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Neurology > 1(E) - Cerebrovascular Accident > Flashcards

1(E) - Cerebrovascular Accident Flashcards

1
Q

Define stroke

A

Interruption in vascular supply to the brain

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2
Q

What are the two main types of stroke

A

Ischaemic

Haemorrhagic

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3
Q

What is ischaemic stroke

A

Occlusion of blood vessel

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4
Q

What % of strokes are ischaemia

A

85%

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5
Q

What are two types of ischaemic stroke

A
  • Thrombotic

- Embolic

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6
Q

What is a thrombus

A

Narrowing of vessel due to atherosclerosis

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7
Q

What is an embolic stroke

A

Blood Clot, Air , Fat or bacteria that travel and occlude an artery

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8
Q

What is haemorrhage stroke

A

Rupture blood-vessel causing reduction in blood flow

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9
Q

What % of strokes are haemorrhage

A

15%

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10
Q

What are the two types of haemorrhagic stroke

A
  • Intracerebral (10%)

- SAH (5%)

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11
Q

What is the new definition of TIA

A
  • transient episode neurological dysfunction caused by ischaemia to cerebral cortex, spinal cord or retina
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12
Q

What was the old definition of TIA

A
  • Transient neurological dysfunction lasting less than 24-hours
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13
Q

What is difference between TIA and Ischaemic Stroke

A 
TIA = ischaemia
Stroke = infarction
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14
Q

What are modifiable risk-factors for TIA

A
  • Smoke
  • Obesity
  • Alcohol
  • High-Lipids
  • CVD
  • DM
  • COCP
  • HRT
  • HTN
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15
Q

What are 5 non-modifiable risk factors for TIA

A
  • Male
  • Over 65-years
  • African American
  • FH
  • migraine with aura
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16
Q

What is amaurosis fugax

A

Occlusion retinal or ophthalmic artery

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17
Q

If an individual had a TIA in past 7-days, how quickly should they be referred to specialist

A

24 hours

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18
Q

If an individual had a TIA more than one week ago, how soon should they be seen by a stroke specialist

A

7 days

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19
Q

What is given to manage TIA in short-term

A

Aspirin (300mg)

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20
Q

What imaging is ordered same-day in TIA and why

A

MRI

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21
Q

What is given as secondary prevention in TIA

A

Clopidogrel

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22
Q

What imaging do all patients with TIA received

A

Carotid Artery US

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23
Q

If carotid stenosis is present, what imaging is used

A

CTA

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24
Q

What are indications for carotid endarterectomy

A

More than 70%

Symptomatic and 50-99% Occluded

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25
Q

What are individuals with TIA at highest risk of and when is this most common

A

Ischaemic stroke - more common in first few days following TIA

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26
Q

What scoring system was used to predict individuals with TIA risk of developing ischaemic stroke

A

ABCD2

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27
Q

What is an ischaemic stroke

A

Occlusion cerebral blood vessel causing tissue infarction

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28
Q

Wha % of strokes are ischaemic

A

85

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29
Q

What is the main cause of ischaemic strokes

A

Thrombus

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30
Q

What are other causes for ischaemic stroke

A

Embolus
Global cerebral hypo perfusion
Hyper coagulable state

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31
Q

What causes thrombotic stroke

A

Atherosclerosis of cerebral blood vessels

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32
Q

Where are thromboses most likely to form

A

Branching-points

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33
Q

Which artery to embolic strokes most commonly affected

A

MCA

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34
Q

What causes embolic strokes

A

Clots from atrium

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35
Q

What causes a paradoxical embolus

A

Patent foramen ovale - enables thrombus from DVT to pass to cause stroke

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36
Q

What causes global cerebral hypo perfusion

A
  • Bilateral carotid artery stenosis

- Global hypoperfusion

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37
Q

What other causes of stroke

A
  • Polycythaemia
  • Thrombophilia
  • COCP
  • HRT
  • Sickle Cell
  • Vasculitis
  • Arterial Dissection
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38
Q

