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38 Cards in this Set

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What percentage of strokes are hemorrhagic vs. thromboembolic?

12% Hemorrhagic




88% Thromboembolic

What are the broad types of thromboembolic strokes?

The answer is in the question...




1. Thrombic (i.e., originating at the site of occulsion)




2. Embolic (i.e., reduced blood flow at a distance from the occlusion)




3. also, Vasospasm

What parts of the cerebrovascular system are most affected by stroke?

The anterior circulation (i.e., ACA, MCA, and anterior choroidal) is affected in 80% of strokes.




The PCA is affected in only 20% of strokes.

Define ischemia.

Ischemia = Insufficient blood supply to an organ

Define infarct

Infarct = area of necrotic tissue due to ischemia.

What are the broad types of hemorrhagic stroke?

Intracerebral hemorrhage (9% of stroke)




Subarachnoid hemorrhage (3% of stroke)

What are the 4 etiologies of thromboembolic stroke?

All are problems with "Velcro, Jello, Velcro, Jello" in the blood.

(sung to the tune of https://www.youtube.com/watch?v=UePtoxDhJSw)

1. Atherosclerosis

2. Hypertension

3. A fib

4. Other (vasculitis, coagulopathy)

What are the 5 etiologies of hemorrhagic stroke?

1. AVM


2. Aneurysm


3. Cardio Amyloid Angiopathy


4. Hypertensive hemorrage (must be acute spike in hypertension!)


5. Other (crack, cocaine, anticoagulants)

What is the mortality rate of hemorrhagic stroke within 6 months?

50%

What is the most common cause of subarachnoid hemorrhage?

Berry aneurysm at bends in the Acomm artery.

What are the most common regions affected in childhood stroke?

MCA, Thalamus, and Basal Ganglia

What is the more common childhood stroke, hemorrhage or thromboembolic?



Neither. Unlike adults there is equal prevalence of both.

How long does oxygen deprivation need to occur for neuronal damage?

6-8 minutes

What is the time window for saving the penumbra?

6 hours.

What is the time window for tPA?

3 Hours from last known normal period.

What are some secondary injuries in stroke?

1. Edema


2. Vasospasm


3. Herniation


4. Increased ICP


5. Hemorrhagic transformation


6. Sometimes seizures

What is the relationship between age and stroke risk?

Doubles every decade after 55 years of age.

What are other risk factors for stroke?

1. TIA


2. Cardiovascular disease


3. Sleep apnea


4. Obesity


5. Family history (three times greater)

What percentage of stroke survivors over age 65 are institutionalized?

25%

What is the most common presentation of childhood stroke in adulthood?

Seizures

Of those who survive hemorrhagic stroke, what proportion have ongoing cognitive impairment and impaired ADLs?

1/3

What is the cognitive syndrome associated with LEFT MCA SUPERIOR DIVISION INFARCT?

1. Broca's aphasia


2. Right face and Right arm weakness


3. Apraxia in the arm, particularly the right


4. Impaired working memory and executive functioning

What is the cognitive syndrome associated with RIGHT MCA SUPERIOR DIVISION INFARCT?

1. Left Face and Arm Weakness


2. Impaired working memory and executive deficits


3. Left hemineglect to a variable extent.

What is the cognitive syndrome associated with LEFT MCA INFERIOR DIVISION INFARCT?

1. Wernicke's aphasia.


2. Right visual field deficit


3. Right face and arm sensory loss


4. Limb apraxia


5. Gerstmann syndrome

What is the cognitive syndrome associated with RIGHT MCA INFERIOR DIVISION INFARCT?

1. Profound left hemineglect

2. Left visual field deficit

3. Motor neglect resulting in poor movement initiation, but with normal strength

4. Anosognosia

5. Right Gaze Preference

6. Visuospatial problems

7. Constructional and dressing apraxia

What is the most common cause of hemorrhagic stroke in adults?

Hypertension, which causes intracerebral hemorrhagic stroke.

What is the single most important factor in prognosis of stroke mortality?

Whether it is hemorrhagic or ischemic.

What cognitive syndrome would be observed in LEFT MCA DEEP TERRITORY STROKE?

1. Right pure motor hemiparesis
2. Large infarcts will create more cortical infarcts

What cognitive syndrome would be observed in LEFT MCA STEM STROKE?

1. Combination of all other MCA territory strokes


2. Left gaze preference from frontal eye field damage


3. Right hemipelegia and hemianesthesia


4. Right homonymous hemianopsia

What cognitive syndrome would be observed in RIGHT MCA DEEP TERRITORY STROKE?

1. Left pure motor hemiparesis


2. Large lesions can cause other problems

What cognitive syndrome would be observed in RIGHT MCA STEM STROKE?

1. A combination of all the other right MCA stroke types.


2. Right gaze preference


3. Left hemipeligia


4. Left hemianesthesia


5. Left homonymous hemianopsia


6. Profound left hemineglect


7. Anosognosia

What cognitive syndrome is observed in a RIGHT ACA STROKE?

1. Left leg weakness


2. Grasp reflex


3. Executive function deficits


4. Possible left hemineglect

What cognitive syndrome is observed in LEFT ACA STROKE?

1. Right leg weakness


2. Grasp reflex


3. Executive dysfunction


4. Transcortical aphasia

What cognitive syndrome is observed in LEFT PCA STROKE?

1. Right homonymous hemianopsia


2. Alexia without agraphia if it hits splenium of corpus callosum and occipital cortex.


3. Verbal memory deficit can be seen if left medial temporal lobe is hit.


4. If thalamus is hit, then right hemiparesis or hemianethesia are possible

What cognitive syndrome is observed in RIGHT PCA STROKE?

1. Left homonymous hemianopsia


2. Spatial memory deficits if it extends to the right hippocampal or medial temporal area.


3. Left hemipelegia and hemianesthesia is possible if the thalamus is involved.

What are the limitations of head CT after stroke?

It is not sensitive to ischemia within 24 hours of stroke, but it is sensitive to hemorrhage.




DWI is more sensitive to acute ischemia with a sensitivity of 83% (vs. 26% in CT).

What imaging technique is more sensitive to lacunar infarcts?

MRI

What stroke risk factors does MRA reveal?

Aneurysms and AVMs