Ferocious Diagnosis
T/F: History and physical exam are super important for diagnosing strokes.
TRUE
(if you said false you should probs drop out now)
What artery supplies the lateral aspect of the brain, and when compromised can result in C/L face, arm, and leg weakness, sensory loss, field cut, gaze preference, and either aphasia or neglect?
Middle Cerebral Artery (MCA)
The most common type of stroke is ______, and this type of stroke is most commonly caused by ___________.
Ischemic stroke, atherosclerosis
What surgical procedure is most commonly done for secondary prevention of stroke?
Carotid endarterectomy
What might you expect to see in a patient who had a small stroke in the thalamus?
Decreased sensation on C/L side of body
What is usually the 1st type of imaging done on a patient suspected of experiencing a stroke?
Bonus Question (50 pts): Acute blood (indicating hemorrhage) would appear as what color on these images?
CT
Bonus Q Answer: white
What artery supplies the medial aspect of the brain, and when compromised results in C/L leg weakness?
Anterior Cerebral Artery (ACA)
What are the 3 most common locations for a hypertensive hemorrhagic stroke?
Thalamus, basal ganglia, internal capsule
What treatment for an acute stroke is performed by a surgeon, and has been shown to improve long term disability after ischemic stroke?
Intra-arterial therapy (mechanical removal of blood clot, or direct application of clot dissolving meds)
Name 2 common, delayed effects of stroke.
Depression, fatigue, anxiety
The ____ is a stroke assessment tool used by EMS in the field, whereas the ______ is most commonly used in the hospital.
RACE, NIH Stroke Scale
A stroke caused by compromise to the posterior cerebral artery (PCA) may result in what clinical presentation?
C/L visual field cut
What are the 3 causes/types of hemorrhagic stroke?
Hypertensive, aneurysm rupture, traumatic
The head position of patients recovering from ischemic stroke should be relatively ____, whereas the head position of patients recovering from hemorrhagic stroke should be relatively _____.
Lower, higher
(Lower for ischemic stroke to maintain perfusion)
(Higher for hemorrhagic stroke to dec ICP)
Large involuntary muscle movements of 1 side of the body is known as _________.
Bonus Question (100 pts): This tends to occur with strokes to which part of the brain?
Hemiballismus/hemichorea
Bonus Q Answer: subthalamic nucleus
Subdural hemorrhages tend to appear ______-shaped on brain imaging, whereas epidural hemorrhages tend to appear more ______-shaped.
Crescent shaped (subdural)
Lens shaped (epidural)
What artery, when compromised, may result in lower CN deficits, ataxia, and crossed sensory deficits?
Vertebral Artery
What is a "subclavian steal"?
Occlusion or stenosis of subclavian artery proximal to the origin of the vertebral artery --> retrograde blood flow (aka "stealing blood from the brain") in the ipsilateral vertebral artery [toward the upper arm]
TPA must be given within ____ hours (the sooner the better), though it's only FDA approved for ___ hours.
4.5 hours, 3 hours
Name 4 s/s that with sudden onset may indicate stroke.
Weakness, numbness, changes in vision, changes in speech, severe headache, change in balance, altered level of consciousness
What are the 3 methods for evaluating what the cause of the stroke was?
-Lab Testing (blooooood!!!!)
-Echocardiogram
-Angiography
Name 3 clinical findings that can be observed in a patient who had a Basilar Artery stroke.
Oculomotor deficits, ataxia, crossed sensory/motor deficits, diminished level of consciousness
Name 4 of the 5 causes of a thrombotic ischemic stroke.
Bonus Q for OTHER player (100 pts): Name the 5th cause of this type of stroke that has not been mentioned.
-Dissection (tearing of inner lining of artery --> flap of inner tissue that occludes vessel)
-Inflammation (from vasculitis or other conditions)
-Hypercoagulable states (excessive clotting)
-Vasospastic arteries (caused by drugs, or by blood in subarachnoid space)
These 2 blood thinner medications have an advantage over Coumadin because they don't require blood testing, and have fewer side effects.
Bonus Question (50 points): Which clotting factor do these 2 meds act on?
Eliquis (apixaban) and Xarelto (rivaroxaban)
Bonus Q Answer: Inhibit Clotting Factor X
What are the 3 most common cortical signs for stroke?
Aphasia, Neglect, Visual Field Cuts