Stroke Treatment and Diagnosis Overview

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Questions and Answers

Which of the following is NOT a component of stroke prevention?

Lowering dietary intake of cholesterol

Controlling blood pressure

Implementing immediate emergency evacuation (correct)

Maintaining a healthy weight

What is the primary focus of acute care for stroke patients?

Maximizing rehabilitation outcomes

Setting long-term recovery goals

Reducing dietary intake of fats

Preventing further deficits (correct)

Which of the following is a critical measure to minimize brain injury in stroke patients during acute care?

Rapid diagnosis and treatment (correct)

Long-term rehabilitation support

Regular follow-up after discharge

Controlled dietary interventions

What does the NIH Stroke Scale measure?

Neurologic outcome and recovery degree Signup and view all the answers

Which imaging test is primarily used to detect hemorrhage in stroke diagnosis?

CT scan Signup and view all the answers

What is the importance of assessing the time of onset of stroke manifestations?

Administering appropriate treatments Signup and view all the answers

What is a goal of rehabilitation following a stroke?

Restoring lost functions and skills Signup and view all the answers

Which statement about certified stroke centers is true?

They ensure immediate, appropriate care from admission to discharge. Signup and view all the answers

What should be done if a patient's systolic blood pressure is greater than 185 mmHg or diastolic blood pressure is greater than 110 mmHg before receiving IV tPA?

Initiate blood pressure control measures Signup and view all the answers

Which medication can be prescribed to manage increased intracranial pressure (ICP) and is an osmotic diuretic?

Mannitol Signup and view all the answers

What is the primary purpose of administering tissue plasminogen activator (tPA) in the event of an ischemic stroke?

To dissolve blood clots Signup and view all the answers

When is the best time to administer tPA for optimal recovery outcomes after symptom onset?

Within 3 hours Signup and view all the answers

What impact does administering anticoagulant medications have on a patient with a hemorrhagic stroke?

Worsens the patient’s bleeding condition Signup and view all the answers

Which of the following is the most common complication observed during tPA therapy?

Brain hemorrhage Signup and view all the answers

What is the primary contraindication for administering tPA therapy?

Recent trauma or bleeding Signup and view all the answers

Which procedure may be necessary for patients with TIA to prevent future strokes?

Carotid endarterectomy Signup and view all the answers

What dietary restrictions should a patient avoid after receiving tPA to prevent impacting the clotting mechanism?

Dark leafy greens Signup and view all the answers

Which intervention is critical for monitoring patients after the administration of tPA?

Monitoring vital signs for bleeding Signup and view all the answers

What is the method of action of the tPA drug alteplase?

It converts plasminogen to plasmin Signup and view all the answers

What outcome is least likely from the administration of corticosteroids for cerebral edema?

Increased intracranial pressure Signup and view all the answers

What follow-up medication should be avoided for 24 hours after tPA administration?

Aspirin Signup and view all the answers

What is an extracranial–intracranial bypass intended to accomplish in stroke management?

It restores blood flow to the brain Signup and view all the answers

Which immune cells are primarily responsible for phagocytosis?

Neutrophils Signup and view all the answers

What is the primary function of H1 receptors in the inflammatory response?

Vasodilation and bronchoconstriction Signup and view all the answers

Which substance is considered the first line of treatment for anaphylaxis?

Epinephrine Signup and view all the answers

What are common triggers for anaphylaxis?

Food, insect stings, and medications Signup and view all the answers

Which of the following is NOT a symptom of anaphylaxis?

Continuous cough Signup and view all the answers

Where are H4 receptors primarily located?

In peripheral white blood cells and mast cells Signup and view all the answers

What complication can arise if anaphylaxis is left untreated?

Airway obstruction or vascular collapse Signup and view all the answers

What is the preferred route of administration for epinephrine during an anaphylactic reaction?

Intramuscularly Signup and view all the answers

Which of the following describes a symptom associated with anaphylaxis?

Cyanosis due to decreased tissue oxygenation Signup and view all the answers

What is a common characteristic of antihistamines in relation to allergy symptoms?

They block histamine receptors Signup and view all the answers

What is the primary goal of physical therapy?

To prevent contractures and improve muscle strength Signup and view all the answers

Which therapy aims specifically to aid in recovering motor skills for daily activities?

Occupational therapy Signup and view all the answers

What does inflammation primarily occur in response to?

Injury or illness Signup and view all the answers

Which of the following is NOT a manifestation of inflammation?

Impaired hearing Signup and view all the answers

Which phase is first in the healing process after an injury?

Inflammatory phase Signup and view all the answers

Which type of inflammation is characterized by a rapid response to injury or infection?

Acute inflammation Signup and view all the answers

What is the term for the increased blood flow to an injured area during inflammation?

Hyperemia Signup and view all the answers

Which agents can trigger an inflammatory response?

Microorganisms, chemical agents, and physical agents Signup and view all the answers

What happens during the margination process in inflammation?

Leukocytes roll along and adhere to the vessel wall Signup and view all the answers

Which term describes a prolonged inflammatory response that lasts for months or years?

