Neuro 2 > Stroke > Flashcards

Stroke Flashcards

(48 cards)

Study These Flashcards
1
Q

What is a stroke?

A
  • Stroke is an acute, focal neurological deficit with no other
    explanation than a cerebrovascular cause.
  • Common symptoms include hemiparesis, dysarthria, sensory
    deficits, aphasia, and visual deficits.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

National Institute of Health
Stroke Severity Scale (NIHSS)

A

NIHSS – A 15 Item scale assessing:
* consciousness
* language
* dysarthria
* extraocular movements
* visual-fields
* motor strength
* ataxia
* sensory loss
* neglect

*the higher the score, the more severe the symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

TIA vs Stroke

A
  • TIA is a temporary episode of neurologic dysfunction caused by focal brain
    ischemia AND not associated with evidence of acute infarction on brain
    imaging.
  • A transient episode (lasting less than 24 hours) of neurological dysfunction
    caused by focal brain, spinal cord, or retinal ischemia, without acute
    infarction
  • In contrast, an acute ischemic stroke is an episode of sudden neurologic
    dysfunction caused by focal brain ischemia that is associated with
    evidence of acute infarction on brain imaging, regardless of symptom
    duration.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Estimate stroke risk following TIA

A

Key point:
Risk is highest in the first 48 hours and
with symptoms of unilateral motor
weakness or speech disturbance
Initial treatment – Antiplatelets (Dual) for
3 weeks followed by single agent alone,
with high dose statin
Urgent CT/CTA head and neck

ABCD2 score 0-7
risk factors:
Age >50 = 1
BP - SBP >140 or DBP >90 = 1
Clinical features of TIA - unilateral weakness with or w/o speech impairment =2 or speech impairment w/o unilateral weakness = 1
Duration - TIA >60 mins =2 or TIA10-59 mins = 1
Diabetes = 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Internal carotid artery

A

● There are 4 anatomic divisions:
cervical part
petrous part
cavernous part (C4 and C5)
carotid siphon is C3
cerebral part (C1 and C2)
● Branches of ICA:
Ophthalmic artery
Anterior choroidal artery
Anterior cerebral artery
Middle cerebral artery
Posterior communicating artery

*disease of internal carotid can have vision loss to anterior segment of eye - opthalmic artery or visual cortex - posterior cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Choroidal artery syndrome

A
  • hemiplegia
  • hemianesthesia
  • sector-sparing homonymous
    hemianopsia (dual blood supply
    to LGB)
    *pts can see top and bottom but nothing in between
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anterior cerebral artery

A
  • weakness leg > arm
  • abulia (lack of motivation)
  • if bilateral mesial frontal
    (akinetic mutism)
  • paratonia
  • sphincter disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Middle cerebral artery

A
  • Contralateral weakness
  • Aphasia (left)
  • Neglect (right)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Posterior cerebral artery

A
  • alexia without agraphia
  • can write normally but can’t read - even their own writing
  • temporal field vision loss on one side and medial on the other
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Unique PCA syndromes

A

Anton’s Syndrome:
- Results from occlusion of distal,
bilateral PCAs (bilateral occipital)
Results in cortical blindness and
often confabulation as well (say they can see and make things up, technically they can’t - can’t process what they see)

Balint’s Syndrome: (classic triad)
- optic ataxia - visually difficult to reach for objects; may see and recognize but movement is misdirected
- psychic paralysis of gaze - difficulty in visual scanning - not able to maintain fixation on object and will wander to another
- simultanagnosia - can only see one object at a time
(bilateral occipital parietal lesions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Thalamic syndromes: bilateral paramedian

A

● The paramedian arteries of the two sides
may share a common trunk, called the
artery of Percheron
● Triad of altered mental status, vertical gaze
palsy, and memory impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Unique cerebellar syndromes

