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20 Cards in this Set
- Front
- Back
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1. Stroke vs. TIA definition?
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a. Strokes last for ≥24 hrs. There will be permanent neurologic deficits, caused by ischaemia or haemorrhage
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2. Percentage of ischaemic vs. haemorrhagic strokes?
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a. 80% ischaemic
1. Ischaemic will be either emboli or thrombolic. Emboli present w/more sudden symptoms. b. 20% haemorrhagic |
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3. What part of the face is spared by strokes?
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a. Upper 1/3 of the face.
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4. Presentation of TIAs?
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a. <24 hs and resolve completely.
b. Cases may present only w/transient loss of vision in one eye. |
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5. Transient loss of vision in one eye is also known as?
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a. Amaurosis Fugax.
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6. Cause of Amaurosis Fugax?
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a. This happens during a transient ischaemic attack because the first branch of the carotid artery is the ophthalmic artery.
b. TIAs are always caused by emboli or thrombosis. Never due to haemorrhage; haemorrhages do not resolve in 24 hrs. |
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7. A 67 yo man w/a hx of HTN and DM comes to the ED w/a sudden onset of weakness in the R. arm and leg over the last hr. On exam, he cannot lift he bottom of the right side of his face. What is the best initial step?
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a. Head CT w/o contrast.
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8. When is contrast used in a head CT?
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a. To detect cancer or an abscess.
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9. Presentation of Anterior Cerebral artery infarct?
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a. Profound lower extremity weakness (contralateral in the case of unilateral arterial occlusion).
b. Mild upper extremity weakness (contralateral in the case of unilateral arterial occlusion). c. Personality changes or psychiatric disturbance d. Urinary incontinence. |
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10. Presentation of Middle Cerebral Artery infarct?
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a. Profound upper extremity weakness (contralateral)
b. Aphasia c. Apraxia/neglect d. The eyes deviate TOWARD the side of the lesion. e. Contralateral homonymous hemianopsia, w/macular sparing. |
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11. Presentation of posterior cerebral artery infarct?
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a. Prosopagnosia (inability recognize faces).
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12. Presentation of posterior Inferior Cerebellar artery infarct?
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a. Ipsilateral face
b. Contralateral body c. Vertigo and Horner’s syndrome |
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13. Presentation of lacunar infarct?
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a. There must be an ABSENCE of cortical deficits
b. Ataxia c. Parkinsonian signs d. Sensory deficits e. Hemiparesis (most notable in the face) f. Possible bulbar signs. |
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14. Presentation of Ophthalmic artery infarct?
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a. Amaurosis Fugax
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15. Best initial diagnostic test for either stroke or TIA?
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a. CT scan of the head w/o contrast.
b. Within the first several days, all non-haemorrhagic strokes should be associated w/a normal head CT scan. c. MRI is NOT done, bc the CT is more widely available, less expensive, and more sensitive for blood. |
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16. Value of Head CT?
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a. Extremely sensitive for blood. Needs 3-5 days to achieve >95% sensitivity in the detection of non-haemorrhagic strokes.
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17. Value of Brain MRI?
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a. Achieves 95% sensitivity for a non-haemorrhagic stroke W/I 24 hrs.
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18. Most accurate imaging test for brainstem?
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a. MRA.
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19. Tx of Ischaemic stroke?
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a. Thrombolytics. Should be administered w/I 3 hours of the onset of the symptoms of a stroke.
b. ALWAYS get a head CT w/o contrast before anticoagulating to r/o haemorrhagic stroke. c. Must know the contraindications to thrombolytics as well. |
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20. Absolute contraindications to haemorrhagic stroke?
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1. Hx of haemorrhagic stroke
2. Presence of intracranial neoplasm/mass 3. Active bleeding or surgery w/I the 6 weeks 4. Presence of bleeding disorders 5. CR w/in 3 weeks that was traumatic (e.g., chest compressions) 6. Suspicion of aortic dissection 7. Stroke w/in 1 year 8. Cerebral trauma or brain surgery w/I 6 months. |
