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