A

AICA:
Unique to infarcts in this territory include
facial palsy and deafness
(+ signs of lateral medullary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

lateral medullary syndrome

A
  • ipsilateral loss of pain and temp over half the face - SPT and descending nucleus and tract of CN V
  • ataxia, falling to side of lesion - inferior cerebellar peduncle, SPT
  • ipsilateral Horner syndrome (constricted pupil, ptosis, decreased sweating) - descending sympathetic tract
    dysphagia, dysarthria, ipsilateral paralysis of palate and vocal cord, diminished ipsilateral gag - efferent fibers of CN IX and X and nucleus ambiguus (NA)
    contralateral impaired pain and temp sense below neck - SPT and nucleus of CN V
    vertigo/dizziness - vestibular nuclei and vestibulocerebellar pathway in inferior cerebellar peduncle
    N/V, nystagmus and diplopia - vestibular nuclei
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

lacunar stroke

A

Occlusion of penetrating arteries, resulting
in small ischemic stroke in deep regions of
the brain (no greater than 15 mm)
* pure motor (posterior limb internal
capsule, basis pontis, corona radiata)
* pure sensory (VPL nucleus of
thalamus)
* sensorimotor (posterior limb internal
capsule and VPL nucleus of thalamus)
* ataxic-hemiparesis (posterior limb
internal capsule or basis pontis)
* clumsy hand-dysarthria (basis pontis
and genu of internal capsule)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Code stroke: neuro imaging

A
  • Emergency imaging plays a key role in the
    management of acute stroke
  • Primary Goal :
  • To exclude intracerebral hemorrhage/stroke
    mimics
  • Secondary Goals :
  • Identify the location of the arterial occlusion
    -Collateral assessment
  • Existence of the ischemic penumbra
  • Identification of core & quantification of its
    volume
  • Etiology of Stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

role of imaging

A
  • Diagnosis: Does the patient have a stroke or not? Is the
    stroke ischemic or hemorrhagic?
  • Prognosis: What is the size of the stroke? Is the stroke
    already so big that the patient is likely to have a poor prognosis?
  • Treatment selection: Would this patient with ischemic
    stroke benefit from thrombolysis, endovascular treatment,
    or a combination of
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

imaging modalities for acute stroke

A
  • CT Protocols :
  • NCCT
  • CTA (single vs multi)
  • CTP
  • MR Protocols :
  • DWI and ADC
  • T2 FLAIR
  • GRE
  • SWI
  • MR perfusion
  • MRA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

suspected ischemic stroke

A
  • ASPECTS: Alberta Stroke
    Program Early CT Score
  • 10-point topographic scoring
    system of MCA territory
  • Normal MCA territory is
    assigned 10 points
  • One point deducted for each
    area involved on non-contrast
    CT

*score <5 is bad and cut off for intervention
*freshly ischemic tissue is soft and intervening with clot busting or thrombectomy can cause more harm than benefit - likely to hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CT perfusion

A

Functional examination representing current hemodynamic state of
the brain
Main purpose of perfusion
* Detect ischemic core – irreversibly
damaged infarcted brain
* Identify penumbra – hypoperfused but
salvageable tissue

when:
➢ DAWN and DEFUSE 3 ➝ recommended at patients with symptom
onset > 6h, unknown onset and wake-up stroke
➢ Disagreement between clinical and imaging findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IV thrombolysis (IVT)

Study These Flashcards
A

● All eligible patients with disabling ischemic stroke, who can receive
IVT with either Alteplase or Tenecteplase within 4.5 h of stroke
symptom onset should be offered Rx
● Individuals receiving IVT should be closely monitored for the first
24 h
● Only absolute contraindication
● Any source of active hemorrhage or any condition that could increase
the risk of major hemorrhage after intravenous thrombolysis
administration.
● Any hemorrhage on brain imaging

21
Q

Relative contraindications to IVT

Study These Flashcards
A
  • DOACs recent ingestion < 48 h
  • On warfarin and INR >1.7
  • BP >185/105 mmHg
  • Life expectancy <3 m
  • Stroke or serious head or
    spinal
    trauma <3 m
  • Major surg <14 d
  • Arterial Puncture <7 d
  • Patients not functionally
    dependent
  • Seizure with post-ictal Todd’s
  • Extensive infarction >1/3rd
  • Blood glucose <2.7 or >22.2
    mmol/L
  • Platelet <100,000 ml3
22
Q

Adverse events from IVT

Study These Flashcards
A
  • orolingual edema - 1%
  • 24 hour symptomatic intracerebral hemorrhage -3%
  • extracranial bleeding - 0.8%
  • remote parenchymal hematoma - 1%
23
Q

Endovascular tx - who is a candidate?

