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

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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

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

T/F symptom onset is sudden

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

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)

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)

Discuss prognosis & quality of life after stroke

f

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

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

f

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

Vincent

Discuss the types of ischemic strokes

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

Diagnosis?

Normal

Define ischemic stroke

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

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

Name 3 risk factors for ischemic stroke

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

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

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

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

Contraindications for tPA use

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

Ischemic stroke accounts for __% of all strokes

80-85%

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 =

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

Rule out hemorrhage - contraindication for tPA

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

4.5 hours

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

Diagnosis? tPA administration if within 75 minutes?

Acute MCA infarct

What does the acronym FAST stand for?

Facial drooping; arm weakness; speech difficulties; time

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)

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)

Relate risk factors to pathogenesis of ischemic stroke

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

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

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

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

Damage from ischemic stroke depends on

location and time!

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