Chronic inflammation Signup and view all the answers

What role do histamines play during inflammation?

Dilate blood vessels and increase blood flow Signup and view all the answers

In what situation does chronic inflammation typically follow acute inflammation?

When acute inflammation is not resolved Signup and view all the answers

What is the main function of speech and language therapy?

Enhancing swallowing and communication skills Signup and view all the answers

What is a key characteristic of hemorrhagic stroke on a CT scan?

It presents with early clinical symptoms. Signup and view all the answers

Which imaging test can immediately identify cerebral ischemia after a stroke onset?

Diffusion-weighted imaging Signup and view all the answers

What blood test has been approved to screen for recurrent stroke risk?

PLAC test Signup and view all the answers

In which scenario is lumbar puncture considered safe?

When there is no danger of elevated ICP Signup and view all the answers

What is the main goal of antiplatelet agents in stroke prevention?

To prevent blood vessel occlusion Signup and view all the answers

Which medication is often used for acute ischemic stroke treatment?

Alteplase (rt-PA) Signup and view all the answers

How long after symptom onset can IV tPA be administered for patients under age 80?

4.5 hours Signup and view all the answers

Which of the following medications is specifically contraindicated in patients who have had both diabetes and a prior stroke?

Alteplase Signup and view all the answers

What is a common use for thiazide diuretics in stroke prevention?

Reducing blood pressure Signup and view all the answers

Which of the following drugs is a direct thrombin inhibitor used to reduce stroke risk?

Dabigatran Signup and view all the answers

What is the role of anticoagulants in the acute phase of thrombotic stroke?

To prevent further thrombus formation Signup and view all the answers

What may be added to patient therapy after thrombolytic therapy with tPA?

Antiplatelet therapy Signup and view all the answers

Which class of medications is considered effective in managing high blood pressure for stroke prevention?

Angiotensin II receptor blockers (ARBs) Signup and view all the answers

What is the usual effect of aspirin in preventing strokes?

Inhibits platelet aggregation Signup and view all the answers

What happens during leukocytosis?

Bone marrow produces more leukocytes and releases them into circulation. Signup and view all the answers

What is purulent exudate typically identified by?

It contains a high concentration of leukocytes and necrotic debris. Signup and view all the answers

Which tissue types have limited regenerative capacity?

Nervous and muscular tissues. Signup and view all the answers

What characterizes the reparative phase of the inflammatory response?

Replacement of destroyed cells with identical or similar cells. Signup and view all the answers

Which type of exudate is associated with blood from damaged vessels?

Hemorrhagic exudate Signup and view all the answers

What role does histamine play in the inflammatory response?

Causes vasodilation and increases vascular permeability. Signup and view all the answers

What is the primary purpose of chemical mediators during inflammation?

To initiate and modulate the inflammatory response. Signup and view all the answers

What causes the erythema and swelling seen in inflammation?

Increased blood flow and vascular permeability. Signup and view all the answers

What is the first stage of the inflammatory response characterized by?

Increased numbers of circulating leukocytes. Signup and view all the answers

Which mediator is primarily responsible for chemotaxis during the inflammatory response?

Complement Signup and view all the answers

What is a typical injury that might lead an individual to seek treatment for stage 1 inflammation?

Minor sprained ankle Signup and view all the answers

Granulation tissue is characteristic of which process?

The reparative stage of healing. Signup and view all the answers

Which cells contribute to the inflammatory response by secreting cytokines?

Neutrophils and macrophages Signup and view all the answers

What is the role of fibrin in the inflammatory process?

To form a network supporting repairing tissue. Signup and view all the answers

Study Notes

Stroke Treatment Stages

Prevention: Controlling blood pressure, managing cholesterol and saturated fat intake, avoiding smoking, managing diabetes, maintaining a healthy weight, and regular exercise
Acute Care: Diagnosing stroke type and cause, maintaining cerebral blood flow, minimizing brain injury, and maximizing recovery
Rehabilitation: Specialized therapies for recovery, including physical therapy, occupational therapy, and speech and language therapy

Stroke Diagnosis

Clinical Assessment: Observation, complete history, head-to-toe physical examination, including a comprehensive neurological examination
National Institutes of Health (NIH) Stroke Scale: Assesses neurological outcome and recovery, focusing on LOC, vision, facial paralysis, motor abilities, ataxia, sensation, language, and attention
Imaging: Identifies increased stroke risk and pathophysiologic changes after a stroke
- CT Scans: Demonstrates hemorrhage, aneurysm, ischemia, edema, tumors, and tissue necrosis, differentiates stroke types
- Cerebral Arteriography, MRI, Magnetic Resonance Angiography, Transcranial DUS, PET, and Single-Photon Emission CT: Additional diagnostic tools
Blood Test: New test screens for recurrent stroke risk by detecting high levels of lipoprotein-associated phospholipase

