Strokes

Question 1

Head CT is very sensitive to intracranial bleeding/suspected stroke (and even small amounts!) (but an out of clinic- i.e. “I may have had a stroke yesterday but it resolved”- get an MRI)

Signs of stroke: facial drooping, weakness one side of body, time sensitive to tx

Answer 1

Ischemic stroke is the most common cause of stroke (85%- no bleeding)

Question 2

Causes of stroke: atherosclerosis, embolus, and less common lacunar (attributable to small vessel brain disease; isolated- risk factors: HTN, diabetes)

Cryptogenic/Esus (embolic stroke of uncertain source)= when the cause of stroke is not seen (the longer you wait from onset the less likely you are to find a cause)

Answer 2

Emoblic stroke workout minimum: CT, MRI, CT angiography, 24 hr Holter monitor (if all negative, then ESUS)

If embolic of nature (ie. from a. fib) or ESUS (thought is that a fib is the cause of most of these), need to be on anticoagulation

Question 3

Blood is less bright than bone

AA are more likely to be on meds for BP= uncontrolled HTN can cause parenhcymal bleeding

Right: bleed due to amyloid

Answer 3

Question 4

Answer 4

Question 5

White matter is darker

Air is the darkest, then water, then white matter

Infarct (ischemic stroke) of left MCA (middle)

A stroke is diagnosed by damage on imaging, and no damage = TIA

Question 6

Can give tPa up to 4.5 hrs

7ml/mg results in neuronal death (calcium influx), lactic acid at 17-19ml/mg

Answer 6

Diffusion weight imagina (DWI) becomes positive within minutes of ischemic insult

IV tPa is the front line tx for stroke to melt the clot (risk of bleeding- need to manage BP to prevent this)

Question 7

Hypodensity is irreversible!

Answer 7

Question 8

Answer 8

Question 9

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Question 10

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Question 11

Now, anyone with a suspected TIA is admission for at least 2 days to determine etiology and prevent 2 day stroke risk

first step upon admission is MRI (CT scan with resolved bleeding will not show symptoms)

Answer 11

A. fib

Lacunar= brain specific small vessel disease

Aminestic stroke= presentation of streoke like symptoms caused by infection, metabolic dirangements, and seizures with no leisons

Question 12

Range is in megaHz

Answer 12

Question 13