Stroke

Question 1

Non-modifiable risk factors for stroke

Answer 1

• age
• gender
• ethnicity or race
• family hx
• heredity

Question 2

Modifiable risk factors for stroke

Answer 2

• HTN
• heart disease
• diabetes mellitus
• smoking
• excessive alcohol consumption
• obesity
• sleep apnea
• metabolic syndrome
• lack of exercise
• poor diet
• drug abuse

Question 3

Characteristics of transient ischemic attack (TIA):

Carotid system

Answer 3

• temporary loss of vision in one eye
• transient hemiparesis
• numbness or loss of sensation
• sudden inability to speak

Question 4

Characteristics of transient ischemic attack (TIA):

Vertibrobasilar system

Answer 4

• tinnitus
• vertigo
• darkened or blurred vision
• diplopia
• ptosis
• dysarthria
• dysphagia
• ataxia
• unilateral or bilateral numbness or weakness

Question 5

Ischemic strokes

Answer 5

• thrombotic

- embolic

Question 6

Hemorrhagic strokes

Answer 6

• intracerebral

- subarachnoid

Question 7

Thrombotic stroke

Answer 7

• results from injury to blood vessel and blood clot formation
• warning: TIA (30-50% of cases)
• onset: often during or after sleep
• S&S develop slowly, usually some improvement, recurrence in 20-25% of survivors

Question 8

Embolic stroke

Answer 8

• occurs when an embolus lodges and occludes a cerebral artery
• warning: TIA (uncommon)
• onset: lack of relationship to activity, sudden onset!
• single event, D&S develop quickly, usually some improvement, recurrence common without aggressive tx of underlying disease

Question 9

Intracerebral stroke

Answer 9

• bleeding within the brain caused by a rupture of a vessel (most important cause-HTN)
• warning: headache (25% of cases)
• onset: activity (often)
• progression over 24 hour
• poor prognosis, fatality more likely with presence of coma

Question 10

Subarachnoid stroke

Answer 10

• intracranial bleeding into CSF-filled space between arachnoid and pia mater
• warning: headache (common)
• onset: activity (often), sudden onset, most commonly related to head trauma
• usually single event, fatality more likely with presence of coma

Question 11

Clinical manifestations for pt who have had a stroke

Answer 11

Motor function impairment:

• mobility
• respiratory function
• swallowing and speech
• gag reflex
• self-care abilities

Question 12

Right-brain stroke

Answer 12

• paralyzed left side: hemiplagia
• left-sided neglect
• spatial-perceptual deficits
• tends to deny or minimize problems
• rapid performance, short attention span
• impulsive, safety problems
• impaired judgement
• impaired time concepts

Question 13

Left-brain stroke

Answer 13

• paralyzed right side: hemiplagia
• impaired speech/language aphasia
• impaired right/left discrimination
• slow performance, cautious
• aware of deficits: depression, anxiety
• impaired comprehension related to language, math

Question 14

Drug tx for pts with ischemic strokes

Answer 14

• thrombolytic (fibrinolytic) therapy
• TPA within 3-4.5 hours of onset of stroke
• Anticoag therapy

Question 15

Surgical tx for pts with ischemic strokes

Answer 15

• stent retrievers-way to open blocked arteries

- mechanical embolus removal in cerebral ischemia (MERCI) retriever

Question 16

Drug tx for pts with hemorrhagic stroke

Answer 16

-drugs to manage HTN
(oral and IV agents to keep BP in normal limits)
-seizure prophylaxis in acute period after (situation specific)

Question 17

Surgical tx for pts with hemorrhagic stroke

Answer 17

• immediate evacuation of aneurysm-induced/cerebral hematomas >3 cm
• arteriovenous malformation (AVM)-resection and/or radiosurgery (gamma knife)
• “clipping” aneurysm