Random Stroke Facts

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Hypercoagulability confirmation tests:

Test for Lupus cardiolipin, ANA, homocysteine, protein C, protein S, factor V Leiden, anti-thrombin III, and antiphospholipid antibodies.

Vertebrobasilar insufficiency:

Patients with vertebrobasilar insufficiency (due to a stroke) may present with dizziness. So if you have a patient dizziness, you have to rule out vertebrobasilar insufficiency which can be fatal. Vertebrobasilar insufficiency may involve the cerebellum and the brain stem. The test of choice is an MRI.

Frontal lobe lesion:

Presents with cognitive impairment, Broca's aphasia, ataxia, bladder and bowel involvement.

Normal vs obstructive pressure hydrocephalus:

Presentation is very similar to that of frontal lobe lesion.

Parietal love lesion:

Patient presents with parietal hemineglect.

Stroke case management:

A 56 year old male is brought into the ER by his wife. The wife states that the patient developed slurred speech and was drooping on one side on the dinner table. You send in a nurse to take the vitals and she reports his blood pressure to be 210/110. You examine the patient and you find him to have hemiplegia with slurred speech.

Stroke theory:

There are three types of strokes: ischemic, thrombotic, or bleed stroke.

Stroke Management:

1. The first step you do is order a CT without contrast. You need to be able to tell whether it is an infarction or a bleed because the treatment between the two differs drastically. If the first CT scan which is done with the first 24 hours comes out normal, it is not a bleed. It could very well be an infarction or a thrombotic event. If it is an infarction, the only way it went up to the brain is through the carotid arteries.

2. Order a CBC in order to look at his platelet count and/or check if he has any infection.

3. Order a PT/INR.

4. Electrolytes.

5. EKG.

6. Echo of the heart in order to look for LV or AV thrombus.

The patient is moved to ICU. We give oxygen, anti-thrombolytics, Ca-channel blockers, aspirin or plavix or aggrenox,

NOTE: We do not decrease the blood pressure in the first 24 hours of an ischemic stroke patient; however, if the blood pressure was 130/80, you would need to bring the blood pressure up. The MAP has to be over 135. Exceptions include patients bleeding in their brains.

How do you confirm a subarachnoid hemorrhage?

Lumbar puncture.

How do you decide what IV fluids to give?

The choice of IV fluids depends on the vitals. Never give dextrose to a hyperglycemic patient. Give 0.9% NS in a hypotensive patient and 0.45% NS in a hypertensive patient.

How do you bring cerebral edema down in a patient?

Hyperventilate the patient, give mannitol, or give steroids (NOTE: never give steroids in a stroke patient).

What anti-hypertensive medication causes tachycardia?

Procardia.

Additional Reading:

Random USMLE Facts

1. Random USMLE Facts volume 1-1
2. Random USMLE Facts volume 2-1
3. Random USMLE Facts volume 3-1
4. Random USMLE Facts volume 4-1
5. Random USMLE Facts volume 5-1
6. Random USMLE Facts volume 6-1
7. Random USMLE Facts volume 7-1
8. Random USMLE Facts volume 8-1
9. Random USMLE Facts volume 9-1
10. Random USMLE Facts volume 10-1
11. Random USMLE Facts volume 11-1
12. Random USMLE Facts volume 12-1

General and Systemic Examinations

1. General Examination for Internal Medicine
2. Jugular Venous Distention Workup
3. ER Chest Pain Workup
4. Format for Patient Presentation
5. Pulmonary Examination for Internal Medicine
6. Cardiac Examination for Internal Medicine
7. Abdominal Examination for Internal Medicine
8. Cranial Nerve Reflexes
9. Motor System Examination
10. Random Sensory System Facts
11. Random Stroke Facts

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3. Irritable Bowel Syndrome [Size: 170 kB; Format: MS Powerpoint]
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5. Thrombocytopenia [Size: 2.42 MB; Format: MS Powerpoint]
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USMLE Step 2 CS Videos

1. Video of Cardiology Examination in a Clinical Setting
2. Video of Neurology Examination in a Clinical Setting
3. Video of Pulmonology Examination in a Clinical Setting
4. Video of Musculoskeletal Examination in a Clinical Setting
5. Video of Abdominal Examination in a Clinical Setting
6. Video of HEENT Examination in a Clinical Setting
7. Video and Description of Rinne Hearing Test
8. Video and Description of Weber Hearing Test

USMLE Laboratory (lab) Values

1. USMLE Blood Lab Values
2. USMLE Cerebrospinal Lab Values
3. USMLE Hematologic Lab Values
4. USMLE Sweat and Urine Lab Values

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Useful Medical Images & Diagrams (link opens in a new window)

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