Study These Flashcards
A

Patient:
* Functionally independent
* Life expectancy > 3 months
Imaging:
* Large vessel occlusion (LVO)
* Small to moderate infarct (core)

24
Q

EVT indications

Study These Flashcards
A

Within 6 Hours of Onset
* Inclusion
* Presence of intracranial artery occlusion including terminal ICA
* Presence of small to moderate ischemic core on NCCT
* Posterior circulation – considered for EVT based on expected risks and benefits

Beyond 6 Hours of Onset
* Inclusion
* Presence of intracranial artery occlusion including terminal ICA
* Presence of small to moderate ischemic core on NCCT (
* Also recommend one of:
* Good pial collateral filling on multiphase CTA or evidence of CTP mismatch (ESCAPE) OR use core/mismatch criteria

25
Medical complications after stroke
pneumonia, UTI, pressure ulcer, falls, VTE, constipation, depression, dysphagia
26
Subacute complications after stroke
* Post-stroke spasticity * Post stroke epilepsy * Post-stroke painful limb * Post stroke depression * Post stroke fatigue *pts may not always fully recover - 50% chance *weakness can evolve into spasticity - can be painful
27
preventing recurrence is important
- high risk of having another stroke - need to figure out why had a stroke in the first place ex. atherosclerosis - large vessel or small vessel, embolic source from heart
28
causes of ischemic stroke
causes of ischemic stroke: - small vessel occlusion (lacunar stroke) - cardioembolic - a fib, HF, etc - large artery atherosclerosis - nonstenosing atherosclerotic plaques ex. - underdetermined - other
29
large artery atherosclerosis
* ASA reduces the risk of recurrent stroke/vascular events ~19% (8 to 29%) as compared to placebo * Clopidogrel reduces the risk by 8.7% compared with aspirin. * Combinations of ASA and clopidogrel are not more effective than either clopidogrel or ASA monotherapy * Lipid management * Risk factor management (HTN/DM) * Revascularization : choice and timing
30
cardioembolic stroke
1. Atrial fibrillation 2. Dilated cardiomyopathy 3. Acute MI 4. Infective endocarditis 5. Marantic endocarditis 6. Rheumatic mitral stenosis 7. Mechanical prosthetic valves 8. Cardiac tumors (Myxoma) 9. Aortic arch atheroma *need anticoagulant not antiplatelet
31
Estimating risk with a fib - CHADS2-VASc score
CHF = 1 HTN = 1 Age >75 = 2 DM = 1 Stroke/TIA/Systmic embolism = 2 Vascular disease = 1 Age 65-74 = 1 Sex (female) = 1 * score >2 = initiate anticoagulation score 1 - clinical judgment to initiate or not
32
Intracranial atherosclerotic disease (ICAD)
* For patients with a recent stroke/TIA due to symptomatic ICAD of 70%–99%, the SAMMPRIS protocol- dual antiplatelet therapy (acetylsalicylic acid and clopidogrel) for the first 3 months followed by single agent + BMT * Medical therapy over stenting * Recurrent stroke in the setting of BMT: there is lack of evidence to guide management decisions; intracranial angioplasty (with or without stenting) may be reasonable in carefully selected patients.
33
Other causes and unknown cause
Other causes ● Genetic – CADASIL, CoL4A ● Hypercoagulable states ● Dissection ● Drug induces ● Procedural/Iatrogenic Unknown cause ● 30% of all ischemic strokes ● ASA 81mg daily alone
34
Intracranial hemorrhage (ICH) burden
* 15-20% of strokes * Incidence: ~20-25/100 000 in western populations Outcomes: * 55% mortality at 1 year * 25% resume independent life * 35% of survivors demonstrate progressive cognitive decline * Cost: $11000 to $260000 per hospitalization alone.
35
Causes of ICH
- Hypertensive arteriopathy 53% - Cerebral amyloid angiopathy 21% - Vascular malformations 14% - Other 12% * Head trauma * Intracranial tumors * Bleeding disorders * CNS vasculitis * Sympathomimetic agents * RCVS * Moyamoya * Hemorrhagic infarction * Infective endocarditis * CADASIL (rarely)
36
