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Stroke Quiz - Naturopathic Medicine is Better Medicine

[fa icon="calendar'] Jan 17, 2015 9:00:00 AM / by Dr. Isadora Guggenheim

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Test your stroke knowledge with our free quiz. Learn about how you can reduce your risk of stroke for you, family and friends.  

Stroke is the leading cause of death and disability in adults. We take stroke prevention seriously at Second Nature. We test your MTHFR status and make the necessary corrections to lower your risk of stroke with high quality nutraceuticals. We lower your cholesterol, blood pressure and help you lose weight.  We will review all of your health habits and create strategies to make better choices. Start your stroke prevention program today.  Go to www.personalogix.com.  Sign in from any device with my special passcode: SECOND NATURE and my last name: GUGGENHEIM.  You'll get a detailed individualized health report and a phone call from me.  

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Acute ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, typically in a vascular territory, resulting in a corresponding loss of neurologic function. Nearly 800,000 people suffer strokes each year in the United States; 82%-92% of these strokes are ischemic. Stroke is the fourth leading cause of adult death and disability, resulting in over $72 billion in annual cost. Do you know the complications, proper workup, and best treatment practices? Test yourself with our quick quiz.

Which of the following subtypes of acute ischemic stroke is most commonly associated with hemorrhagic transformation of ischemic stroke?
Large-artery
Small-vessel
Cardioembolic infarction
It is equally common in all three subtypes
Hemorrhagic transformation represents the conversion of an ischemic infarction into an area of hemorrhage. This is estimated to occur in 5% of uncomplicated ischemic strokes, in the absence of fibrinolytic treatment. Hemorrhagic transformation of an ischemic infarct occurs within 2-14 days post-ictus, usually within the first week. It is more commonly seen following cardioembolic strokes and is more likely to occur with larger infarct volumes.

Which of the following is the most important modifiable risk factor for ischemic stroke?

Patent foramen ovale
Oral contraceptive use
Sickle cell disease
Hypertension

The most important modifiable risk factor for ischemic stroke is hypertension. Other risk factors that can be corrected and modified include:

• Diabetes mellitus;

• Cardiac disease: atrial fibrillation, valvular disease, heart failure, mitral stenosis, structural anomalies allowing right-to-left shunting (eg, patent foramen ovale), and atrial and ventricular enlargement;

• Hypercholesterolemia;

• TIAs;

• Carotid stenosis;

• Hyperhomocystinemia;

• Lifestyle issues: excessive alcohol intake, tobacco use, illicit drug use, physical inactivity;

• Obesity; and

• Oral contraceptive use/postmenopausal hormone use.

Which of the following is NOT a common sign or symptom of ischemic stroke?
Hemisensory deficits
Quadriparesis
Hemiparesis
Visual field loss

Quadriparesis is not a common sign or symptom of ischemic stroke. 

Consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Common signs and symptoms of stroke include the abrupt onset of any of the following:

• Hemiparesis, monoparesis, or (rarely) quadriparesis

• Hemisensory deficits

• Monocular or binocular visual loss

• Visual field deficits

• Dysarthria

• Facial droop

• Ataxia

• Vertigo (rarely in isolation)

• Aphasia

Although such symptoms can occur alone, they are more likely to occur in combination.

Which of the following is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent stroke?

Noncontrast CT scanning
Transcranial Doppler ultrasonography
Echocardiography
Single-photon emission CT (SPECT) scanning

Emergent brain imaging is essential for confirming the diagnosis of ischemic stroke. Noncontrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. The noncontrast CT scan is fast, readily available, and can identify intracranial hemorrhages allowing for proper selection of patients for reperfusion therapies.

Transcranial Doppler ultrasonography is useful for evaluating more proximal vascular anatomy—including the middle cerebral artery, intracranial carotid artery, and vertebrobasilar artery—through the infratemporal fossa. Echocardiography is obtained in all patients with acute ischemic stroke in whom cardiogenic embolism is suspected. The use of SPECT scanning in stroke is still experimental and is available only at select institutions.

