Term
| Strokes are the ____ leading cause of death in the US. |
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Definition
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Term
| Strokes happen most frequently between the hours of _____________. |
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Definition
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Term
| Of those that do survive a stroke, 9 out of 10 will have long-term impairment of _________, __________, ___________, or ____________. |
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Definition
movement
sensation
memory
reasoning |
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Term
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Definition
rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin.
the brain is not getting what it needs |
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Term
| What are the 2 things the brain needs to survive? |
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Definition
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Term
| Irreversible damage from a stroke can begin in as little as __________. |
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Definition
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Term
| What are the two kinds of stroke? |
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Definition
ischemic stroke
hemorrhagic stroke |
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Term
| What is an ischemic stroke? |
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Definition
blood is not getting to the brain
85% of all strokes
arise from:
thrombus (the most common)
embolus
hypo-perfusion (drop in BP)
every minute app. 1.9 million neurons are destroyed |
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Term
| What is a hemorrhagic stroke? |
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Definition
bleeding into the brain or brain cavity
bleeding into the parenchyma of the brain, usually due to High BP (intracerebral hemorrhage)
due to rupture of an artery with bleeding onto the surface of the brain, usually due to an aneurysm (subarachnoid hemorrhage)
thunderclap headache
"the worst headache I've ever had" |
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Term
| What are the unmodifiable risk factors for strokes? |
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Definition
age
gender
prior stroke
race
genetics and family history |
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Term
| What are the modifiable risk factors for a stroke? |
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Definition
high BP
high cholesterol
smoking
diabetes
obesity
inactivity |
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Term
| What are 2 stroke risk factors that are more important in women then men? |
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Definition
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Term
| How does smoking affect the liklihood of having a stroke? |
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Definition
increases likelihood for clots
reduces HDL |
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Term
| What are some signs of a stroke? |
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Definition
sudden numbness/weakness of face, arm or leg
especially one-sided
sudden confusion, trouble speaking or understanding
sudden trouble seeing - one eye or both
sudden trouble walking, dizziness, loss of balance or coordination |
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Term
| What other problems can mimic a stroke? |
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Definition
brain tumors
unrecognized seizures
subdural hematomas
toxic/metabolic confusional states especially hypoglycemia |
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Term
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Definition
transient ischemic strokes -- "mini strokes"
looks just like a stroke
typically lasts a few minutes to a few hours, by definition it resolves in 24 hours
IT IS A MEDICAL EMERGENCY - CALL 911
IT IS A WARNING |
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Term
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Definition
transient blurring or fogging of vision
motor weakness or clumsiness
diplopia, vertigo, dyphagia, ataxia
sensory loss or paresthesias
blindness or visual field cuts |
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Term
| Why is it important to recongnize TIAs? |
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Definition
significant indicator of stroke risk
1/4 of patient who have strokes have had previous TIA
1 in 20 patients w/ TIA will have a major stroke in 1 week if untreated
that drops to 1 in 100 if treated immediately after a TIA |
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Term
| What are some TIA treatment options? |
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Definition
anti-platelet drugs
aspirin, plavix, ticlid
anti-HTN drugs
diuretics, ACE inhibitors, beta-blockers, Ca Channel
anti-lipemic drugs
lipitor, pravachol, zocor
surgery
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Term
| What are the TIA treatment options in terms of surgeries? |
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Definition
carotid endarterectomy
carotid artery stenting
embolectomy |
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Term
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Definition
the only FDA-approved drug for dissolving blood clots in stroke patients
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Term
| t-PA is only used to treat... |
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Definition
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Term
| How soon do you have to use t-PA after a stroke |
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Definition
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Term
| National institute of neurological disorders and stroke recommends "door to t-PA time" of... |
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Definition
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Term
| What do you need to do when someone comes into the ER with stroke like symptoms? |
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Definition
history
general PE
neurologic exam
lab investigations: fingerstick glucose, serum electrolytes, CBC, coagulation studies, ECG |
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Term
| How can you tell which kind of stroke it is? |
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Definition
non-contrast CT
(bc contrast and blood look the same- white blob_
must be negative, must be read by a radiologist
recommended door to CT scan = 25 mins |
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Term
| What % of subarachnoid hemorrhages will appear normal? |
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Definition
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Term
| What will you have to do if the CT looks normal but you still fear a hemorrhage? |
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Definition
lumbar puncture
if the CSF appears yellow it means there is blood in it |
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Term
| What is the t-PA inclusion criteria? |
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Definition
- 18 or older
- clinical diagnosis of ischemic stroke causing a measurable neurological deficit
- time of sx onset is < 180 mins |
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Term
| What is the exclusion criteria for t-PA use? |
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Definition
intracranial hemorrhage
