Tia And Stroke

Front 1

what is a TIA?

Back 1

acute neurologic deficit of vascular origin lasting minutes to an hour and clears completely

Front 2

Transient deficits lasting more than 24hrs. but clearing completely in less than 3 days

Back 2

Reversible ischemic nuerological deficit

Front 3

patient reports that they suddenly lost their vision, the symptom lasted only a couple minutes what do you expect? what might you see in the eye or discover on further evaluation?

Back 3

suspect a carotid TIA. you may find a carotid bruit and reduced carotid pulse. in the back of the eye you could discover a ipsilateral hollenhorst plaque, rarely hornet's may present in these patients

Front 4

patient reports diplopia lasting less than an hour what do your expect?

Back 4

Vertebrobasilar TIA you might ask them about any loss of consciousness or bilateral motor or sensory deficits

Front 5

compare visual symptoms expected in a carotid TIA vs. a Vertebrobasilar TIA

Back 5

loss of vision=carotid
diplopia=vertebrobasilar

Front 6

name and describe a source of a Vertebrobasilar TIA

Back 6

Subclavian steal syndrome: narrow subclavian artery proximal to vertebral arter. the left arm steals blood from the basilar artery by way of the vertebral artery. stroke is rare.

Front 7

76 year old patient comes to the office complaining of losses of vision lasting 30 minutes at a time. Her blood pressure is taken and is 142/92. She seems confused and lethargic. what is her Lancet risk determination?

Back 7

• Age: >60, +1
• Blood Pressure>140/90 +1
• Clinical features
o Weakness one side (face, arm or leg) +2
o Difficulty speaking or understanding +1
• Duration
o One hour or more +2
o >10min but less than 60min +1

-->this patient has a score of 4

Front 8

this type of stroke is felt behind the eyes or over forehead/temples

Back 8

anterior circulation stroke

Front 9

Person complains that they woke up this morning and couldn't hold their coffee cup, they also have a history of HA in the back of their head what do you expect?

Back 9

posterior circulation stroke (thrombotic stroke)

Front 10

patient tells you they have a clumsy hand, they also say something about swiss cheese disease in their brain. what are they referring to?

Back 10

lacunar stroke (small vessel thrombotic stroke)

Front 11

patient comes in with right eye in the down and out position. the pupil is dilated and a ptosis is present. what do you expect? what signs will be seen with the face and tongue?

Back 11

Weber's syndrome.
contralateral hemiplegia with face and tongue paralysis

Front 12

Patient with 3 & 4th nerve palsy, pupil dilation and ptosis what do you expect? what motor abnormalities will support this dx?

Back 12

Red nucleus: claude's syndrome: contralteral motor hemiplegia and rubral tremor

Front 13

what level of cholesterol is considered a risk factor for stroke? what about HDL?

Back 13

cholesterol 240, HDL less than 35

Front 14

over what BP does the risk of stroke increase?

Back 14

140/90

Front 15

sundown sign is seen in what type of stroke?

Back 15

Intracerebral "Primary hypertensive hemorrhage"

Front 16

patient report the worse he ache of their life after a brief game of basketball they also report sever neck stiffness what do you expect?

Back 16

Subarachnoid hemorrhagic stroke order a CT

Front 17

what is the treatment prognosis for strokes?

Back 17

-cannot tell true extent for first 3 days
-some/little improvement in first 3 wks
-3months estimate potential recovery
-3months later (6months) 90% of potential recovery
-up to 18 months (3X) will get 10% more of potential

Front 18

how is a carotid TIA tx?

Back 18

surgically or medically. A carotid endarterectomy is performed if stenosed 70-90%. Anticoagulants are given for large vessel dz, and anti platelet agents are also given.

Front 19

who are vertebrobasilar TIAs tx?

Back 19

meically. Use of anticoagulant with sudden onset of TIAs of less than 2 months (warfarin X 3 months) then antiplatlet given until TIA free for one year. If the TIA symptoms occurred for over 2 months bf. tx is started then antiplatlet agents are given only unless there is a recent increase in frequency.

Front 20

how are cerebral or basilar TIAs managed?

Back 20

anticoagulants such as warfarin for large vessel disease X4-6 monthsAntiplatelet agent s are given after anticoagulant tx. for 1 year if TIA free

Front 21

true or false TIAs with a negative workup should not be tx, instead the pt. needs to be monitored.

Back 21

false. this is 40% of patients. they will tx with an anticoagulant followed by an antiplatlet for 1 year if TIA free.