What are 3 risk factors for embolic ischaemic stroke

A

AF
Endocarditis
Patent FO

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39
Q

What are modifiable risk factors for ischaemic thrombotic stroke

A

Cardiovascular RF: Smoking, HTN, Alcohol. DM, PVD, CAD,. COCP

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40
Q

What are non modifiable risk factors for thrombotic ischaemic stroke

A

Male
Age
FH

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41
Q

How does occlusion ACA present clinically

A

Hemiplegia (usually) of the leg and hemiparesis (weakness) of the arm

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42
Q

How will MCA occlusion present

A
  • Hemiparesis of face (forehead sparing) and arm
  • Contralateral homonymous hemianopia
  • Expressive and receptive aphasia (Brocca’s and Wernicke’s)
  • If non-dominant = semi-spatial neglect
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43
Q

Where does the ophthalmic artery originate

A

Internal carotid artery

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44
Q

What causes amaurosis fugax

A

Clot in opthalmic which passes to occlude central retinal artery

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45
Q

If a patient with a stroke has hemianopia, what vessels must be affected

A

PCA or MCA

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46
Q

How do PCA strokes present

A

Homonymous hemianopia with macula sparing. May not present acutely but can present to opticians with history bumping into things

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47
Q

Why does MCA cause homonymous hemianopia

A

Due to ischaemia Meyer’s loop and Baum’s loop

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48
Q

Where is broccas areas

A

Pars opercularis, Pars triangularis

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49
Q

Where is Wernicke’s area

A

Superior temporal gyrus

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50
Q

What do the vertebrobasilar arteries supply

A

Occipital Lobe
Cerebellum
Brain Stem

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51
Q

What is weber syndrome also known as

A

Medial Midbrain Syndrome

52
Q

What causes weber syndrome

A

Occlusion branches PCA than innervate midbrain

53
Q

How does weber syndrome present clinically

A
  • Ipsilateral CN3 palsy = Lateral Gaze Palsy

- Contralateral hemiparesis

54
Q

What causes marie-fox syndrome

A

Occlusion anterior-inferior cerebellar artery (AICA)

55
Q

What is Marie-fox syndrome also known as

A

Lateral pontine syndrome

56
Q

What causes Marie-Fox Syndrome

A
  • Ipsilateral: Gait ataxia, Weakness, Vertigo, Facial Paralysis, Hearing Loss, Horner’s Syndrome
  • Contralateral: loss pain, temperature. And weakness
57
Q

What is Wallenberg syndrome also known as

A

Lateral Medullary Syndrome

58
Q

What causes a lateral medullary syndrome

A

Occlusion PICA

59
Q

How does Wallenberg syndrome present clinically

A

Ataxia and Nystagmus

Ipsilateral: facial numbness, dysphagia, Horner
Contralateral: sensory loss in limbs

60
Q

What causes locked in syndrome

A

Bilateral basilar artery occlusion

61
Q

How does locked in syndrome present

A
  • Paralysis all voluntary muscles

- Eye movements and blinking

62
Q

What classification is used to determine presentation strokes

A

Oxford Stroke Classification

63
Q

What % of strokes are TACI

A

15%

64
Q

What does TACI strokes involve

A

ICA: ACA and MCA

65
Q

What is the presentation of TACI

A

All 3 Of:
Homonymous hemianopia
Hemiparesis face, arm and leg
Higher cortical dysfunction

66
Q

What % of strokes are PACI

A

25

67
Q

What is a PACI

A

Occlusion of MCA or ACA

68
Q

Describe clinical presentation of PACI

A

2 Of:
Homonymous hemianopia
Hemiparesis face, arm and leg
Higher cortical dysfunction

69
Q

What % of strokes are lacunar infarcts

A

15

70
Q

What causes lacunar infarcts

A

occlusion arteries supplying basal ganglia, thalamus, internal capsule

71
Q

What is the Oxford stroke criteria for lacunar infarcts

A

One of:

