Stroke Recognition and Response Flashcards

What does the acronym 'FAST' stand for in stroke recognition?

Answer: Face droop, Arm weakness, Speech difficulty, Time to call 911

FAST stands for Face drooping, Arm weakness, Speech difficulty, and Time to call 911 — the primary stroke warning sign assessment.

What is the maximum time window for administration of tPA (tissue plasminogen activator) for eligible ischemic stroke patients?

Answer: 3-4.5 hours from last known well time

tPA can be administered within 3-4.5 hours of last known well time in eligible ischemic stroke patients to dissolve the clot.

A patient suddenly develops severe 'thunderclap' headache described as 'the worst headache of my life.' What type of stroke should be suspected?

Answer: Subarachnoid hemorrhage (bleeding around the brain)

A sudden, severe 'thunderclap' headache is the classic presentation of subarachnoid hemorrhage (SAH), a life-threatening emergency.

Which of the following is NOT a typical warning sign of stroke?

Answer: Gradual onset of bilateral leg weakness over several days

Stroke symptoms are typically sudden in onset. Gradual bilateral symptoms over days are more characteristic of other conditions (e.g., spinal cord disease, Guillain-Barré).

What is the difference between an ischemic stroke and a hemorrhagic stroke?

Answer: Ischemic stroke is caused by a clot blocking blood flow; hemorrhagic stroke is caused by a ruptured blood vessel bleeding into or around the brain

Ischemic stroke (87% of strokes) is caused by arterial occlusion; hemorrhagic stroke is caused by vessel rupture causing bleeding into brain tissue or subarachnoid space.

What is a transient ischemic attack (TIA), and why is it clinically important?

Answer: A brief episode of neurological dysfunction caused by temporary brain ischemia that resolves completely, serving as a warning sign of impending stroke

A TIA causes transient stroke-like symptoms that fully resolve, but carries a high short-term risk of complete stroke (up to 10% within 48 hours).

What is the recommended first response action when stroke is suspected in a community setting?

Answer: Call 911 immediately and note the time symptoms started

Call 911 immediately and note the exact time symptoms started—this information is critical for determining tPA eligibility at the hospital.

Which scale is commonly used by EMS providers to screen for stroke in the field?

Answer: Cincinnati Prehospital Stroke Scale (CPSS)

The Cincinnati Prehospital Stroke Scale (CPSS) is a 3-item tool (facial droop, arm drift, speech) validated for prehospital stroke screening.

What does 'penumbra' refer to in the context of ischemic stroke management?

Answer: The zone of ischemic but potentially salvageable brain tissue surrounding the core infarct

The ischemic penumbra is the at-risk but potentially recoverable brain tissue surrounding the dead core infarct—the target for acute stroke treatments.

What type of stroke involves a blood vessel rupturing within the brain tissue itself (not in the subarachnoid space)?

Answer: Intracerebral hemorrhage (ICH)

Intracerebral hemorrhage (ICH) involves bleeding directly into brain parenchyma, most commonly due to hypertension.

What is the 'door-to-needle' time target for tPA administration in eligible ischemic stroke patients?

Answer: Within 60 minutes of hospital arrival

The AHA/ASA recommends tPA administration within 60 minutes of hospital arrival (door-to-needle time ≤60 minutes).

What are the warning signs of stroke in the posterior circulation (vertebrobasilar territory)?

Answer: Dizziness, sudden loss of balance, double vision, severe headache, difficulty swallowing

Posterior circulation strokes affect the brainstem and cerebellum, causing dizziness, balance problems, diplopia, dysphagia, and occipital headache.

Why should aspirin NOT be given to a stroke patient before hospital evaluation?

Answer: Aspirin could worsen hemorrhagic stroke by interfering with clotting

Aspirin is contraindicated in hemorrhagic stroke because it impairs platelet function and worsens intracranial bleeding; CT scan is needed first to exclude hemorrhage.

What is 'mechanical thrombectomy' in the context of stroke treatment?

Answer: Endovascular removal of a blood clot from a large cerebral artery using specialized catheter-based devices

Mechanical thrombectomy uses catheters and stent retrievers inserted through the femoral artery to physically remove clots from large intracranial vessels.

What neurological assessment scale do healthcare providers use to quantify stroke severity and deficits?

Answer: National Institutes of Health Stroke Scale (NIHSS)

The NIHSS is an 11-item structured neurological examination that quantifies stroke deficits from 0 (normal) to 42 (most severe), guiding treatment decisions.

Which of the following is a contraindication to tPA therapy in ischemic stroke?

Answer: Blood pressure above 185/110 mmHg (uncontrolled at time of treatment)

Blood pressure must be reduced to ≤185/110 mmHg before tPA administration to reduce hemorrhagic transformation risk.

What does the 'BE-FAST' acronym add to the original 'FAST' stroke recognition tool?

Answer: Balance problems and sudden Eye/vision changes

BE-FAST adds B for sudden Balance loss and E for sudden Eye/vision problems to the original FAST, helping recognize posterior circulation strokes.

What initial first aid action should a lay rescuer take for a person experiencing a suspected stroke?

Answer: Keep the person calm, note the time symptoms started, call 911, do not give food or drink

Keep the person calm, note symptom onset time precisely, call 911, and don't give food or drink due to potential swallowing problems.

How does stroke differ from cardiac arrest, and how does this affect the initial emergency response?

Answer: In stroke, the heart is still beating and CPR is not indicated; the priority is rapid transport to a stroke center for time-sensitive interventions

Stroke patients typically have a pulse and are often conscious; the priority is rapid transport to a certified stroke center, not CPR.

Which of the following statements about stroke and age is accurate?

Answer: While stroke risk increases with age, strokes can occur at any age including in young adults, children, and newborns

Stroke can affect people of all ages; while risk increases with age, young adults and children can have strokes from various causes.