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25 Cards in this Set
- Front
- Back
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what is a stroke?
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acute onset of focal neuro deficits resulting from disruption of cerebral circulation
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name 5 causes of stroke
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1. atherosclerosis of of extracranial vessels
2. lacunar infarcts 3. cardiac emboli 4. fibromuscular dysplasia 5. hypercoagulable states |
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atherosclerosis of what extracranial vessels are often involved in stroke?
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1. internal/common carotid
2. basilar artery 3. vertebral artery |
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stroke in MCA: sx?
dominant vs. non-dominant hemisphere |
dominant: aphasia
non-dominant: neglect contralateral hemiparesis gaze preference homonymous hemianopsia |
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stroke in ACA: sx?
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leg paresis
amnesia personality changes foot drop gait dysfunction cognitive changes |
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stroke in PCA: sx?
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homonymous hemianopia
memory deficits dyslexia/alexia |
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stroke in basilar artery: sx?
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coma
'locked-in' syndrome cranial nerve palsies apnea visual sx drop attacks dysphagia |
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lacunar stroke: sx?
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pure motor or sensory stroke
dysarthria-clumsy hand syndrome ataxic hemiparesis |
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what is a TIA?
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a transient neuro deficit that lasts <24hrs (most last <1hr)
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what are 5 studies that can be used to work-up strokes?
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1. CT w/o contrast: differentiate ischemic from hemorrhagic stroke
2. MRI: to identify ischemic changes 3. ECG/Echocardiogram: if embolic stroke is suspected 4. vascular studies 5. screen for hypercoagulable states |
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vascular studies for stroke: extracranial vs. intracranial studies.
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extra: carotid u/s, MRA, traditional angiography
intra: transcranial Doppler or MRA |
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when do you screen for hypercoagulable states in stroke pts?
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hx of bleeding
first stroke pts <50yo |
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acute treatment of stroke?
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- monitor for signs and sx of brain swelling, incr. ICP, herniation
- for ischemic stroke, tPA is indicated if administered w/in 3hrs of sx onset (check for contraindications!) - ASA to decrease morbidity and mortality in acute ischemic stroke w/in 48hrs of onset - prevent hypotension and hypoxemia: keep systolic BP at 20mmHg above normal - tx poststroke complications |
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tx for stroke 2* to small vessel disease or thrombosis or if anticoagulation is contraindicated?
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ASA, clopidogrel
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when is endarterectomy indicated in stroke pts?
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stenosis >70% in symptomatic pts or >60% in asymptomatic pts; NOT in 100% occlusion!!
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when is anticoagulation indicated in stroke pts?
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new emboli
new AFib hypercoagulable states target INR of 2-3 |
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what can cause a subarachnoid hemorrhage?
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trauma
aneurysms AVM's trauma to the Circle of Willis (often at the MCA) |
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what is xanthochromia, and when is it seen?
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yellowish CSF due to breakdown of RBC's
seen in SAH |
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what are the three most common cerebral aneurysms?
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1. ACA - anterior
2. PCA - posterior 3. MCA - middle |
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how do you treat SAH?
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1. prevent rebleeding
2. CCB's and IV fluids; maintain BP to prevent vasospasm and furthur neuro deterioration 3. seizure ppx 4. decr. ICP by raising head of the bed and hyperventilating 5. surgery |
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mental status changes occur within minutes to hours and include a classic 'lucid interval': epidural or subdural hematomas?
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epidural
subdural hematomas lead to MS changes occurring over days and weeks |
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head trauma, rupture of bridging veins, common in elderly and alcoholics: epidural or subdural hematoma?
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subdural hematoma
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lateral skull fracture, tear of middle meningeal artery, 'blown pupil': epidural or subdural hematoma?
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epidural hematoma
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biconcave lens shaped morphology on head CT: epidural or subdural hematoma?
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epidural
subdural presents with crescent shaped artifact and midline shift |
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what are the risk factors for parenchymal hemorrhages of the brain?
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HTN
tumor amyloid angiopathy (in the elderly) vascular malformations (AVM's, cavernous malformations) |
