Family Fridays 2.docx - Stroke sudden focal neurological sx d\/t vascular cause Types Ischemic(87 Hemorrhagic(13(Intraparenchymal(10 vs subarachnoid(3

Family Fridays 2.docx - Stroke sudden focal neurological sx...

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Stroke : sudden focal neurological sx d/t vascular cause Types: Ischemic (87%) Hemorrhagic (13%) (Intraparenchymal (10%) vs. subarachnoid (3%)) TIA : transient focal neuro deficit d/t ischemia- sx mimic stroke - Less than 24 h in duration - Definition now based on imaging- nml MRI - Risk of impending stroke up to 8% in next 48h – seek medical attn! Mimics: - Sz: post-ictal “Todd” paralysis - Structural lesion tumor, abscess, subdural hematoma, encephalitis - Metab derangements (hypo/hyperglycemia- can cause focal sx) - Migraine- HA after aura even paresis possible - HTN encephalopathy- focal sx possible - Recrudescence of prior stroke sx (infection, stress, asx UTI, hemodialysis) - Psychiatric dz (conversion d/o >> malingering) Acute Stroke Tx: Goal- save the penumbra Core infarct- damaged by lack of blood flow, penumbra is area salvageable around it Acute ischemic stroke tx goals: Reperfusion - restore cerebral blood flow: - Systemic: IV tPA vs. Endovascular: IA tPA and mechanical thrombolysis Supportive - minimize damage, prevent cx Prevent recurrent stroke- antithrombotic tx, determine cause Initial Eval: - Brief history: exact timing sx, timing and acuity of onset- last seen nml - PMHx: prior similar sx, vascular RF (obesity, smoking, HTN, DM, HLD), medications (anti- thrombolytic- Aspirin, Clopidigrel, glycoprotein IIb/IIIa receptor antagonists- abciximab, eptifibatide, tirofiban) - Brief physical exam: vitals, cardiac rate/rhythm, murmurs, clues to alternative d- head trauma - Neuro exam: NIH stroke scale 1. Level of consciousness 2. LOC questions (mon, age) 3. LOC commands (close eyes, make fist) 4. Best gaze 5. Visual field 6. Facial palsy 7. Motor L arm 8. Motor R arm 9. Motor L leg 10. Motor R leg 11. Limb ataxia (FNF, HKS) 12. Sensation (pin) 13. Best language
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14. Dysarthria 15. Extinction and inattention
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- Initial Imaging: CT- r/o hemorrhage or stroke mimic Acute ischemic stroke: loss of grey-white distinction loss of insular ribbon
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  • Winter '14
  • ischemic stroke, acute ischemic stroke

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