CVA1
The standard imaging modality to detect the presence or absence of intracranial hemorrhage
What is CT scan of the head without contrast ?
Medication class that decreases risk of stroke even in patients without elevated LDL or low HDL and shows benefit in secondary stroke reduction for patients with recent stroke or TIA
What are statins ?
Also accept: HMG co A reductase inhibitors ?
Condition that occurs as a result of rupture of a saccular aneurysm at bifurcations of arteries of the circle of willis
what is subarachnoid hemorrhage ?
Note: Subarachnoid hemorrhage presents with "the worst headache of my life," signs of meningeal irritation (photophobia, nuchal rigidity), and vomiting. Death may ensue if not identified and treated quickly. Diagnosis is via non contrast CT scan of the head.
Process in which venous thrombi migrate to the arterial circulation via a patent foramen ovale or atrial septal defect
What is paradoxical embolus ?
Surgical treatment for symptomatic carotid stenosis with > 70% occlusion
What is carotid endarterectomy ?
Stenosis of the subclavian artery proximal to the origin of the vertebral artery in which exercise of the upper extremities results in dizziness, diplopia, numbness of the face, and dysarthria
What is the subclavian steal syndrome ?
Note: subclavian steal syndrome occurs as a result of stenosis of the subclavian artery proximal to the origin of the vertebral artery. Exercise of the arms results in a reversal of blood flow down the same sided vertebral artery to fill the subclavian artery distal to the stenosis. The subclavian steal refers to decreased cerebral blood flow when the arm is exercised (blood is stolen from the basilar system).
'Medical slang' term referring to the process in which a primary stroke center administers rtPA to an eligible patient and then rapidly refers the patient to a comprehensive stroke center that has endovascular capability for further intervention
What is 'drip and ship' protocol ?
Medication that decreases the risk of vasospasm after a subarachnoid hemorrhage
What is nimodipine ?
In patients without contraindications, IV thrombolysis is effective in CVA management only if given within this time frame from onset of symptoms
What is < 3 hours ?
Also accept: < 4.5 hours
Note: New studies suggest that rtTPA may be effective up to 4.5 hours from symptom onset
High intensity statins (with dosage)
What is atorvastatin 40 - 80 mg, rosuvastatin 20 - 40 mg ?
Contralateral paralysis and loss of sensation of the upper limb and face and aphasia suggests a stroke of this artery
What is middle cerebral artery ?
Treatment of acute ischemic stroke > 4.5 hours after symptom onset
What is aspirin ?
Yellow color of the CSF in subarachnoid hemorrhage
What is xanthochromia ?
An expressive, confluent aphasia characterized by extremely slowed or absent speech which frustrates the person affected; Patients understand both written and spoken language but have a difficult time expressing what they want to say
What is Broca's aphasia ?
Note: Broca's aphasia is characterized by preserved comprehension but they have problems with language production. The lesion occur due to a large stroke in the territory of the super division of the middle cerebral artery. Patient's with Broca's aphasia can understand language, can follow commands, but they cannot speak and for this reason are frustrated.
The only laboratory test that is absolutely required before rTPA is administered
What is blood glucose ?
A receptive & fluent aphasia in which patients cannot understand both written language or spoken language involves stroke of this artery
What is inferior division of the middle cerebral artery ?
Note: Wernicke's aphasia results from stroke of the inferior division of the middle cerebral artery. It results in jargon speech and an inability to understand written or spoken language.
Patients with mitral stenosis and atrial fibrillation are at high risk of thromboembolic stroke and should receive long term anticoagulation with this medication
What is warfarin ?
Major cause of death within the first 24 hours of presentation of subarachnoid hemorrhage after an initial bleed is stabilized
What is re-bleeding ?
Note: Re-bleeding is the major cause of death within the first 24 hours of subarachnoid hemorrhage presentation. Vasospasm does not usually occur until on or around day 3.
The only two criteria allotted 2 points in the clinical prediction tool used for estimating the risk of stroke in patients with nonrheumatic atrial fibrillation
What is age > 75 and history of CVA/TIA ?
Note: The CHADSVASC is a clinical prediction rule for estimating the risk of stroke in patients with non rheumatic atrial fibrillation. This tool is used to determine whether or not treatment is required with anticoagulation therapy or anti platelet therapy.
Bony anatomic location where the frontal, parietal, temporal, and sphenoid bones meet and if disrupted by trauma can damage the underlying middle meningeal artery
What is the pterion ?
Note: Trauma at the pterion can damage the middle meningeal artery that lies just below it. Damage to the middle meningeal artery can result in epidural hematoma.
Stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia due to midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery
What is Weber's syndrome ?
Blood pressure goal if tissue plasminogen activator is to be used in acute ischemic stroke management
What is < 185 / 110 mmHg ?
Note: Contraindications to rtPA therapy include: BP > 185 / 110 mmHg, rapidly improving symptoms, GI bleed in last 3 weeks, recent MI, major surgery within 14 days, use of heparin within 48 hours, prior stroke or head injury within 3 months, prior intracranial hemorrhage, and platelets < 100,00, HCT <25%, and glucose < 50 or >400 mg/dL
Three scenarios in which screening for intracranial aneurysm in ADPKD is recommended
What is patients with previous aneurysm rupture, family history of intracerebral bleed, or those employed by high risk occupations (i.e. pilots) ?
Medical term that describes tissue surrounding core infarction that is ischemic but reversibly dysfunctional post cerebrovascular accident
What is the Penumbra ?
Note: the Penumbra will eventually infarct if no change in flow occurs. Saving the penumbra in CVA is the goal of revascularization.
Syndrome occurring due to stroke of the occipital lobe resulting in blindness in a patient failing to accept being blind
What is Anton syndrome ?
Note: Anton syndrome can occur due to stroke in the occipital lobe. Patients with Anton syndrome are cortically blind, but affirm, often quite adamantly and in the face of clear evidence of their blindness, that they are capable of seeing. Why patients with Anton syndrome deny their blindness is unknown.