Please enable JavaScript.
Coggle requires JavaScript to display documents.
Neurology Part 2 (Stroke/TIA (hemorrhagic (management (HTN - aggressively…
Neurology Part 2
Stroke/TIA
definition
sudden onset a focal neurologic impairment that can be ascribed to a specific location in the brain, retina, or spinal cord.
definition of TIA
no more than 24 hours (new guidelines- no time), normal MRI
-
types of stroke
Ischemic (blockage)
large vessel
carotid, MCA, PCA, cerebral
mono-ocular blindness
carotid
treatment
Carotid revascularization, preferably within 14 days from the index event, is indicated for nondisabling strokes or TIAs in patients with symptomatic extracranial internal carotid artery stenosis in the range of 70% to 99% and can be performed with endarterectomy or angioplasty-stenting.
small vessel
internal capsule, lacunar, basal ganglia
lacunar - medial longitundial fasciculus (INO - cannot convege ipsilateral (adduction weakness) - If old. If young then think multiple sclerosis, but can converge
symptoms
pure motor, clumpsy hand, ataxic hemiparesis
-
-
-
-
hemorrhagic
-
Subarrachnoid
-
what to order
CT, if negative then LP (for xanthochromia), gold standard cerebral angiogram
vasospasm prevention
Oral nimodipine improves neurologic outcomes in patients with aneurysmal SAH and is recommended in all patients with SAH for the first 21 days or until hospital discharge
-
Subdural
crosses suture lines concave (venous), will have ruffle
-
surgery candidates
- Cerebellar stroke (posterior fossa - prevention of herniation of the 4th ventricle)
- 1 cm from the surface
- with greater 30 cc lobar blood
- life threatening
epidural
cannot suture lines (arterial), expands inside the brain - get neurosurgery, convex
Evaluation
CT (rule out blood) /MRI
ECG - atrial fibrillation
Echo (TTE) - cardioembolic
(CT angiogram head and neck) > MRA (if renal issues) > CUS and Transcranial Doppler (if pacemaker)
Risk Factors:
A1c, lipid panel, urine drug screen, TSH
-
-
-
-
amyloid angiopathy
Lobar hemorrhages in older patients without hypertension that originate near the cortical surface can be caused by amyloid angiopathy stemming from amyloid-β deposits in distal cerebral arterioles; this process is similar to what occurs in Alzheimer disease, in which amyloid-β deposits are found in the parenchyma
Treatment
-
-
-
risk factors
BP management
CT scan pending - if the BP > 220/120 treat it irrespective
CT scan - hemorrhage - <140
CT scan - ischemic - TPA - **185/110**
CT scan - ischemic - status post TPA - **180/105**
in 24-48 allow permissive HTN at >220/120
-
DAPT
high-risk TIA (ABCD2 score ≥ 4) or minor ischemic stroke (National Institute of Health Stroke Scale score ≤ 3), a 21-day course of combination aspirin and clopidogrel followed by clopidogrel monotherapy for a total of 90 days reduced the risk of subsequent stroke when administered within 24 hours of onset compared with aspirin monotherapy.
-
-
Where is my lesion?
-
name the 5 regions
cortex, subcortex, midbrain, pons, medulla
cortical signs
language (aphasia) broca- frontal + comprehension, no motor, wernikes - temporal/parietal, talk fluent but doesn't take sense, neglect aka non-dominant parietal lobe, visual field
-
-
-
-
-
-
-
-
-
-
-