clinmed2test3: TIA & Stroke ppt

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the estimated percentage of all cases of facial nerve palsy that Bell's palsy represents?

60%

25%

50% (correct)

75%

Which of the following is NOT a symptom of Bell's palsy?

Difficulty making facial expressions

Excessive tearing

Seizures (correct)

Impaired ability to taste (anterior ⅔ of tongue)

What is the likely cause of Bell's palsy in most cases?

Herpes zoster virus activation

Herpes simplex virus activation (correct)

Autoimmune disorder

Bacterial infection

What is the time frame for recovery to some degree in Bell's palsy?

6 months Signup and view all the answers

Which group of people is at higher risk of developing Bell's palsy?

Diabetic individuals Signup and view all the answers

What is the primary method of diagnosis for Bell's palsy?

Examination of facial movement Signup and view all the answers

What is the mainstay of pharmacotherapy for acute treatment?

Short-term prednisone (glucocorticoid) therapy Signup and view all the answers

What is the significance of evaluating for large vessel occlusion in TIA/Stroke Evaluation?

To determine if the patient is a candidate for thrombectomy Signup and view all the answers

What is the recommended blood pressure control for the first 24-48 hours in TIA/Stroke patients?

Permissive hypertension Signup and view all the answers

What is the primary goal of reperfusion therapy in acute ischemic stroke?

To restore blood flow to the regions of the brain that are ischemic but not yet infarcted Signup and view all the answers

What is the time frame for initiation of alteplase (tPA) in acute ischemic stroke?

Within 4.5 hours of clearly defined symptom onset Signup and view all the answers

What is the inclusion criterion for tPA in acute ischemic stroke?

Ischemic stroke causing clinically significant neurological deficit Signup and view all the answers

What is the significance of evaluating for symptomatic carotid stenosis in TIA/Stroke Evaluation?

To consider carotid stent or carotid endarterectomy Signup and view all the answers

What is the recommended anticoagulation therapy for cardioembolic TIA or stroke?

Novel oral anticoagulant (NOAC; i.e. Apixaban) Signup and view all the answers

What is the recommended imaging study for intracranial vessels in TIA/Stroke Evaluation?

CTA head Signup and view all the answers

What is the significance of evaluating for dissection in TIA/Stroke Evaluation?

To treat with either dual antiplatelet therapy or anticoagulation Signup and view all the answers

Study Notes

Bell's Palsy

Defined as an acute peripheral facial nerve palsy of unknown cause
Represents about 50% of all cases of facial nerve palsy
Risk is 3X higher during pregnancy
Diabetics also have a higher risk
Herpes simplex virus activation is the likely cause in most cases
Herpes zoster is the 2nd most common viral infection associated with Bell's palsy
Involves the facial nerve
Symptoms appear rapidly (usually over hours) and range from mild to severe
Symptoms include drooping eyelid or corner of mouth, difficulty making facial expressions, paralysis, drooling, excessive tearing, tingling in the eye, and impaired ability to taste (anterior ⅔ of tongue)
Diagnosis includes diffuse facial nerve involvement, paralysis of facial muscles, with or without loss of taste on anterior 2/3 of tongue and altered secretion of lacrimal and salivary glands
Onset is acute, progressive course, reaching maximal clinical weakness/paralysis within 3 weeks
Recovery to some degree within 6 months
Treatment involves short-term prednisone (glucocorticoid) therapy, eye care, physical therapy, and surgical decompression

Transient Ischemic Attack (TIA)

Defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction
Symptoms are transient, short-lived, and often resolve prior to presentation
Last less than 24 hours
Symptoms mimic stroke
Brain MRI is needed to determine if there was ischemia or not (TIA vs. Stroke)
Evaluation involves the same workup as for stroke
Patients with TIA are at increased risk of stroke

TIA/Stroke Evaluation

MRI of the Brain
Imaging of intracranial vessels (CTA head superior to MRA head)
Evaluate for large vessel occlusion, significant intracranial atherosclerosis
Imaging of extracranial vessels (CTA neck superior to MRA neck)
Evaluate for dissection, symptomatic carotid stenosis
Can also consider carotid ultrasound if CTA/MRA is not available

TIA/Stroke Secondary Prevention

BP Control
Permissive HTN for first 24-48 hours (unless stroke is ruled out)
Lifestyle modifications (smoking cessation, substance counseling, weight loss, exercise, eval for sleep apnea)
Antiplatelet therapy for non-cardioembolic TIA or stroke
Anticoagulation therapy for cardioembolic TIA or stroke

Acute Ischemic Stroke: Treatment

Reperfusion therapy includes two options: intravenous thrombolytic (tPA) and mechanical thrombectomy
Immediate goal is to restore blood flow to the regions of the brain that are ischemic but not yet infarcted
Long-term goal is to improve outcome by reducing stroke-related disability and mortality
Alteplase: tissue plasminogen activator (tPA) initiated within 4.5 hours of clearly defined symptom onset

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge about Bell's palsy, a condition that affects the facial nerve, including its causes, symptoms, and risk factors. Learn about the role of herpes simplex virus and diabetes in this condition.