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22 Cards in this Set
- Front
- Back
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What are risk factors for ischemic strokes?
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• atrial fibrillation
• diabetes • drugs (ex. sympathomimetics, OCP, cocaine) • family history of premature vascular disease • history of TIA, MI, or CHF • hyperlipidemia • hypertension • smoking |
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What is the ischemic penumbra?
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• transition zone between normal and infarcted central core
• target area for salvage |
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What usually causes global cerebral ischemia?
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• cardiac arrest
• ventricular fibrillation |
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Generally, what are cause of focal cerebral ischemia?
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• embolism
• hematologic • mural abnormalities |
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What are mural abnormalities that can cause acute cerebral ischemia?
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• athersclerosis
• compression • dissection • fibromuscular dysplasia • vasculitis • vasospasm |
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What are different types of emboli that can cause stroke?
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• air
• artery-to-artery • cardiogenic • fat • paradoxical (emboli of venous origin passing through a patent foramen ovale) |
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What are hematologic conditions that can cause a stroke?
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• antiphospholipid antibodies
• homocystinuria • hypercoaguable state • Protein C or Protein S deficiency • sickle cell disease |
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What are the different classes of stroke?
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• completed stroke
• lacunar stroke • RIND • stroke in evolution |
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What is the common pattern for left hemisphere stroke?
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• aphasia
• difficulty reading, writing, or calculating • dysarthria • poor right conjugate gaze • right hemiparesis • right-sided sensory loss • right visual field defect |
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What is the common patern for a right hemisphere stroke?
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• 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 |
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A patient presents with stroke-like signs and symptoms. What other diagnosis should be included in your differential?
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• 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 |
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What percentage of acute ischemic strokes are readily visible in the first 24 hours?
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5%
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What is the treatment for carotid stenosis?
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• if asymptomatic bruit or extracranial stenosis less than 60% » treat with antiplatelet drugs
• extracranial stenosis more than 70% (with or without symptoms) » carotid endarterectomy |
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What are contraindications for administering TPA?
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• 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 |
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What are characteristics of hypertensive encephalopathy?
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• diffuse cerebral effects of HTN not caused by infarction or hemorrhage
• signs & symptoms: - confusion - drowsiness - headache - papilledemia - retinal hemorrhages - seizures - severe HTN - visual blurring |
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What are the different types of intracerebral hemorrhage?
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• diffuse: subarachnoid hemorrhage
• focal: intraparenchymal |
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What are causes of intraparenchymal hemorrhage?
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• amyloid angiopathy
• AVMs • bleeding diathesis (ex. anticoagulants, thrombolytics • drugs (ex. amphetamines, cocaine) • hypertension • trauma |
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What are the 3 forms of intracranial aneurysms?
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• fusiform
• mycotic • saccular |
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What test is the gold standard for evaluating subarachnoid hemorrhage?
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cerebral angiography
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What are complications of subarachoid hemorrhage?
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• hemorrhage
• hydrocephalus • hyponatremia (SIADH, cerebral salt wasting) • hypertension • vasospasm |
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Describe the Hunt and Hess system for classifying subarachnoid hemorrhages
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• 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) |
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List different types of vascular malformations in the brain?
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• AV malformations
• capillary telangiectases • cavernous angiomas • venous angiomas (most common) |
