SSM SCRN Review Exam 2024 with 100% correct answers

Stroke Risk Factors - Age Gender (men >women) Genetics Stroke Primary Prevention - Tobacco cessation Blood pressure reduction Stroke Secondary Prevention - Prevention of another stroke Targets treatment for change once disease is present i.e. Blood Pressure control, LDL control, recognition of S/S stroke Frontal Lobe Functions - LOC Regulates personality and affect Impulsivity and judgement Abstract thinking Conjugate eye movements Frontal Lobe Precentral Gyrus - AKA Motor Strip Parietal Lobe Functions - Sensory: Interpretation of: Pain, temperature, light touch, vibration, two-point discrimination, proprioception Temporal Lobe - Functions: Hearing, Memory, Learning Seizures Wernicke's area - located in Temporal lobe responsible for understanding spoken language Occiptal lobe - Functions: Vision The right half of the occiptal lobe interprets information received from the right half of both the right and left eyes (and vice versa) Cerebrum - Made up of Basial ganglia and Limbic system Basial ganglia - Coordinates movement Limbic system - Amygdala, Cingulate gyrus, Hippocampus Amygdala and Cingulate gyrus - Memory and emotion Hippocampus - Memory and learning Diencephalong - Thalmus, Hypothalmus, Pituitary and pineal gland Thalamus - Receives input from cerebral cortex and acts as relay center Hypothalamus - Hunger Thirst Autonomic functions Endocrine functions Pituitary and pineal gland - Hormonal modulation Sleep-wake cycle Spinothalamic Tract - An ascending pathway of the spinal cord . It is responsible for the transmission of pain, temperature, and crude touch to the somatosensory region of the thalamus. Corticospinal tract - A descending tract of the spinal cord which contains bundles of axons which originate in the cerebral cortex and descend to synapse within the brainstem or spinal cord. The neurons are called "upper motor neurons". Cerebellum - Coordination of motor function: Rapid alternating movements Balance and Position sense Brain Stem - Medulla, Midbrain, Pons Medulla - Foramen magnum to the pons CN XII, IX, X, XI Corticospinal tracts- pyramids: decussate and cross midline Midbrain - Coordinates Eye Movement, some reflexes related to hearing and vision CN II, III, IV Pons - Between medulla and midbrain CN VI, VII, VIII, V message center between cerebellum and cerebrum Cranial Nerve I - Olfactory-smell Cranial Nerve II - Optic- transmits visual information, visual fields, deficit=hemianopsia Cranial Nerve III - Occularmotor- eyeballs look up deficit= eyelid drooping, diplopia, strabismus, ptosis, pupil dilation Cranial Nerve IV - Trochlear- move eyeball down and in deficit=diplopia, strabismus Cranial Nerve V - Trigeminal- 3 branches sensation to the skin of the face, muscles of mastication deficit=decreased facial sensation Cranial Nerve VI - Abducens- move eyeball down and out deficit=strabismus (poor muscle control of eye) Cranial Nerve VII - Facial- facial muscle innervation deficit= facial droop or weakness If caused by virus- can be Bells Palsy Cranial Nerve VIII - Acoustic- hearing and balance deficit= spinning, dizziness Cranial Nerve IX - Glossopharyngeal- oral sensation, taste, salvation Cranial Nerve X - Vagus- parasympathetic innervation to multiple organs deficit= increased blood pressure, increased heart rate, difficulty swallowing Cranial Nerve XI - Spinal Accessory- Shoulder Elevation and head turning deficit= winged scapula, difficulty shrugging shoulders Cranial Nerve XII - Hypoglossal- tongue movement deficit= tongue fasiculation, atrophy, weak tongue movement How much of the body's oxygen supply does the brain require? - 20% of body's oxygen supply How much of the cardiac output does the brain require? - 15% of cardiac output Anterior circulation - originates from carotid arteries Posterior circulation - originates from vertebral arteries Circle of Willis (COW) - merge of anterior and posterior circulation Collateral circulation Large vessel strokes - Carotid, vertebral, COW, ACA, MCA, PCA ischemic stroke: occlusion occurs due to thrombus or embolus ICH: hemorrhage occurs at junctions and vessel turns SAH: Aneurysms form at vessel junctions and turns Small vessel strokes - smaller branching vessels Ischemic stroke: occlusion occurs due to atherosclerosis or other pathology ICH: Hemorrhage occurs due to amloyid angiopathy, tumor or vascular malformation Symptoms from Carotid Artery Stroke - Aphasia if dominant side Contralateral neglect if non-dominat side motor and sensory loss face, are and leg on contralateral side visual field deficit contralateral to occluded carotid artery Anterior Circulation is made up of what arteries? - Anterior Cerebral Artery (ACA) Middle Cerebral Artery (MCA) Posterior Cerebral Artery (PCA) Anterior Cerebral Artery Supplies - 5 segments A1-A3 commonly discussed Supplies: Frontal lobe, olfactory cortex, corpus callosum, leg motor cortex Symptoms of Anterior Cerebral Artery (ACA) stroke? - Major symptoms: Apathy, abulia and disinhibition Conjugate eye deviation Contralateral motor/sensory loss leg>arm What is the Middle Cerebral Artery? - Major structures: with M1-M4 covers Large cerebral territory Effects: Speech and language Motor and sensory cortex Gaze Symptoms of MCA Stroke? - Major stroke symptoms: Aphasia (dominant hemisphere) Neglect (non-dominant hemisphere) Forced eye deviation/gaze preference Contralateral homonymous heminaopsia Contralateral motor/sensory loss face/arm>leg Posterior Cerebral Artery (PCA) - Major structures: Occiptial lobe Midbrain Thalamus Corpus Callosum Symptoms of PCA stroke? - Major stroke symptoms: contraleral loss of pain temp and senstation visual field loss Horner's syndrome Weber's syndrome Perinaud's syndrome Horner's Syndrome - Ptosis (sluggish pupil), miosis (small pupil), dilation lag and anhidrosis (impaired flushing and sweating) Weber's syndrome - Midbrain stroke from PCA or BA infarct Contralateral weakness of upper and lower extremities (corticospinal tract) Ipsilateral gaze weakness (cranial nerve 3) Also known as Lateral medullary syndrome Perinaud's Syndrome - Also know as dorsal midbrain syndrome Vertical gaze palsy- sun setting sign Pupils mid-dilated, light dissociation Convergence-retraction nystagmus Wallenberg Syndrome - Verterbral or PICA stroke Ipsilateral CN V involvement (sensory, pain, temp loss on ipsilateral face) Ipsilateral ataxia (cerbellum) Nystagmus, N/V, vertigo Posterior Circulation is made up of what arteries? - Verterbral arteries Basilar artery Anterior Inferior Cerbellar Artery (AICA) Posterior Inferior Cerbellar Artery (PICA) Posterior inferior Cerbellar artery stroke symptoms? - Major structure=major symptoms Horner syndrome Wallenberg syndrome Ipislateral limb ataxia Decrease pain and temperature sensation contralateral body Anterior Inferior Cerbellar Artery - Major structure=major symptoms Ipsilateral deafness Ipsilateral facial motor/sensory loss Ipsilateral limb ataxia Decreased pain and temperature senstation contralateral body Basilar Artery Stroke Symptoms - Decreased LOC Facial paresis Occulomotor difficulties facial paresis Ataxia Quadraparesis Causes Millard-Gubler syndrome or Ventral-pontine syndrome S/S of Anterior Circulation Left dominate hemisphere stroke symptoms - Left gauze preference Right visual field deficit Right hemipaersis Right hemisensory loss S/S of Anterior Circulation Right non dominant hemisphere stroke? - Right gauze preference Left visual field deficit Left hemiparesis Left hemisensory loss Neglect/inattention S/S Posterior Circulation Brainstem stroke? - Nystagmus Diplopia, disconjucate gaze, gaze palsy Dysarthria, dysphagia Vertigo, tinnitus Hemiparesis, quadriplegia senssory loss in hemibody or all 4 limbs Decreased LOC Hiccups, abnormal respirations S/S of a Lucunar stoke? - small vessel stroke- small penetrating arteries Vascular Dementia Loss of memory usually comes in as trauma 1st intervention: distraction Types of Ischemic strokes? - 1. Thrombotic ( larger artery disease) 2. Embolic (cardiac origin) 3. Cryptogenic (no known risk factors) 4. Lacunar (vascular dementia) Types of Hemorrhagic Strokes? - 1. Intracerebral (ICH): caused by HTN 2. Subarchnoid (SAH): caused by: cerebral aneurysm and AVM 3. Interventricular (IVH): ICH or SAH 4. Hemorrhagic transformation of ischemic stroke What is neuroplasticity? - Remodeling process of brain Makes new pathways to control speech, motor, vision and hearing How soon after a stroke does neuroplasticity begin? - 1-3 days but takes months to years What is the success of neuroplasticity and recovery post stroke depend upon? - 1. Repetition 2. Robotic therapy 3. Desire What is a carotid-cavernous fistula? - An AV fistula where high pressure arterial blood enters the low pressure venous cavernous sinus What is a Type A Carotid Cavernous Fistula? - Direct connection b/t intracavernous branches of the internal carotid artery and the cavernous sinus Caused by high flow and pressure patients present with hearing swishing noise unilateral bulging eye What kind of flow is associated with Type B, C and D Carotid Cavernous Fistulas? - Low Flow and Low Pressure A cavernous angioma is associated with what kind of lesion? - Purple low flow/low pressure vascular lesion Where are the majority of Dural Arteriovenous Fistulas located? - Posterior Fossa How much does CSF does the body produce an hour? - Approximately 20ml/hr Where is CSF produced? - Chorid plexus in the lateral, third and fourth ventricles What are some stroke mimics? - Hypoglycemia Seizure and Todd's paralysis Migraines with aura Degenerative Neurological Disorders (MS) Indigestions (tylenol, opioid, lithium) EMS Management of Stroke - Maintain 02sat >94% Administer NS HOB flat if hypotensive Glucose check IV access Treat SBP>220 NPO Cincinnati pre-hosptial stroke scale includes? - Facial Droop Arm Weakness Speech Los-Angeles pre-hospital stroke scale includes? - Facial weakness Arm strength Grip Blood Glucose Phase 1 of Stroke Care? - Emergency/Hyperacute First 3-24 hours Phase 2 of Stroke Care? - Acute Care 24-72 hours How many hours of therapy does a patient get in acute rehab? - At least 3 hours of therapy per day Therapy is provided 5-7 days per week How many hours of therapy does a patient get in sub cute rehab? - less than 3 hours per day 3-5 days per week What are the 7 D's of stroke care? - Detection Dispatch Delivery Door Data Decision Drug How long does an ED doc have to see a stroke patient? - Less than 10 min How soon does a CT need to be done for a stroke patient upon arrival to the hospital? - Less than 25 min How long does the stroke team have to get the CT read for a stroke patient? - Less than 45 min How long does the ED have to administer tPA for a stroke patient? - Less than 60 min How fast does the stroke patient need to be admitted to a stroke unit from the ED? - Less than 3 hours What are the 3 most important Pneumba saving interventions? - Maintain oxygen greater than 94% BP less than 185 Glucose b/t 140-180