Stroke Pharmacological Therapy

Prevention: Medications based on patient history, including antiplatelet/anticoagulant agents, antihypertensives, and cholesterol-lowering drugs
- Antiplatelet Agents: Aspirin and clopidogrel (Plavix), reduce clot formation and vessel occlusion
- Anticoagulants: Warfarin (Coumadin, Jantoven), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and dabigatran (Pradaxa), prevent clot formation in the heart
- Antihypertensives: Thiazide diuretics, CCBs, ACE inhibitors, and ARBs, manage high blood pressure
- Cholesterol-Lowering Drugs: Statins (atorvastatin, lovastatin, simvastatin) and fibric acid agents (fenofibrate and fenofibric acid)
Acute Stroke: Anticoagulants, platelet inhibitors, and thrombolytic agents manage thrombotic stroke
- Thrombolytic Therapy: Recombinant tissue plasminogen activator alteplase (rt-PA, tPA), converts plasminogen to plasmin to dissolve clots
- tPA Administration: Most effective within 3 hours after symptom onset, up to 4.5 hours for specific patient groups
- tPA Contraindications: Age over 80, history of diabetes and prior stroke, aspirin may be an alternative
- Anticoagulants/Antiplatelet Therapy: Used to prevent further clot formation and extension

Stroke Surgical Management

Carotid Endarterectomy: Removes atherosclerotic plaque from the carotid artery bifurcation to prevent stroke
Extracranial-Intracranial Bypass: Reestablishes blood flow in occluded or stenotic vessels not amenable to radiologic clearance
Carotid Angioplasty with Stenting: Treats cerebral stenosis

Inflammation

Adaptive Response: Brings fluids, dissolved substances, and blood cells to the site of injury or illness
Nonspecific Response: Identical events regardless of the cause
Neutralization and Elimination: Removes the invader, destroys tissue, and initiates healing
First Phase of Healing: Following tissue injury or infection
Agents Causing Inflammation: Microorganisms (bacteria, viruses, fungi, helminths, protozoans), chemical agents (internal or external), and physical agents (trauma, heat, cold, radiation)
Disorders: Denote with suffix '-itis' (e.g., bronchitis, colitis, gastritis)
Manifestations: Erythema (redness), heat, swelling (edema), pain, and potential impaired function

The Inflammatory Process

Complex Vascular Response: Triggered by harmful stimuli
Protection: Isolates damaged area and promotes surrounding tissue repair
Classification: Acute or chronic
Acute Inflammation: Quick response within minutes to hours of injury
Chronic Inflammation: Persistent response for months or years, can follow acute inflammation but not always

Stages of Inflammation

Vascular and Cellular Responses: Immediate vascular constriction, release of histamine, kinins, and prostaglandins, resulting in vasodilation, hyperemia (increased blood flow), and erythema (redness), increased vascular permeability, edema (swelling), and pain
Exudate Production: Fluid, proteins, and leukocytes leak into interstitial spaces
Reparative Phase: Tissue healing and repair

Inflammation Phases

The inflammatory response has three phases: adhesion/transmigration, exudate production, and reparative phase.
Adhesion: Leukocytes attach to receptors on endothelial cells.
Transmigration: Leukocytes squeeze through the cell lining and enter the wound site.
Leukocytosis: The bone marrow increases leukocyte production and releases them into the blood.
Exudate Production: Inflammatory exudate leaks from blood vessels and contains fluid, cytokines, histamines, dead cells, and injured tissue cells.
Types of Exudate:
- Serous: Clear or straw-colored, associated with mild inflammation.
- Purulent: Contains leukocytes, other cells, and debris, indicating infection.
- Hemorrhagic: Contains blood from ruptured vessels, red and thick.
Reparative Phase: The body shifts from inflammation to repair.
- Regeneration: Damaged cells are replaced with identical or similar cells.
- Fibrous (scar) tissue formation: Occurs when regeneration is not possible.
- Granulation tissue: Fragile, gelatinous tissue with new capillaries.
- Cicatrix (scar tissue): Firm fibrous tissue formed from contracted collagen fibers.

Mediators of Inflammation

Mast cells: Found in many tissues and release mediators like histamine and heparin.
Histamine: Causes vasodilation and increased permeability, attracting eosinophils.
Heparin: Prevents blood clotting.
Complement: A system of proteins that contribute to various aspects of inflammation, including dilation, permeability, chemotaxis, phagocytosis, and histamine release.
Leukotrienes: Attract neutrophils and macrophages.
Prostaglandins: Cause vasodilation.
Anaphylaxis: A life-threatening allergic reaction with a rapid release of inflammatory mediators.
Triggers of Anaphylaxis:
- Foods (peanuts, shellfish, milk, eggs)
- Insect stings
- Medications (penicillin, anesthetics, NSAIDs)
- Latex
Epinephrine (adrenaline): First-line treatment for anaphylaxis, dilates bronchi, constricts blood vessels, and counteracts the negative effects of the allergic response.
Antihistamines: Block histamine receptors, reducing allergic symptoms.

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Description

This quiz covers the essential stages of stroke treatment, including prevention, acute care, and rehabilitation strategies. Additionally, it explores the various methods for diagnosing stroke, such as clinical assessments and imaging techniques. Test your knowledge on the vital aspects of stroke management and recovery.