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45 Cards in this Set
- Front
- Back
what is a TIA?
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acute neurologic deficit of vascular origin lasting minutes to an hour and clears completely
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Transient deficits lasting more than 24hrs. but clearing completely in less than 3 days
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Reversible ischemic nuerological deficit
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patient reports that they suddenly lost their vision, the symptom lasted only a couple minutes what do you expect? what might you see in the eye or discover on further evaluation?
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suspect a carotid TIA. you may find a carotid bruit and reduced carotid pulse. in the back of the eye you could discover a ipsilateral hollenhorst plaque, rarely hornet's may present in these patients
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patient reports diplopia lasting less than an hour what do your expect?
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Vertebrobasilar TIA you might ask them about any loss of consciousness or bilateral motor or sensory deficits
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compare visual symptoms expected in a carotid TIA vs. a Vertebrobasilar TIA
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loss of vision=carotid
diplopia=vertebrobasilar |
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name and describe a source of a Vertebrobasilar TIA
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Subclavian steal syndrome: narrow subclavian artery proximal to vertebral arter. the left arm steals blood from the basilar artery by way of the vertebral artery. stroke is rare.
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76 year old patient comes to the office complaining of losses of vision lasting 30 minutes at a time. Her blood pressure is taken and is 142/92. She seems confused and lethargic. what is her Lancet risk determination?
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• Age: >60, +1
• Blood Pressure>140/90 +1 • Clinical features o Weakness one side (face, arm or leg) +2 o Difficulty speaking or understanding +1 • Duration o One hour or more +2 o >10min but less than 60min +1 -->this patient has a score of 4 |
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this type of stroke is felt behind the eyes or over forehead/temples
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anterior circulation stroke
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Person complains that they woke up this morning and couldn't hold their coffee cup, they also have a history of HA in the back of their head what do you expect?
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posterior circulation stroke (thrombotic stroke)
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patient tells you they have a clumsy hand, they also say something about swiss cheese disease in their brain. what are they referring to?
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lacunar stroke (small vessel thrombotic stroke)
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patient comes in with right eye in the down and out position. the pupil is dilated and a ptosis is present. what do you expect? what signs will be seen with the face and tongue?
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Weber's syndrome.
contralateral hemiplegia with face and tongue paralysis |
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Patient with 3 & 4th nerve palsy, pupil dilation and ptosis what do you expect? what motor abnormalities will support this dx?
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Red nucleus: claude's syndrome: contralteral motor hemiplegia and rubral tremor
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what level of cholesterol is considered a risk factor for stroke? what about HDL?
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cholesterol 240, HDL less than 35
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over what BP does the risk of stroke increase?
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140/90
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sundown sign is seen in what type of stroke?
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Intracerebral "Primary hypertensive hemorrhage"
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patient report the worse he ache of their life after a brief game of basketball they also report sever neck stiffness what do you expect?
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Subarachnoid hemorrhagic stroke order a CT
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what is the treatment prognosis for strokes?
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-cannot tell true extent for first 3 days
-some/little improvement in first 3 wks -3months estimate potential recovery -3months later (6months) 90% of potential recovery -up to 18 months (3X) will get 10% more of potential |
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how is a carotid TIA tx?
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surgically or medically. A carotid endarterectomy is performed if stenosed 70-90%. Anticoagulants are given for large vessel dz, and anti platelet agents are also given.
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who are vertebrobasilar TIAs tx?
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meically. Use of anticoagulant with sudden onset of TIAs of less than 2 months (warfarin X 3 months) then antiplatlet given until TIA free for one year. If the TIA symptoms occurred for over 2 months bf. tx is started then antiplatlet agents are given only unless there is a recent increase in frequency.
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how are cerebral or basilar TIAs managed?
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anticoagulants such as warfarin for large vessel disease X4-6 monthsAntiplatelet agent s are given after anticoagulant tx. for 1 year if TIA free
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true or false TIAs with a negative workup should not be tx, instead the pt. needs to be monitored.
