Stroke Basics
Acute Management
Cortical Signs
Brainstem Stroke Syndromes
Stroke Rehab
100

These are the two main types of strokes

What are ischemic and hemorrhagic?

100

First imaging you get when concerned for stroke

What is CT head/brain noncon?

Also would expect to get MRI/MRA w/ con to see burden remeber blood is dark on T2, infarction is white
Also get TTE/TEE, Carotid US or CTA, can get LP if SAH suspected 

100

Unilateral ACA stroke will most commonly affect this 

What are the legs?
Motor and sensory

can also affect bowel/bladder (paracentral gyrus) and executive fxn if b/l or hypoplastic vessels/weird anatomy

100

Biggest clue on exam that stroke is located in the brainstem

What are crossed signs?
100

This therapy technique is the "use what you got" technique, uses flexor/extensor synergies 

What is Brunnstrom technique?

Rationale- originally developed gross movements as an infant so no need to discourage synergies

200

The percent of strokes that are ischemic

What is about 87%? (48% thrombotic, Embolic 26%, Lacunar 13%)


13% are hemorrhagic 

200

SBP goals for ischemic and hemorrhagic strokes respectively

What is SBP <220, SBP<180

Permissive HTN but don't want to hemorrhage out
Return to normotension over days to weeks

200

Hemineglect is most commonly seen with a stroke affecting what part of the brain?

Nondom parietal lobe

Can be seen with dominant as well

200

Name the midline structures in Rule of 4's

What is Motor (Corticospinal), Medial Lemniscus, Motor Nuclei 3,4,6,12, MLF

200

Also known as the neurodevelopmental technique, aim to eliminate primitive reflexes, do not allow patients to use flexor/extensor synergies

What is Bobath technique?

Rationale- patient's may never advance past synergy patterns if not forced to do controlled/fine motor

300

This is the most common type of ischemic stroke

What is Thrombotic stroke?

300

Time frame to give tPA

What is 3-4.5 hours?

300

The type of visual deficit would you expect with a unilateral PCA stroke- be specific

Contralateral Hemianopsia w/ Macular sparing

Macula spared due to collateral flow from MCA

300

Name the "side" structures in Rule of 4's

What are the STT, Spinocerebellar tract, Sensory nucleus of 5, Sympathetics

300

Therapy intervention shown to be useful for Broca Aphasia

What is Melodic Intonation Therapy

Use non-dom side of head- musicality

400

The usual onset of embolic, thrombotic, lacunar stroke respectively

What is sudden, gradual, variable?

Embolic: Sudden, can also present with seizures

Thrombotic: gradual, 50% present with previous TIA in the same distribution.

lacunar: abrupt or gradual

400

ICP and CPP goals in stroke management

What is ICP<20, CPP>60?

CPP = MAP - ICP

400

Bilateral PCA stroke syndrome, "blind and denying"

What is Anton Syndrome?

400

This stroke syndrome can present with hoarse voice, dypshagia, ipsilateral ataxia/nystagmus, ipsilateral horner syndrome 

What is Wallenberg Syndrome

"Dr. Wallenberg at the VA says don't PICA horse that can't eat"

Can be both VA and PICA 

400

Therapy technique where cutaneous stimuli is used to enhance motor control, reduce spasticity

What is Rood technique?

Rood = Rude stop touching me

500

The three most commonly affected areas of the brain with lacunar strokes

What is putamen, thalamus, internal capsule?

500

tPA INclusions (given ischemic with negative CT and within time frame) there are a total of 5 others- (hint- age group, VS, labs, imaging findings)

What is- Adult, SBP<185, INR<1.7, Plt >100K, stroke territory <1/3 MCA territory

BP can be managed acutely and SBP >185 not absolute C/I
Lab values can vary by hospital protocol but these are the recommendations

500

Alexia without agraphia can occur with a lesion here- Be specific (dom/nondom)

What is PCA territory dominant side?

Infarct of splenium of corpus callosum so language centers are intact but unable to receive information from contralateral visual cortex and visual word form area may be disrupted

500

Intractable hiccups (singultus) can be a symptom of this brainstem stroke syndrome

What is Wallenberg?

MOA- Imbalance and involuntary inspiration by destruction of the expiratory area in the medulla and is related in the nucleus ambiguus and dorsal motor nucleus of the vagus nucleus

500

Brunnstrom Stage of recovery corresponding to when spasticity first decreases

What is Stage 4

1. Flacid, 2. Spastic w/ UE flexor and LE extensor synergy, 3. Spasticity Peaks, 4. SPasticity decreases, 5. Complex voluntary movements, 6. Spasticity gone, 7. Normal