Epidemiology of
Etiology of
Complications of
Imaging of
Drugs for acute and chronic management of stroke patients
100
The most important non-modifiable risk factor for both ischemic and hemorrhagic strokes
Age (>65 years old)
100
Exposure of this after the rupture of an atheroma plaque attracts platelets and leads to the formation of a thrombus
Subendothelial collagen
100
Cardiac dysfunction (arrhythmias, MI) is a possible complication of strokes due to a surge in ____
Catecholamines:
In stroke, parts of the brain that help regulate the autonomic nervous system — especially the insula and hypothalamus— are often injured. These regions normally keep the sympathetic nervous system (SNS) in balance, but when they are damaged, the SNS becomes overactive. The body interprets this surge in sympathetic activity as a major stress event, triggering the hypothalamic–pituitary–adrenal (HPA) axis. In response, the adrenal medulla floods the bloodstream with catecholamines such as norepinephrine and epinephrine. This sudden chemical surge drives up blood pressure, predisposes to dangerous arrhythmias, and can even cause cardiac injury such as myocardial infarction or stress-induced cardiomyopathy.
100
Test indicated to all patients with a suspected acute stroke to rule out intracerebral hemorrhage or tumors
Non-contrast Head CT
100
This drug is given within 4.5 hours of symptom onset in eligible patients to dissolve the clot causing an acute ischemic stroke.
What is IV alteplase (tPA)?
200
The most important modifiable risk factor for both ischemic and hemorrhagic stroke
Arterial hypertension
200
The 3 main types of emboli
1- Cardiac emboli (Afib; Atrial/Ventricular thrombi; Rheumatic heart disease).
2- Atheroemboli (i.e. Internal carotid artery; Aortic arch (less common)
3- Infectious emboli (bacterial endocarditis)
200
A complication that is more likely to happen in embolic strokes than in thrombotic strokes
Conversion to hemorrhagic stroke. Why?
Because emboli lodge in the cerebral vasculature and the vessels beyond the blockage undergo ischemic damage. Clot dissolution, either naturally or with tPA allows blood to rush back into areas of vascular damage resulting in the extravasation of blood into the infarcted area. Thrombosis is an in situ event in which clot reformation occurs, decreasing the likelihood of blood extravasation.
200
With Middle Cerebral Artery Thrombosis there is an early sign on Head CT. This sign is called... and it looks like...
"Hyperdense MCA sign": The right middle cerebral artery is hyperdense compared to the regions of the left MCA and tip of the basilar artery.
This sign is a marker of middle cerebral artery thrombosis and is visible before parenchymal changes of ischemia. (<2 hours after event)
200
This antiplatelet drug is the most commonly used for secondary prevention after ischemic stroke.
What is aspirin?
300
A specific non-modifiable risk factor for ischemic stroke that Norma reported in her history
History of TIA (presenting as amaurosis fugax due to retinal artery emboli most commonly from carotid artery disease)
300
Explain Paradoxical Embolism
Venous thromboembolism (especially due to Deep Vein Thrombosis) in patients with right-to-left cardiac shunt (e.g., persistent foramen ovale or atrial septal defect).
Transient increases in right atrial pressures allow emboli originating from the venous system to pass directly from the right atrium into the left atrium, from which point they may enter the cerebral arterial system.
300
A type of cognitive impairment that is the 2nd most common in older adults and a results of chronic cerebral ischemia
Vascular dementia. MRI or CT shows multiple cortical and/or subcortical infarcts and prominent sulci:
(^MRI)
(^CT)
300
Should you or should you not delay a contrast CTA in a suspected stroke patient until results for renal function/TSH levels are back?
Do not delay CTA to wait for creatinine or TSH levels. Per multiple sources: the risk of iodine-induced hyperthyroidism and contrast-induced nephropathy is relatively low, especially in patients with no known history of thyroid or renal abnormalities.
300
In patients with atrial fibrillation who have had an ischemic stroke, these drugs are prescribed long-term to reduce the risk of cardioembolic stroke.
What are oral anticoagulants (warfarin, apixaban, rivaroxaban)?
400
Stroke is the # __ leading cause of death and the # __ leading cause of disability in the United States.
4, 1
400
The specific risk factor for ischemic strokes + the most common brain areas affected
Hypoxemia or Hypoperfusion (i.e. Cardiovascular surgeries).
Affects either the ACA/MCA junction, the MCA/PCA junction, or the superficial/deep MCA branches junction
400
A complication of more than 60% of hemorrhagic stroke survivors and up to 50% of ischemic stroke survivors
Persistent neurologic deficits (hemiparesis, aphasia), cognitive impairment, mood changes, disability.
400
The main Head CT pattern difference between an embolic ICA stroke and a thrombotic MCA stroke and which one did Norma likely have
Embolic: Multiple wedge-shaped cortical infarcts in MCA/ACA distribution, sparing deep white matter if embolus goes past perforators
Thrombotic: Large territorial infarct in both cortical and deep regions, because thrombosis at the origin blocks flow into both superficial and perforating branches. ("a hypodense region extending from the basal ganglia to parietal cortex on the right side.")
In case: the CT result + history of TIA+ corticaL & subcortical signs + Carotid bruit --> likely thrombotic rather than embolic (cannot tell only by CT)
400
This class of drugs, used for blood pressure control, not only lowers the risk of recurrent stroke but also helps prevent progression of small vessel disease.
What are antihypertensives (ACE inhibitors, ARBs, thiazides)?
500
A non-modifiable risk factor for strokes that applies for both family history and patient's medical history
Migraines
500
These 2 inherited thrombophilias lead to a hypercoagulable state and hence the occurrence of a thrombotic ischemic stroke
1- Protein C deficiency: Protein C is a vitamin K–dependent anticoagulant that normally degrades Factors Va and VIIIa. No protein C = Unopposed clotting.
2- Factor V Leiden Mutation: An Arg506Gln mutation that makes Factor V resistant to inactivation by protein C = hypercoagulable state.
500
This patient underwent a decompressive hemicraniotomy for a rare but lethal complication of large MCA infarctions
What is a "malignant MCA infarction/syndrome"?
The rapid aggravation of neurological symptoms following an MCA infarction that are attributed to space-occupying vasogenic edema and/or hemorrhagic transformation with consecutive raised intracranial pressure. Malignant infarction has, if left untreated, a very high mortality due to compression of vital brain structures.
Prognostic factors for developing a malignant infarction are affection of 50 % or more of the MCA territory, a small penumbra and a large infarcted core as well as early signs of midline shift.
Therapeutic options are limited, with decompressive hemicraniectomy being the best option and hence, is the mainstay of treatment.
500
The 2 (MOST important) imaging modalities used in Brain MRI stroke protocol are:
1- DWI
2- FLAIR
Bright DWI + Dark FLAIR = Recent Infarct (within 4.5 hours of symptoms onset)
Bright both = Old Infarct (>6 hours)
500
This medication class is indicated for ALL ischemic stroke survivors because of its ability to stabilize plaques and reduce the risk of future vascular events.
What are statins (atorvastatin, rosuvastatin)?