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false. this is 40% of patients. they will tx with an anticoagulant followed by an antiplatlet for 1 year if TIA free.
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what anti platelet agents are given for ulcerated or irregular plaques without severe stenosis?
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ASA, ticlopidine, clopidogrel
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what is a common anticoagulant prescribed for TIAs?
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warfarin
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once you have had a stroke what is the chance of a recurrent stroke?
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36%
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what condition may occur secondary to cardiac arrest? is this a stroke?
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global cerebral ischemia, this is not a stroke
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what condition can mimic a stroke and occurs secondary to CSF interference?
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subarachnoid hemorrhage
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TIAs are typically warning signs of what kind of stroke?
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Thrombotic
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patient says they have been having headaches when they wake up in the morning. They also complain that sometimes their balance is off and they walk with a strange gait. dx?
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thrombotic stroke: large vessel , if the HA occurs behind the eyes or over the forehead/temples think anterior circulation stroke HA. it the pain is toward the back of the head think posterior circulation stroke HA
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Diabetic patient complains they have trouble holding their coffee cup with their right hand. They do not have other complaints. dx?
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thrombotic stroke: small vessel, is also commonly associated with HTN
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what are two key features of all thrombotic strokes?
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occur during sleep or is present on awakening.
signs are symptoms progress in a stepwise fashion |
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patient complains of nausea and the room spinning. you note Horner's in the left eye. they also have a burn on their right hand that they cannot remember getting. what is your working dx?
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Wellenberg's syndrome. (Thrombotic Brainstem Syndrome)
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what type of thrombotic syndrome presents with internuclear ophthalmoplegia or a gaze palsy?
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medial pons
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what sign predominates in a lateral pons syndrome?
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sensory loss
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what are 4 ipsilateral signs of weber's syndrome? 2 contralateral signs?
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ipsilateral-complete CN 3 palsy, pupil dilation, ptosis, opthalmoparesis
contralateral-hemiplegia with face and tongue paralysis |
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what are the ipsilateral signs of claude's syndrome? contralteral?
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ipsilateral-CN 3 &4 palsy, pupil dilation, ptosis, opthamloparesis
contralateral: motor hemiplegia and rubral tremor |
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patient has eyes deviated to right OU, pupils are normal size and reactive to light. what is your working diagnosis?
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stroke: putaminal interacerebral hemorrhage
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describe a patient suffering a thalamic intracerebral hemorrhage.
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eyes deviated down to the nose, no vertical gaze (sundown sing) pupils are small and nonreactive
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patient has normal pupils/reactive to light but has trouble with abduction. what type of hemorrhage do you suspect?
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cerebellar intracerebral hemorrhage
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patient turns their head to look in different direction they also have very tiny pupils. However, these pupils do respond when you perform SLEx. working diagnosis?
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pontine intracerebral hemorrhage
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what is the clinical triad for normal-pressure hydrocephalus?
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1. dementia
2. gait instability (wide w/o picking up knees) 3. urinary incontinene |
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describe Global cerebral Ischemia: brief ischemic episodes
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1. coma less than 12 hrs.
2. transient confusion or amnesia occur at awakening 3. recover complete in 7-10day to 1 month |
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patient was in a brief coma; they have pupil responses but NLP. what is your working diagnosis?
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Global Cerebral Ischemia; Prolonged Ischemic Episodes; Focal cerebral dysfunction. full recovery may not occur for months
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patient is awaken after a coma but seems unaware of their surroundings. what is your working diagnosis? what makes this state distinct from coma?
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Global Cerebral Ischemia; Prolonged Ischemic episodes; Persistent Vegetative STATe. distinct from coma with the destruction of the neocortex
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what are the presenting signs and symptoms of spinal cord syndromes?
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impairment of pain and temperature. it produces flaccid paralysis, then spastic paraplegia with brisk tendon reflexes
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what is the tx for global cerebral ischemia?
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1. ventilatory assistance & O2
2. lower systemic BP 3. Reestablish cerebral circulation 4. stabilize cardiac dysrhythmias 5. supply electrolytes |