SCRN flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Ischemic penumbra

Brain tissue with reduced blood flow that is electrically silent but metabolically viable; it can be salvaged if reperfusion is restored quickly enough.

MCA occlusion syndrome

Contralateral face and arm weakness worse than leg weakness, gaze deviation toward the lesion, and aphasia if the dominant hemisphere is involved; neglect if nondominant.

ACA infarction signs

Contralateral leg weakness greater than arm weakness, abulia, urinary incontinence, and grasp reflex, caused by occlusion of the anterior cerebral artery.

Lacunar infarct

Small deep infarct from occlusion of a penetrating artery, producing pure motor, pure sensory, sensorimotor, or ataxic hemiparesis without cortical signs.

Cerebral autoregulation range

Cerebral blood flow stays near 50 mL/100 g/min while mean arterial pressure ranges from about 60 to 150 mm Hg; the curve is right-shifted in chronic hypertension.

Basilar artery occlusion

Produces quadriparesis, cranial nerve palsies, gaze abnormalities, and fluctuating consciousness; it may progress to locked-in syndrome or coma with high mortality.

NIHSS score range

A 15-item scale scored 0 to 42; higher scores mean more severe deficits, and scores of 21 or more generally indicate severe stroke.

Noncontrast CT first step

Rapidly excludes intracranial hemorrhage before thrombolysis; early ischemic changes such as hyperdense MCA sign and loss of the insular ribbon may be subtle.

ASPECTS score

A 10-point CT scoring system for MCA territory ischemia; each affected region loses one point, and scores of 6 or more generally favor thrombectomy.

DWI-FLAIR mismatch

An acute ischemic lesion visible on diffusion-weighted imaging without FLAIR signal suggests onset within about 4.5 hours, which is useful in wake-up stroke.

Stroke mimics

Conditions resembling stroke, including hypoglycemia, seizure with postictal deficit, migraine aura, conversion disorder, sepsis, and brain tumor; glucose testing is essential.

Alteplase dosing

0.9 mg/kg intravenously to a maximum of 90 mg; give 10 percent as a one-minute bolus and infuse the remainder over 60 minutes within 4.5 hours.

Blood pressure before thrombolysis

Blood pressure must be below 185/110 mm Hg before intravenous alteplase and kept below 180/105 mm Hg for the first 24 hours after treatment.

Thrombectomy criteria

Large vessel occlusion of the internal carotid or MCA M1 with NIHSS 6 or more, ASPECTS 6 or more, and treatment up to 24 hours with favorable perfusion imaging.

Door-to-needle time

The interval from hospital arrival to the intravenous thrombolytic bolus; the target is 60 minutes or less, since faster treatment preserves more brain tissue.

ICH blood pressure target

For intracerebral hemorrhage presenting with systolic pressure of 150 to 220 mm Hg, lower systolic smoothly to about 140 mm Hg promptly.

Post-thrombolysis antithrombotic timing

Delay antiplatelet and anticoagulant drugs for 24 hours after thrombolysis and obtain follow-up imaging to exclude hemorrhagic transformation first.

Dysphagia screening

Screen swallowing before any oral intake, medication, or food; dysphagia affects roughly half of stroke patients and raises aspiration pneumonia risk.

Modified Rankin Scale

A 0 to 6 disability scale; scores of 0 to 2 indicate functional independence and are the usual favorable outcome measure in stroke trials.

Constraint-induced movement therapy

Restrains the unaffected upper limb while intensively training the affected arm in patients who retain some voluntary wrist and finger movement.

Spasticity assessment

Graded with the modified Ashworth scale; managed with positioning, stretching, therapy, and focal botulinum toxin injections when spasticity is disabling.

Interdisciplinary rehabilitation team

Includes physiatry, physical therapy, occupational therapy, speech-language pathology, nursing, social work, and neuropsychology, working toward shared functional goals.

Dual antiplatelet therapy after TIA

Aspirin plus clopidogrel started within 24 hours for minor ischemic stroke or high-risk TIA, continued for 21 to 90 days, then reduced to single antiplatelet therapy.

Anticoagulation for atrial fibrillation

Direct oral anticoagulants are preferred over warfarin for nonvalvular atrial fibrillation; warfarin remains standard for mechanical valves and moderate-to-severe mitral stenosis.

Carotid endarterectomy timing

For symptomatic 70 to 99 percent carotid stenosis, surgery is most beneficial within two weeks of the index event and should be done by a low-complication surgeon.

High-intensity statin after stroke

Atorvastatin 80 mg or rosuvastatin 20 to 40 mg regardless of baseline LDL, aiming for an LDL cholesterol level below 70 mg/dL.

PFO closure indication

Considered for cryptogenic ischemic stroke in patients younger than 60 with a patent foramen ovale and high-risk anatomic features, after other causes are excluded.

Emergency consent exception

When a patient lacks capacity and no surrogate is available, thrombolysis may proceed under presumed consent because delay would cause harm.

Post-stroke depression screening

Depression affects about one third of survivors; screen with the PHQ-9 or a similar tool during acute and follow-up visits and treat with therapy or antidepressants.

Caregiver burden

Family caregivers face depression, financial strain, and physical strain; respite services, training, and support groups reduce burden and improve patient outcomes.

Inpatient rehabilitation facility criteria

Requires tolerance of three hours of therapy daily, need for at least two therapy disciplines, and a realistic expectation of functional improvement.

Goals-of-care discussion

Documents patient values and preferences with family and the team, guiding escalation of treatment, resuscitation status, and withdrawal decisions in severe stroke.