Risk factors of ICH
- HTN >140/90 = 56% - lack of regular physical activity =35% - unhealthy diet = 25% - psychosocial stress = 25% - elevated waist to hip ratio = 13% - current alcohol intake = 10% - current smoking = 4% additional risk factors: - increased age - east-south east asian ethnicity - low cholesterol levels - bleeding diathesis - antithrombotic meds - APOE 2 and 4 alleles
37
ICH clinical presentation
* Significantly elevated SBP >220 mmHg * Decreased LOC (50%) * Nausea/vomiting (40-50%) * Sudden severe headache (40%). * Seizure at onset (~10%)
38
ABCD - ICH volume calculation
A = greatest hemorrhage diameter (cm) B = greatest diameter perpendicular to A C = number of CT slices where the hemorrhage is visible, multiplied by the slice thickness ABC/2 = estimation of ICH volume in mL
39
General approach to acute ICH
● Clinical assessment: Awake/drowsy: NIHSS Obtunded/comatose: GCS Strong predictors of outcome. ● Imaging: STAT CT or MRI: Diagnosis, location, and extent Acute ICH: CT/MR/DS angiography is recommended Remote MRI to rule out underlying pathology ● Medication history: Anticoagulant therapy? (give reversal if yes) ● Bloodwork: Platelet count, partial thromboplastin time (PTT), and INR ● Clinical signs of increased intracranial pressure (ICP) **hematoma expansion is bad**
40
Goals of ICH tx
* Prevention of hematoma expansion * ICP reduction * To prevent further tissue injury /herniation and improve morbidity and mortality
41
ICH tx
● A systolic blood pressure threshold at an individual target of less than 140-160 mm Hg for the first 24-48 hours post ICH may be reasonable Monitor BP every 15 mins ● Reversal of anticoagulation ● Surgery: hematoma evacuation ● Aneurysm coiling and clipping
42
Prognosis of ICH
ICH Score: GCS 3-4 = 2 GCS 5-12 = 1 GCS 13-15 = 0 Age > 80 = 1 Age <80 = 0 Infratentorial = 1 Supratentorial = 0 ICH volume >30mL = 1 volume <30 = 0 Intraventricular blood = 1 no intraventricular blood = 0 Score 0-6 30 day mortality: 0 = 0% 1 = 13% 2 = 26% 3 = 72% 4 = 97% 5 = 100% 6 = 100%
43
cerebral venous sinus thrombosis (CVST)
- less common here, seen more in India and Africa - common area of involvement = superior sagittal sinus
44
CVST burden
● Reported prevalence of CVT is somewhat higher than previously reported, ~10- 15/million/y. (DVT ~1/1000/y) ● Blacks > Whites > Asians; similar to other VTE ● Prevalence is much higher in women (3:1 F:M) of childbearing age (80% <55y). ● Pregnancy: 90/million ● COVID-associated CVT: 40/million in first 2 weeks following infection ● ~5% of COVID-associated stroke (~1% of all stroke)
45
Causes of CVST
- Postpartum - Dehydration - OCP use - CNS or sinus infection - Thrombophilia - Systemic malignancy - Trauma - Cocaine and EtOH abuse
46
Clinical presentation of CVST
superior sagittal sinus - motor defects, seizures - inferior sagittal sinus - motor defects, seizures - straight sinus - motor defects, mental status changes - transverse sinus - intracranial HTN (headache), tinnitus, cranial nerves palsies, aphasia (if left sided) internal jugular vein - neck pain, tinnitus, cranial nerve palsies cavernous sinus - orbital pain, chemosis, proptosis, cranial nerve palsies (III-VI)
47
Acute management of CVST
● Anticoagulation and hydration ● ICP Management - routine ophthalmology involvement if possible ● Seizure management ● Pain control ●Treat/remove/investigate any precipitant (anemia, OCP, etc) *clot in venous system = blood thinners *thrombolysis only in select cases *no role for sx usually *if clot progresses - catheter and try to pull clot out
48
CVST tx
1-acute: LMWH or UFH; thrombolysis or endovascular therapy 2-chronic: warfarin (INR range 2-3); if provoked, 3-6 months; if unprovoked 6-12 months
Neuro 2
flashcards
Decks in class (40)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions