Podcast
Questions and Answers
What do you call a person with a stroke who seems unaware of their disability?
What do you call a person with a stroke who seems unaware of their disability?
anosognosia
What area of the brain can cause internuclear ophthalmoplegia in a patient who presents with double vision?
What area of the brain can cause internuclear ophthalmoplegia in a patient who presents with double vision?
brainstem
What is a watershed stroke?
What is a watershed stroke?
Stroke between two adjacent cerebral arteries
At what rate is cerebrospinal fluid produced?
At what rate is cerebrospinal fluid produced?
A patient with locked-in syndrome most likely had an infarct in which part of the brain?
A patient with locked-in syndrome most likely had an infarct in which part of the brain?
What does a lacunar infarct indicate?
What does a lacunar infarct indicate?
What is the most important point to emphasize in a community education program on strokes?
What is the most important point to emphasize in a community education program on strokes?
What is a risk factor for a spontaneous carotid dissection?
What is a risk factor for a spontaneous carotid dissection?
What is the most significant risk factor for stroke?
What is the most significant risk factor for stroke?
At what age do one-fourth of all strokes occur in patients?
At what age do one-fourth of all strokes occur in patients?
What condition is associated with an increased risk of stroke and mortality?
What condition is associated with an increased risk of stroke and mortality?
What is an example of exclusion criteria for tPA administration?
What is an example of exclusion criteria for tPA administration?
What findings are consistent with alterations in posterior cerebral circulation?
What findings are consistent with alterations in posterior cerebral circulation?
What score is a predictor of a two-day risk for stroke following a TIA?
What score is a predictor of a two-day risk for stroke following a TIA?
What sign indicates meningeal irritation during a physical examination?
What sign indicates meningeal irritation during a physical examination?
What is the most sensitive and specific imaging technique for demonstrating acute infarction?
What is the most sensitive and specific imaging technique for demonstrating acute infarction?
What should a cerebral angiogram identify for a patient with SAH?
What should a cerebral angiogram identify for a patient with SAH?
What diagnosis is a contraindication for performing a lumbar puncture?
What diagnosis is a contraindication for performing a lumbar puncture?
What does TTE best identify?
What does TTE best identify?
What procedure would you expect for a woman with sickle cell disease undergoing preventative stroke diagnostic testing?
What procedure would you expect for a woman with sickle cell disease undergoing preventative stroke diagnostic testing?
What is the goal of embolization for L AVM?
What is the goal of embolization for L AVM?
What symptoms may indicate a dural arteriovenous fistula?
What symptoms may indicate a dural arteriovenous fistula?
In an MRI report describing a low flow, low pressure vascular lesion in the left temporal lobe, what is it likely to be?
In an MRI report describing a low flow, low pressure vascular lesion in the left temporal lobe, what is it likely to be?
What condition describes slow speech with inappropriate silences and audible inspirations?
What condition describes slow speech with inappropriate silences and audible inspirations?
What are primary nursing considerations when administering mannitol IV every 3 hours?
What are primary nursing considerations when administering mannitol IV every 3 hours?
What is the primary laboratory testing/monitoring for heparin infusion?
What is the primary laboratory testing/monitoring for heparin infusion?
What is an adverse side effect of anticonvulsant therapy?
What is an adverse side effect of anticonvulsant therapy?
What estimated percentage of ischemic stroke patients receive tPA?
What estimated percentage of ischemic stroke patients receive tPA?
What is anisocoria?
What is anisocoria?
What is apraxia?
What is apraxia?
What type of stroke is most likely when a patient presents with BP 260/140, methamphetamine use, chronic heavy ETOH use, and stroke-like symptoms?
What type of stroke is most likely when a patient presents with BP 260/140, methamphetamine use, chronic heavy ETOH use, and stroke-like symptoms?
What factors may increase the likelihood of stroke in women taking oral contraceptives? (Select all that apply)
What factors may increase the likelihood of stroke in women taking oral contraceptives? (Select all that apply)
What does the Hunt vs Hess Score describe?
What does the Hunt vs Hess Score describe?
What does the CHADS2 Score estimate?
What does the CHADS2 Score estimate?
What does the ABCD2 score predict?
What does the ABCD2 score predict?
What is a rare but potential complication of tPA administration?
What is a rare but potential complication of tPA administration?
What would a stroke patient with sodium of 128, low urine output, and weight gain likely have?
What would a stroke patient with sodium of 128, low urine output, and weight gain likely have?
What is the most common cause of vertebral dissection?
What is the most common cause of vertebral dissection?
What is cavernous angioma?
What is cavernous angioma?
What is the discharge instruction for a patient who underwent carotid artery endarterectomy regarding taking aspirin?
What is the discharge instruction for a patient who underwent carotid artery endarterectomy regarding taking aspirin?
What evidence-based standard is used to measure neurological functional improvement over time?
What evidence-based standard is used to measure neurological functional improvement over time?
What condition is sixth nerve palsy associated with?
What condition is sixth nerve palsy associated with?
What symptoms may indicate a basilar artery aneurysm?
What symptoms may indicate a basilar artery aneurysm?
What are primary presentation symptoms of cerebral venous thrombosis? (Select all that apply)
What are primary presentation symptoms of cerebral venous thrombosis? (Select all that apply)
What is the characteristics of MCA stroke?
What is the characteristics of MCA stroke?
What is the characteristics of ACA stroke?
What is the characteristics of ACA stroke?
What is the characteristics of PCA stroke?
What is the characteristics of PCA stroke?
What is the characteristics of PICA stroke?
What is the characteristics of PICA stroke?
What is the characteristics of AICA stroke?
What is the characteristics of AICA stroke?
What is the characteristics of Basilar Stroke?
What is the characteristics of Basilar Stroke?
What are the diagnostic indications for a lumbar puncture?
What are the diagnostic indications for a lumbar puncture?
What is the sensitivity and specificity of MR diffusion-weighted imaging for acute infarction?
What is the sensitivity and specificity of MR diffusion-weighted imaging for acute infarction?
What are signs and symptoms specific to hemorrhagic strokes? (Select all that apply)
What are signs and symptoms specific to hemorrhagic strokes? (Select all that apply)
What type of stroke is nuchal rigidity associated with?
What type of stroke is nuchal rigidity associated with?
What is a dural AV fistula?
What is a dural AV fistula?
What is tinnitus?
What is tinnitus?
What is the definition of cavernous angioma?
What is the definition of cavernous angioma?
What are examples of stroke mimics? (Select all that apply)
What are examples of stroke mimics? (Select all that apply)
What is the equivalent of 1 kg in pounds?
What is the equivalent of 1 kg in pounds?
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Study Notes
Stroke and Neurological Conditions
- Anosognosia: Condition where a stroke patient is unaware of their disability.
- Internuclear Ophthalmoplegia: Caused by lesions in the brainstem affecting eye movements; characterized by double vision and preserved tracking.
- Watershed Stroke: Occurs at the border zone between two cerebral arteries, often due to hypertension or hypoperfusion.
- Cerebrospinal Fluid (CSF) Production: Normal rate is 0.3-0.4 ml/min.
- Locked-In Syndrome: Typically results from an infarct in the pons, leading to complete paralysis except for eye movement.
- Lacunar Infarct: Indicates a blockage in a small penetrating artery.
- Stroke Education: Emphasis on activating EMS immediately can significantly improve outcomes.
Risk Factors and Signs
- Spontaneous Carotid Dissection: Connective tissue diseases are notable risk factors.
- Hypertension: Recognized as the most significant stroke risk factor.
- Stroke Age Statistics: 25% of all strokes occur in individuals under 75.
- Atrial Fibrillation: Associated with a heightened risk of stroke and mortality.
tPA Administration and Imaging
- Exclusion Criteria for tPA: Includes conditions like bleeding diathesis.
- Posterior Cerebral Circulation Symptoms: Ataxia and visual deficits suggest alterations in blood flow.
- MR Diffusion-Weighted Imaging: Most sensitive and specific imaging for acute infarction; sensitivity 88-100%, specificity 95-100%.
Diagnosing and Monitoring
- Kernig's Sign: Indicates meningeal irritation during physical examination.
- ABCD2 Score: Used to predict the two-day risk of stroke after a transient ischemic attack (TIA).
- Risk Mitigation in Sickle Cell Patients: Transcranial doppler studies are crucial for stroke prevention.
- TTE Utilization: A transthoracic echocardiogram is effective for identifying ventricular thrombus.
Stroke Characteristics
- Cerebral Venous Thrombosis Symptoms: Include headache, papilledema, diplopia, and sixth nerve palsy.
- MCA Characteristics: Symptoms often include aphasia, neglect, and contralateral sensory/motor loss.
- ACA Characteristics: Results in contralateral deficits in leg function more than arms; may present with abulia and incontinence.
- PCA Characteristics: Symptoms feature visual field loss and visual agnosia; typically does not involve paralysis.
- PICA and AICA Symptoms: PICA leads to Wallenberg syndrome, while AICA results in lateral pontine syndrome with vertigo and hearing loss.
Complications and Contraindications
- Cautions with tPA: Anaphylaxis is a rare complication; continuous monitoring is necessary.
- Monitor for SIADH: Characterized by low sodium, low urine output, and weight gain in stroke patients.
- SAH Contraindications: Any patient with subarachnoid hemorrhage (SAH) is not suitable for lumbar puncture.
Miscellaneous
- Dural Arteriovenous Fistula: Represents a direct connection between arteries and veins in the brain, causing symptoms like tinnitus.
- Cavernous Angioma: Marked by clusters of abnormal blood vessels and potential for slow blood flow.
- Stroke Mimics: Conditions that can resemble strokes include migraines, metabolic syndromes, and CNS tumors.
Measurements and Conversions
- 1 kg Conversion: Equivalent to 2.2 lbs.
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