Stroke Management

Question 1

Stroke Presentation

Answer 1

• abrupt onset of focal neurologic symptoms & signs

- evaluate & stabilize vital signs (BP, HR, Vent, T)

Question 2

Stroke History

Answer 2

• HxPI - time of symptom onset, progression, headache - formulate anatomic Dx
• PMHx - stroke risk factors, medications
• FHx - vascular disease, HTN, hyperlipideia
• SHx - tabacco, EtOH, illicit drugs

Question 3

Stroke Exam

Answer 3

• medical examination - provides info on pathogenesis or etiology, heart rate & rhythm, BP in both arms, listen for carotid bruits, peripheral vascular exam
• Neuro: info on lesion location
• Working diagnosis: stroke or other cause, ischemic vs. hemorrhagic, vascular territory, etiology

Question 4

Stroke Labs

Answer 4

• EKG with rhythm strip
• Chest x-ray to evaluate heart size
• CBC with differential & platelet count
• Chemistry profile (glucose, BUN, electrolytes)
• Lipid profile
• Clotting times (INR, aPTT)
• Head CT without contrast

Question 5

Other Stroke lab Values

Answer 5

• RPR
• Coag (lupus, anticardiolipin Ab, protein C & S activity, factor V leiden)
• Viscosity tests: blood viscosity, protein electrophoresis
• Vascultis: ESR especially in elderly, FANA, etc.
• Homocysteine levels
• Urine drug screen

Question 6

Radiologic Evaluation of Stroke

Answer 6

• Echo
• Carotid artery ultrasound
• Head MRI
• Head & Neck MRA
• CT arteriogram
• Digital subtraction arteriogram

Question 7

Digital Subtraction Arteriography

Answer 7

-interventiaonal neuroradiographic methods for catheter placement via the femoral artery and injection contract dye to create digital subtraction images of extra and intracranial blood vessels

Question 8

Acute Treatment of Stroke

Answer 8

-treat with IV tPA if <8 hr from symptom onset & patient meets other strict criteria

Question 9

Stroke Prophylactic Treatment

Answer 9

• vascular stenting or endarterectomy for stenosis >70% of lumen diameter
• anti-hypertensive Rx
• Anti-lipid Rx
• Anti-platelets Rx for atherothrombotic stroke
• Anti-coagulants only for cardioembolic stroke
• Anti-diabetic Rx
• Stop smoking
• Physical exercise