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22 Cards in this Set

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  • Back
What are risk factors for ischemic strokes?
• atrial fibrillation
• diabetes
• drugs (ex. sympathomimetics, OCP, cocaine)
• family history of premature vascular disease
• history of TIA, MI, or CHF
• hyperlipidemia
• hypertension
• smoking
What is the ischemic penumbra?
• transition zone between normal and infarcted central core
• target area for salvage
What usually causes global cerebral ischemia?
• cardiac arrest
• ventricular fibrillation
Generally, what are cause of focal cerebral ischemia?
• embolism
• hematologic
• mural abnormalities
What are mural abnormalities that can cause acute cerebral ischemia?
• athersclerosis
• compression
• dissection
• fibromuscular dysplasia
• vasculitis
• vasospasm
What are different types of emboli that can cause stroke?
• air
• artery-to-artery
• cardiogenic
• fat
• paradoxical (emboli of venous origin passing through a patent foramen ovale)
What are hematologic conditions that can cause a stroke?
• antiphospholipid antibodies
• homocystinuria
• hypercoaguable state
• Protein C or Protein S deficiency
• sickle cell disease
What are the different classes of stroke?
• completed stroke
• lacunar stroke
• RIND
• stroke in evolution
What is the common pattern for left hemisphere stroke?
• aphasia
• difficulty reading, writing, or calculating
• dysarthria
• poor right conjugate gaze
• right hemiparesis
• right-sided sensory loss
• right visual field defect
What is the common patern for a right hemisphere stroke?
• dysarthria
• extinction of left-sided stimuli
• left hemiparesis
• left-sided sensory loss
• left visual field defect
• neglect of left visual field
• poor left conjugate gaze
• spatial disorientation
A patient presents with stroke-like signs and symptoms. What other diagnosis should be included in your differential?
• Craniocerebral/cervical trauma
• intracranial mass
• meningitis/encephalitis
• metabolic (ex. hyperglycemia, hypoglycemia, post-cardiac arrest ischemia, drug overdose)
• migraine with persistent neurological signs
• RIND
• seizure with persistent neurological signs
• TIA
What percentage of acute ischemic strokes are readily visible in the first 24 hours?
5%
What is the treatment for carotid stenosis?
• if asymptomatic bruit or extracranial stenosis less than 60% » treat with antiplatelet drugs
• extracranial stenosis more than 70% (with or without symptoms) » carotid endarterectomy
What are contraindications for administering TPA?
• history of intracranial hemorrhage
• repeated systolic BPs > 185 mm Hg or diastolic BPs > 110 mm Hg
• previous stroke or serious head trauma in preceding 3 months
• rapidly improving neurological deficit or minor symptoms
• recent invasive surgical procedure
• requires aggressive treatment to reduce BP to specified limits
• taking anticoagulants or propensity to hemorrhage
What are characteristics of hypertensive encephalopathy?
• diffuse cerebral effects of HTN not caused by infarction or hemorrhage
• signs & symptoms:
- confusion
- drowsiness
- headache
- papilledemia
- retinal hemorrhages
- seizures
- severe HTN
- visual blurring
What are the different types of intracerebral hemorrhage?
• diffuse: subarachnoid hemorrhage
• focal: intraparenchymal
What are causes of intraparenchymal hemorrhage?
• amyloid angiopathy
• AVMs
• bleeding diathesis (ex. anticoagulants, thrombolytics
• drugs (ex. amphetamines, cocaine)
• hypertension
• trauma
What are the 3 forms of intracranial aneurysms?
• fusiform
• mycotic
• saccular
What test is the gold standard for evaluating subarachnoid hemorrhage?
cerebral angiography
What are complications of subarachoid hemorrhage?
• hemorrhage
• hydrocephalus
• hyponatremia (SIADH, cerebral salt wasting)
• hypertension
• vasospasm
Describe the Hunt and Hess system for classifying subarachnoid hemorrhages
• Grade I: asymptomatic of minimal headache and slight nuchal rigidity

• Grade II: moderate to severe headache, nuchal rigidity, no neurological defict other than cranial nerve palsy

• Grade III: drowsiness, confusion, or mild focal deficit

• Grade IV: stupor, moderate to severe hemiparesis, possible early decerebrate rigidity, & vegetative disturbance

• Grade V: deep coma, decerebrate rigidity, moribund appearance (looks like they're going to die)
List different types of vascular malformations in the brain?
• AV malformations
• capillary telangiectases
• cavernous angiomas
• venous angiomas (most common)