALREADY on aspirin? |
switch to clopidogrel
or
add dipyridamole |
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does surgical drainage do anything for hemorrhagic stroke? |
no |
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3 dx tests that are useful in just about every stroke presentation |
echo to look for valvular abnormalities or thrombi
EKG to look for a fib or flutter
Carotid ultrasound |
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what do you do if the initial EKG findings are normal in the case of a stroke? |
give a 24 to 48 hour Holter monitor and look for a fib or flutter |
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What is the mgmt for a thrombus detected by echo? |
give heparin and bridge to warfarin |
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What level of stenosis definitiely benefits from carotid endarterectomy? |
it depends on gender of the patient
basically any male with stenosis over 60 or 70% should have it done. I think any sypmtomatic lesion shows benefit but Fischer says no.... |
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however if the stenosis is udner 50% the answer is... |
just follow with serial ultrasound |
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does CHADS2 score matter to whether to anticoagulate these patients? |
no a stroke is worth 2 so they should all get warfarin with INR 2 to 3 |
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what type of control should we achieve in a diabetic patient with a stroke? |
HbA1c under 7% |
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if carotid stenosis was the cause of a stroke what is the new goal LDL for these patients? |
under 100 |
