Stroke

Question 1

Which 6 cardiac disorders are a risk factor for stroke?

Answer 1

1) Valvular heart disease (dysf. or prosthetic valve)
2) Cardiac dysrhythmia (i.e., atrial fibrillation)
3) Mural thrombus
4) Endocarditis
5) Atrial myxoma
6) Interatrial septal abnormalities

Question 2

Which legal and illegal drugs are risk factors for strokes?

Answer 2

• IVDA
• Cocaine
• Amphetamines
• Oral contraceptives

Question 3

Fibromuscular dysplasia is a risk factor for _______

Answer 3

Stroke

Question 4

Which 6 inflammatory disorders are risk factors for stroke?

Answer 4

1. Giant cell arteritis
2. SLE
3. Polyarteritis Nodosa
4. Granulomatous Angitis
5. Syphilitc Arteritis
6. AIDS

Question 5

T/F migrains are a risk factor for stroke?

Answer 5

True

Question 6

What are the symptoms of a stroke occuring in the left hemisphere?

Answer 6

• Aphasia
• Right sided sensory and motor symptoms
• Right visual field cut

Question 7

What are the symptoms of a stroke occuring in the right hemisphere?

Answer 7

• Left hemineglect
• Left sided sensory and motor symptoms
• Left visual field cut

Question 8

What are the symptoms of a stroke occuring in the cerebellum?

Answer 8

• Ipsilater ataxia
• Vertigo
• Nystagmus

Question 9

What are the symptoms of a stroke occuring in the brainstem?

Answer 9

• CN findings w/ contralateral hemisensory or hemimotor sx’s
• Vertigo

Question 10

How should acute HTN be treated with an ischemic stroke?

Why?

Answer 10

• Should NOT be treated
• Area of infarction may have lost autoregulatory function, so that “normal” BP may be relatively hypotensive in the brain

Question 11

How should IV’s be utilized in the treatment of stroke patients?

What should not be included in the IVF’s?

What about if tPA is to be given?

Answer 11

• All stroke patients need to have IV access
• IVF’s should NOT include glucose as hyperglycemia is associated with worse neurologic outcomes
• If tPA is a consideration, 2 IV access sites will be needed to eliminate venipuncture after infusion

Question 12

What is the NIH stroke scale used for?

What is the score range?

Answer 12

• Important if tPA or intra-arterial intervention is a consideration
• Range from 0 (normal) to 42 (coma)
• Used to predict hemorrhagic conversion as well as indication for potential intra-arterial intervention

Question 13

What does a score of <10 and >20 on the NIH stroke scale tell you?

Answer 13

• Score <10 = 2-3% risk of hemorrhage
• Score >20 = 17% risk of hemorrhage

Question 14

What must be done if a fever is present in a patient presenting with a stroke?

Answer 14

Must be treated, as fever will worsen stroke outcome long-term

Question 15

If the CT findings are normal in a patient believe to have suffered a stroke, what are some other causes you should consider?

Answer 15

Seizure, migraine, hypoglycemia, etc.

Question 16

Administering tPA for the treatment of acute ischemic stroke should be given within _______ hours of the onset of symptoms.

Answer 16

3 hours (better within 1.5 hours)

*She said up to 4.5 hours

Question 17

Which clinical situations is warfarin (or one of the new generation anticoagulants - NOAC’s) generally indicated?

*She stressed this!!!

Answer 17

• Atrial fibrillation
• Prosthetic valve
• MI
• Atrial septal defect
• Hypercoagulable state
• Large vessel disease
• Aortic arch disease

Question 18

Which 2 anticoagulants can be used in combination during the first few weeks after stroke?

Answer 18

ASA + Plavix

Question 19

When should a carotid angioplasty w/ stent placement be considered in a stroke patient?

Answer 19

• When pt at high risk for surgery
• Severe CAD or valvular heart disease, distal carotid disease, or bilateral severe carotid disease

Question 20

What is the significance of endovascular therapy (intra-arterial thrombolysis w/ clot retrieval) in patients with strokes?

Answer 20

Multiple studies have showed improvement in patients treated with endovascular/intra-arterial intervention in addition to tPA when compared to tPA alone

Question 21

What are some conditions that can present w/ focal neuro deficits that may be confused with stroke?

Answer 21

1) Migrane w/ aura (primary headace disorder)
2) Hyperglycemia
3) Hepatic abnormalities