Strokes

Question 1

What is the most common type of stroke?

Answer 1

Ischemic stroke (CVA / brain attack)

Question 2

Describe the pathophysiology of ischemic strokes (2)

Answer 2

• Clot creates a penumbra region
• Occlusion of cerebral vessels leads to ischemia

Question 3

What is a penumbra region?

Answer 3

Area surrounding infarction that can be salvaged with prompt treatment

Question 4

What are the manifestations of an ischemic stroke? (8)

Answer 4

• Aphasia
• Apraxia
• Agnosia
• Hemianopsia
• Hemiparesis
• Hemiplegia
• Dysphagia
• Dysarthria

Question 5

What question is important to ask for a patient having a stroke?

Answer 5

When was the last time that the patient was seen normal?

Question 6

What is the initial test used for diagnosis of a stroke?

Answer 6

Non-contrast CT - within 25 minutes (determines type of treatment)

Question 7

What conditions are important to rule out when diagnosing a stroke? (2)

Answer 7

• Cardiac abnormalities - 12 lead EKG, cardiac enzymes
• Glucose abnormalities - hypoglycemia manifestations mimic stroke

Question 8

What does a NIHSS score of 0 indicate?

Answer 8

No stroke symptoms

Question 9

What does a NIHSS score of 1 - 4 indicate?

Answer 9

Minor stroke

Question 10

What does a NIHSS score of 5 - 15 indicate?

Answer 10

Moderate stroke

Question 11

What does a NIHSS score of 16 - 20 indicate?

Answer 11

Moderate - severe stroke

Question 12

What does a NIHSS score of 21 - 42 indicate?

Answer 12

Severe stroke

Question 13

NIHSS of ______ has a 91% predictive positive value of a central vessel stroke

Answer 13

> 12

Question 14

What test should take place prior to t-PA?

Answer 14

NIH stroke scale

Question 15

When is the NIH stroke scale measured? (4)

Answer 15

• At baseline
• 2 hours
• 24 hours
• 7 - 10 days

Question 16

______ is essential for preserving brain function after a stroke

Answer 16

Prompt diagnosis / treatment

Question 17

What is the primary treatment for ischemic strokes?

Answer 17

t-PA

Question 18

Describe t-PA (2)

Answer 18

• ONLY for ischemic strokes
• DO NOT delay

Question 19

t-PA MUST be administered within ______

Answer 19

3 - 4.5 hours of onset

Question 20

What is the door to treatment time for t-PA?

Answer 20

1 hour

Question 21

t-PA is a ______ loading dose

Answer 21

Weight-based

Question 22

Describe the administration of t-PA (2)

Answer 22

• Establish minimum of 2 IV sites - must have own IV, cannot be mixed
• DO NOT give other anticoagulants for at least 24 hours

Question 23

What is the most common complication of t-PA?

Answer 23

Intracranial bleeding

Question 24

Describe tenecteplase (TNK) (2)

Answer 24

• Modified t-PA - longer duration
• Given as a 5 second bolus - easier administration

Question 25

What is the maximum dosage of TNK?

Answer 25

25 mg

Question 26

When can anticoagulation treatment take place of ischemic strokes?

Answer 26

24 hours AFTER t-PA

Question 27

Describe the surgical treatment of ischemic strokes (4)

Answer 27

- Endovascular therapy - Decompressive hemicraniectomy - Carotid endarterectomy (CEA) - Carotid artery stent (CAS)

Question 28

Which surgical treatment for an ischemic stroke is least invasive / first choice for patients > 70 years old?

Answer 28

Carotid artery stent (CAS)

Question 29

Endovascular therapy MUST be completed within ______

Answer 29

6 hours of onset

Question 30

What is the most common cause of hemorrhagic strokes?

Answer 30

Hypertension

Question 31

What are the causes of hemorrhagic strokes? (4)

Answer 31

- Intracerebral hemorrhage - Subarachnoid hemorrhage - Intracerebral aneurysm - AVM

Question 32

What are the manifestations of hemorrhagic strokes? (5)

Answer 32

- Sudden severe headache - abrupt bursting of artery - Sudden change in LOC - Nuchal rigidity - Vomiting - Seizures

Question 33

What complications are associated with hemorrhagic strokes? (5)

Answer 33

- ICP - Cerebral hypoxia - Vasospasm - Hypertension - Hyponatremia

Question 34

What test confirms diagnosis of intracerebral aneurysm / AVM?

Answer 34

Cerebral angiography

Question 35

When can a lumbar puncture be used for stroke diagnosis?

Answer 35

ONLY if CT shows NO evidence of ICP

Question 36

What is the primary goal of hemorrhagic stroke treatment?

Answer 36

Allow brain to recover / prevent re-bleeding