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32 Cards in this Set

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  • Back
define a stroke
sudden, nonconvulsive focal neruologic deficit
define a TIA (transient ischemic attack)
1. deficit lasting <24 hr (usually <1 hr)
2. but resolves completely
where is the m/c emboli source for a stroke?
1. carotid atheroma
what are common emboli sources for an infarct?
1. carotid atheroma (m/c)
2. cardiac and fat emboli
3. marantic endocarditis (metastasizing cancer cells)
what is a Lacunar infarct?
1. small infarct
2. deep in white mater
3. strongly a/c hypertension and atherosclerosis
where do watershed infarcts occur?
at the border of areas supplied by different arteries
1. middle cerebral artery
2. anterior cerebral artery
3. often following prolonged hypotension
what is Wernicke's aphasia?
1. Wernicke's is wordy
2. temporal lobe lesion
3. receptive aphasia
4. pt speaks fluently but words do not make sense
what aphasia comes from a temporal lobe lesion?
Wernicke's
1. Wernicke's is wordy
2. receptive aphaisa
3. pt speaks fluently but words do not make sense
what is Broca's aphasia?
1. Broca's is broken
2. frontal lobe lesion
3. expressive aphasia
4. pt is unable to verbalize
what are clinical changes 2-4 days postinfarct?
1. edema occurs 2-4 days post infarct
2. decreased consciousness
3. projectile vomiting
4. pupillary changes
what is decorticate posturing?
1. flexion of arms
2. decorticate=cortical lesion
what is decerebrate posturing?
1. arm extension
2. decerebrate=midbrain or lower lesion
what is the ddx of an infarct?
1. stroke
2. seizure
3. neoplasm
4. encephalitis
5. multiple sclerosis
what are m/c storke causes?
1. local atheroembolic (35%)
2. cardiac (30%)
3. lacunar (15%)
4. parenchymal hemorrhage (10%)
5. subarachnoid hemorrhage (10%)
6. vasculitis, temporal arteritis, etc. (1%)
when is a CT indicated in an infarct?
1. in an acute infarct
when is an MRI indicated in an infarct?
1. subacute infarct
2. hemorrhage
what si/sz should you r/o when you suspect an infarct?
1. EKG changes
2. loss of bowe/bladder control
3. tongue injury
why should you perform a lumbar puncture when you suspect a stroke?
1. to r/o encephalitis
2. to r/i intracranial bleed
what is first-line tx for occlusive infarct?
tPA within 3-6 hr of onset!!! (preferably 1 hr)
for occlusive dz only (do NOT use with an intracranial bleed!!!)
what is an absolute contraindication to tPA?
Intracranial bleed!!!
what underlying disorders should you try to correct in the event of an infarct?
1. hyperlipidemia
2. hypertension
3. diabetes
4. valve abnormality
5. coagulopathy
6. atrial fibrillation
what is first line tx for an emoblic stroke?
1. give aspirin/warfarin anticoagulation for prophylaxis
what are indications for an enarterectomy?
1. if carotid is 70% occluded
2. pt having sx
what is an MRA?
Magnetic resonance angiography
*used to see the arteries (e.g. at the base of the brain)
*shown well by MRA s/ use of any contrast
what is the prognosis of an infarct?
1. 20-40% mortality at 30 days (20% atheroemboli, 40% bleed)
2. <1/3 pts achieve full recovery of lifestyle
3. atheroembolic strokes recur at 10% per yr
the presentation of amaurosis fugax (monocular blindness) suggests what artery and lobe for an infarct?
1. carotid (emboli)
2. ophthalmic artery
the presentation of drop attack/vertigo/CN palsy/coma suggests what artery and lobe for an infarct?
1. vertebrobasilar (emboli)
2. brainstem
the presentation of aphasia suggests what artery and lobe for an infarct?
1. middle cerebral
2. dominant frontal or temporal (L=dominant in 99% of R-handers and >50% of L-handers)
the presentation of sensory neglect and apraxia suggests what artery and lobe for an infarct?
1. middle cerebral
2. non-dominant frontal or temporal (R)
apraxia=pt cannot follow commands even if it is understood and the pt is physically capable of it
the presentation of Hemiplegia suggests what artery and lobe for an infarct?
1. middle or anterior cerebral
2. contralateral parietal
the presentation of homonymous hemianopia suggests what artery and lobe for an infarct?
1. middle or posterior cerebral A.
2. temporal or occipital lobe
the presentation of urinary incontinence and grasp reflex suggests what artery and lobe for an infarct?
1. middle or anterior cerebral A.
2. Frontal lobe