Which of the following fibrinolytic agents can be used in patients with acute ischemic stroke?
Alteplase (recombinant tissue plasminogen activator [rt-PA])
Streptokinase
Urokinase
Tenecteplase

The only fibrinolytic agent that has been shown to benefit selected patients with acute ischemic stroke is alteplase. While streptokinase may benefit patients with acute myocardial infarction, in patients with acute ischemic stroke it has been shown to increase the risk for intracranial hemorrhage and death. Tenecteplase is used in myocardial infraction, but definitive phase 3 trials in stroke have not been performed.

Fibrinolytics (ie, rt-PA) restore cerebral blood flow in some patients with acute ischemic stroke and may lead to improvement or resolution of neurologic deficits. Proper patient selection and protocol adherence is essential because fibrinolytics may also cause symptomatic intracranial hemorrhage. Other complications include potentially hemodynamically significant hemorrhage and angioedema or allergic reactions.

This quiz was written by Edward C. Jauch. Quiz: Do You Know the Complications, Proper Workup, and Best Treatment Practices for Ischemic Stroke? Medscape. Dec 29, 2014.

Topics: Heart Health, Healthy Living

Dr. Isadora Guggenheim

Written by Dr. Isadora Guggenheim

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About Me in Connecticut    
Dr. Isadora Guggenheim is a board-certified and licensed Naturopathic physician and RN in CT. Since 2003, Dr. Guggenheim has seen over 8000 patients and successfully treated Parkinson's, acute and chronic Lyme/co-infections, MS, inflammatory arthritis, psoriatic arthritis, Hashimoto's and other thyroid conditions, erectile dysfunction, prostatitis, cardiovascular disease, allergies, ADD/ADHD, fertility issues, asthma, sarcoidosis, COPD, musculoskeletal issues that require non-surgical interventions, mood disorders, women's issues and hormone balancing for men and women.
 
"Treating and reversing autoimmune conditions is personal to me because I was diagnosed with severe psoriatic arthritis in 2006, figured out the root cause of my disease and have been in remission ever since. I have felt the pain and fear of a chronic debilitating illness. I am on a mission to prevent and reverse the ravages of autoimmune conditions. Disease means change and I assist the patient to make strategic changes to achieve a functional and sustainable remission status. We can't change your genes, but we can turn off your "dirty genes" that express disease. "
 
Dr. Guggenheim has advanced training in environmental medicine, oncology, I.V. therapies, functional nutrition and Ozone therapies. Naturopathy is defined as the diagnosis, prevention and treatment of disease and health optimization by stimulation and support of the body's natural healing processes as approved by the State Board of Naturopathic Examiners and with the consent of the Commissioner of Public Health. 
 
About Me in New York State 
Isadora Guggenheim is a licensed nurse practitioner, registered nurse, certified nutrition specialist and licensed massage therapist. She offers holistic primary care consults and physical exams, nursing services, patient education, nutritional counseling, I.V. therapies and massage therapy. Isadora Guggenheim is the head nurse practitioner for all I.V. therapies. 
 
The practice of the profession of nursing is defined and diagnosing and treating human responses to actual or potential health problems through services as case finding, health teaching, health counseling and provision of care supportive to or restorative of life and well-being, executing medical regimens prescribed by a licensed physician, dentist or other licensed health care provider legally authorized under this title and in accordance with the commissioner's regulations. As a nurse practitioner, Dr. Guggenheim is recognized as a primary care provider who can diagnosis and treat patients autonomously. She has full prescribing rights. 
 
The practice of the profession of massage therapy is defined as engaging in applying a scientific system of activity to the muscular structure of the human body by means of stroking, kneading, tapping and vibrating with the hands or vibrators for the purpose of improving muscle tone and circulation. 
 
Isadora Guggenheim ND, FNP, RN, MS, CNS, LMT 
Naturopathic Doctor (CT and VT only), Family Nurse Practitioner (NY), RN (NY, CT, PA, NJ), Masters in Nutrition, Certified Nutrition Specialist (recognized in all states), Massage Therapist 

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Isadora Guggenheim, ND, FNP, RN, MS, CNS, LMT, owner of Second Nature Naturopathic Care, LLC
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