previous brain surgery, trauma or stroke 3 months
recent AMI
high BP
minor/rapidly improving sxs
known bleeding problem
LP in last 7 days
recent arterial puncture
SZ |
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Term
| The average stroke patient will wait at least ___ hours before going to the emergency department |
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Definition
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Term
| What are some ways you can attempt to prevent strokes? |
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Definition
healthy living maintain a normal weight
control heart disease control diabetes
reduce animal fats regular check ups
control HTN control cholesterol
do not smoke exercise |
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Term
| Pathologically Parkinson's disease is characterized by: |
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Definition
| the degeneration of dopamine neurons in the substantia nigra, a dark pigmented area located in the brainstem |
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Term
| Biologically parkinson's disease is characterized by: |
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Definition
| >80% depletion of the NT dopamine in the striatum |
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Term
| Clinically parkinson's disease is characterized by: |
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Definition
| bradykinesia/akinesia, cogwheel rigidity, resting tremor, postural instability/gait disturbances, balance problems |
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Term
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Definition
intracytoplasmic hyaline inclusion
alpha-synuclein in core
ubiquitin at rim |
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Term
| What is parkinson's disease? |
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Definition
| a progressive neurological disorder resulting predominately from the degeneration of dopamine-producing brain cells (important in control of motor function) |
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Term
| What are the cardinal features of Parkinson's Disease? |
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Definition
resting tremor
rigidity
akinesia/bradykinesia
postural instability |
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Term
| What are some additional features of parkinson's disease? |
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Definition
cognitive, mood and behavioral dysfunc
olfactory disturbances
sleep disturbance
constipation
seborrheic dermatitis
pain
autonomic disturbances |
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Term
| How do you diagnose parkinson's disease? |
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Definition
no definitive lab tests
CT/MRI normal/non-specific atrophy
EEG, blood, CSF studies are normal |
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Term
| What are the differential diagnoses for parkinson's disease? |
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Definition
essential tremor
parkinson's plus syndrome
secondary parkinsonism
wilson's disease: (treatable but you'll die w/o txt)
acanthocytosis
depression
hypo-, hyperthyroidism |
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Term
| How do you differentiate parkinson's disease from essential tremor? |
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Definition
PD: resting tremor, minimal difficultly with fine movements
ET: postural tremor, tremor worse with fine movements |
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Term
| What are some causes of secondary parkinsonism? |
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Definition
head trauma
metabolic disorders
toxins and industrial exposure
drugs (neuroleptics, LiCO3, antiemetics, reserpine) |
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Term
| Potential neuroprotective treatments for parkinson's dieases? |
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Definition
| caffeine, coenzyme Q10, creatine, estrogen, GM-1 ganglioside, minocycline, nicotine, GPI-1485, rasagiline, selegiline, ropinirole, pramipexole |
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Term
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Definition
potential neuroprotective treatment for parkinson's disease
selective MAO-B inhibitor
didn't help drastically
dose 5 mg po bid
AEs: nausea, hallucinations, orthostatic hypotension |
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Term
| How do direct dopamine agonists help with parkinson's disease? |
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Definition
bromocriptine
pramipexole
ropinerole (typically not used)
directly stims dopamine receptors
ind of dopamine production
no free radical generation
monotherapy or adjunctive therapy |
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Term
| What are some dopamine agonist AEs? |
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Definition
nausea
vomiting
postural hypotension
hallucinations
hypersexuality
sleep attacks
pathologic gambling |
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Term
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Definition
gold standard for treatment of parkinson's disease
works for almost all patients with PD
improvement of disability and possibly mortality
most effect on bradykinesia and rigidity |
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Term
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Definition
combined with levodopa to treat parkinson's disease
prevents peripheral conversion of levodopa
total of 75 mg/day usually required
high protein diet decs absorption
much flucuation
immediate release half life of 60-90 mins |
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Term
| What are some possible levodopa/carbidopa AEs? |
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Definition
nausea/vomiting
orthostatic hypotension
hallucinations
cardiac arrhythmias
confusion
agitation |
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Term
| What are some possible long term complications of Levadopa/Carbidopa? |
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Definition
wearing off (add COMT inhibitor)
on-off phenomenon
involuntary movements |
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Term
Name 2 COMT inhibitors used to treat parkinson's disease.
What are some possible AEs? |
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Definition
tolcapone
entacapone
AEs: dyskinesias, nausea, hallucinations/vivid dreams, diarrhea, urine discoloration (amber) |
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Term
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Definition
dopamine agonist, glutamenteric agonist used to treat parkinson's disease
enhances dopamine release
blocks reuptake
stims DA receptors
blocks Glu receptors
treats early PD
AEs: dizziness, nausea, nightmares, insomnia, anxiety, livedo reticularis |
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Term
| What are anticholinergics most useful for in the treatment of parkinson's disease? |
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Definition
most useful for tremor
do not use in demented patients
later PD with all symptoms except tremor under good control
AEs: dry mouth, urinary retention, dry eyes, constipation, confusion |
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Term
| What are some surgical treatments for parkinson's diease? |
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Definition
deep brain stim
ablative procedures
grafting |
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