Ischemic stroke | Baamboozle - Baamboozle | The Most Fun Classroom Games!

WHO's WHO - I got into a car accident the day after I got my license

Vincent

At a friends house in high school I heard meowing and released her kitten had snuck into the fridge. I laughed so hard I peed my pants. I was too embarrassed to tell them so I "accidentally" spilled my entire arizona tea in my lap to hide i

Rae

WHO's WHO - I wore heels toa first date and the parking lot was dark and I stepped in a hole and fell down and tore my jeans and showed up to my first date with a skinned knee

Kristen

Discuss prognosis & quality of life after stroke

f

Discuss waiting to re-start lisinopril despite Mr. Clooney's BP remaining elevated

Permissive HTN. Increased BP has better chance of getting blood through narrow blood vessels (he has stenosis of MCA)

Justify prescribing high-dose atorvastatin and short-term dual antiplatelet therapy with clopidogrel and aspirin (include MOA)

Atorvastatin - HMG-CoA reductase inhibitor (inhibits cholesterol biosynthesis in the liver)

Contraindications for tPA use

Recent ischemic stroke; GI malignancy or recent bleed; severe uncontrolled hypertension; nondisabling minor stroke (NIHSS <5)

Discuss mechanisms underlying neuronal injury during ischemic stroke

Deprivation of ATP in cells -> dysfunction of Na/K ATPase -> build up of Na draws in water -> cytotoxic edema & inflammation; excitotoxicity (glutamate)

Discuss the types of ischemic strokes

1. embolic (20%); 2. thrombotic (40%); 3. Global hypoxia (i.e. cardiogenic shock)

Relate risk factors to pathogenesis of ischemic stroke

Smoking = toxin in tobacco damages endothelium -> atherosclerosis -> plaque obstructs arterial blood flow -> thrombotic stroke;

Utility of cardiac telemetry and echocardiogram with bubble study

cardiac telemetry = a fib (L sided clot -> embolus and stroke). Echo with bubble study - checking for PFO (clot on R side -> L side heart -> stroke)

Diagnosis? tPA administration if within 75 minutes?

Acute MCA infarct

Diagnosis?

Normal

Diagnosis? tPA administration if this was taken within 3 hours of arrival?

Acute left MCA distribution hemorrhagic infarction. NO! contraindicated with hemorrhage.

DISCUSS immediate stroke management (not prevention/long term management)

f

DRAW/DISCUSS clinical evaluation flow chart for a suspected stroke patient starting when they arrive at ED. What are you ruling out/confirming?

Serum glucose = other causes of symptoms; non-contrast CT = ruling out hemorrhage for treatment; MRA = find arterial blockage; MRI =

Why is it important to order a CT prior to full clinical evaluation in a suspected stroke patient?

Time is brain... save the penumbra! - Dr. West

Describe the utility and components of NIH stroke scale

0 = no stroke; 1-4 minor; 5-15 moderate; 16-20 moderate-severe; 21-42 severe

Describe the RACE stroke scale - utility and components

Facial palsy; arm motor function; leg motor function; head and gaze deviation. If R hemiparesis - test aphasia; if L hemiparesis - test agnosia

WHO's WHO - I learned only a few years ago due to a rude awakening moment that pink lemonade was not actually made from pink lemons

Sulaiman

Mr. Clooney had RUE and LUE paresis and LUE and LLE intact on neuro exam. What side of the brain was the stroke?

Left! Contralateral side affected

Moving home from college, I had a suitcase with all my clothes. When I picked it up from baggage claim, one of the zippers broke from the pocket with all of my underwear. I looked inside and someone had stuffed all of my underwear back in

Alexa

T/F symptom onset is sudden

F - typically onset over hours (compared to hemorrhagic stroke - sudden onset)

What is the utility of a non-contrast CT in stroke management?

Rule out hemorrhage - contraindication for tPA

What does the acronym FAST stand for?

Facial drooping; arm weakness; speech difficulties; time

tPA should not be administered for an ischemic stroke after how long?

4.5 hours

What is the meaning of "Time is brain...save the penumbra!"

Penumbra = area surrounding the ischemic event. If blood flow is restored quickly enough after a stroke, the penumbra can be preserved by collateral circulation

I took French in middle school. We were tasked to write a short story in English and then translate to French and present to the class. I read the English version with a French accent by mistake

Alyssa

Damage from ischemic stroke depends on

location and time!

Name 3 risk factors for ischemic stroke

Age >65; hypertension; diabetes mellitus; atrial fibrillation; carotid artery stenosis

Ischemic stroke accounts for __% of all strokes

80-85%

Define ischemic stroke

cerebral infarction due to insufficient cerebral blood flow, resulting in ischemia and neuronal injury