Front 22

what anti platelet agents are given for ulcerated or irregular plaques without severe stenosis?

Back 22

ASA, ticlopidine, clopidogrel

Front 23

what is a common anticoagulant prescribed for TIAs?

Back 23

warfarin

Front 24

once you have had a stroke what is the chance of a recurrent stroke?

Back 24

36%

Front 25

what condition may occur secondary to cardiac arrest? is this a stroke?

Back 25

global cerebral ischemia, this is not a stroke

Front 26

what condition can mimic a stroke and occurs secondary to CSF interference?

Back 26

subarachnoid hemorrhage

Front 27

TIAs are typically warning signs of what kind of stroke?

Back 27

Thrombotic

Front 28

patient says they have been having headaches when they wake up in the morning. They also complain that sometimes their balance is off and they walk with a strange gait. dx?

Back 28

thrombotic stroke: large vessel , if the HA occurs behind the eyes or over the forehead/temples think anterior circulation stroke HA. it the pain is toward the back of the head think posterior circulation stroke HA

Front 29

Diabetic patient complains they have trouble holding their coffee cup with their right hand. They do not have other complaints. dx?

Back 29

thrombotic stroke: small vessel, is also commonly associated with HTN

Front 30

what are two key features of all thrombotic strokes?

Back 30

occur during sleep or is present on awakening.
signs are symptoms progress in a stepwise fashion

Front 31

patient complains of nausea and the room spinning. you note Horner's in the left eye. they also have a burn on their right hand that they cannot remember getting. what is your working dx?

Back 31

Wellenberg's syndrome. (Thrombotic Brainstem Syndrome)

Front 32

what type of thrombotic syndrome presents with internuclear ophthalmoplegia or a gaze palsy?

Back 32

medial pons

Front 33

what sign predominates in a lateral pons syndrome?

Back 33

sensory loss

Front 34

what are 4 ipsilateral signs of weber's syndrome? 2 contralateral signs?

Back 34

ipsilateral-complete CN 3 palsy, pupil dilation, ptosis, opthalmoparesis
contralateral-hemiplegia with face and tongue paralysis

Front 35

what are the ipsilateral signs of claude's syndrome? contralteral?

Back 35

ipsilateral-CN 3 &4 palsy, pupil dilation, ptosis, opthamloparesis
contralateral: motor hemiplegia and rubral tremor

Front 36

patient has eyes deviated to right OU, pupils are normal size and reactive to light. what is your working diagnosis?

Back 36

stroke: putaminal interacerebral hemorrhage

Front 37

describe a patient suffering a thalamic intracerebral hemorrhage.

Back 37

eyes deviated down to the nose, no vertical gaze (sundown sing) pupils are small and nonreactive

Front 38

patient has normal pupils/reactive to light but has trouble with abduction. what type of hemorrhage do you suspect?

Back 38

cerebellar intracerebral hemorrhage

Front 39

patient turns their head to look in different direction they also have very tiny pupils. However, these pupils do respond when you perform SLEx. working diagnosis?

Back 39

pontine intracerebral hemorrhage

Front 40

what is the clinical triad for normal-pressure hydrocephalus?

Back 40

1. dementia
2. gait instability (wide w/o picking up knees)
3. urinary incontinene

Front 41

describe Global cerebral Ischemia: brief ischemic episodes

Back 41

1. coma less than 12 hrs.
2. transient confusion or amnesia occur at awakening
3. recover complete in 7-10day to 1 month

Front 42

patient was in a brief coma; they have pupil responses but NLP. what is your working diagnosis?

Back 42

Global Cerebral Ischemia; Prolonged Ischemic Episodes; Focal cerebral dysfunction. full recovery may not occur for months

Front 43

patient is awaken after a coma but seems unaware of their surroundings. what is your working diagnosis? what makes this state distinct from coma?

Back 43

Global Cerebral Ischemia; Prolonged Ischemic episodes; Persistent Vegetative STATe. distinct from coma with the destruction of the neocortex

Front 44

what are the presenting signs and symptoms of spinal cord syndromes?

Back 44

impairment of pain and temperature. it produces flaccid paralysis, then spastic paraplegia with brisk tendon reflexes

Front 45

what is the tx for global cerebral ischemia?

Back 45

1. ventilatory assistance & O2
2. lower systemic BP
3. Reestablish cerebral circulation
4. stabilize cardiac dysrhythmias
5. supply electrolytes