  1. Pure Sensory Stroke
  2. Ataxic hemiparesis
  3. Unilateral weakness face, arm and leg
72
Q

What % of strokes are posterior-circulation infarcts

A

25%

73
Q

What causes a POCI

A

Occlusion vertebrobasilcar artery

74
Q

How does a POCI present clinically

A

One of:

  1. Cerebellar/Brain-stem syndrome
  2. LOC
  3. Isolated homonymous hemianopia
75
Q

What is an isolated homonymous hemianopia

A

No other symptoms

76
Q

What is Weber Syndrome

A

Medial Midbrain Syndrome -

Perforators of PCA

77
Q

What is Marie Foix syndrome

A

Lateral Pontine Syndrome -

AICA

78
Q

What is Wallenberg syndrome

A

Lateral Medullary Syndrome -

PICA

79
Q

Explain distinguishing between ischaemic and haemorrhagic strokes from clinical presentation

A

Cannot distinguish solely on clinical presentation, require CT. However, haemorrhagic more often have nausea, vomitting, headaches and seizures.

80
Q

What causes lacunar strokes

A

Small vessel disease

81
Q

What causes small vessel disease

A

Hyaline arteriosclerosis, which is caused by hypertension

82
Q

Outside of hospital what screening tool is used to identify stroke

A

FAST

83
Q

What is the FAST tool

A

Face = is it drooped on one side

84
Q

In hospital, what scoring system is used to identify stroke

A

ROSIER (Recognition of stroke in emergency room)

85
Q

What ROSIER score requires assessment by stroke specialist

A

> 2

86
Q

What is first-line investigation in suspected stroke cases

A

CT Head in one hour

87
Q

If ischaemic stroke, what other imaging should be ordered

A

CTA

88
Q

What is gold-standard for ischaemic strokes and why is it not used

A

MRI - due to time consuming and not safe to put unstable patient in scanner

89
Q

What is first line for ischaemic strokes

A

Aspirin (300mg)

90
Q

What time frame should aspirin (300mg) be given

A

Within 24h of haemorrhagic stroke exclusion

91
Q

How long is aspirin continued for

A

2W

92
Q

What should be given with aspirin (300mg)

A

PPI

93
Q

What is second-line for stroke

A

Thrombolysis

94
Q

What are prerequisites for thrombolysis

A

Within 4.5 hours symptom onset

95
Q

What are 5 absolute CIs to thrombolysis

A
  • Previous IC haemorrhage
  • IC neoplasm
  • SAH
  • Stroke or TBI in part 3-months
  • LP in past 7 days
  • GI haemorrhage in past 3W
  • Active bleeding
  • Pregnancy
  • Varices
  • Uncontrolled HTN (200/120mmHg)
96
Q

When may thrombolysis be considered up to 24h afterwards

A

Posterior circulation stroke and imaging shows salvageable brain-tissue

97
Q

What is important regarding anti-platelets after thrombolysis

A

Do not give anti platelets for 24-hours

98
Q

In addition to thrombolysis, what are individuals offered to manage stroke

A

Thrombectomy

99
Q

What are the criteria for thrombectomy

A

6h stroke
<3 on modified rankin scale
>5 on NIHSS

100
Q

What time-frame can an individual receive thrombectomy

A

Up to 6h afterwards

101
Q

What are other important points concerning management of stroke patients

A

NBM - until screened by SALT. May require NG tube

Interpneumatic compression stockings for VTE prophylaxis

102
Q

Explain measures for secondary prevention of stroke

A
  • Anti-HTN (Aim 130/80)
  • Statin
  • Control Diabetes
  • Carotid endartectomy if stenosis
  • Lifestyle: diet, exercise, smoking cessation.
103
Q

What are two neurorehabillitaiton scales used

A

Rankin

Barthel

104
Q

What is a respiratory condition that may result from stroke

A

Aspiration pneumonia

105
Q

What is greatest risk 1-2d after ischaemic stroke

A

Haemorrhagic transformation

106
Q

What can happen after MCA strokes

A

Malignant MCA Syndrome

107
Q

Explain malignant MCA syndrome

A

Neurological deteriorations - due to to cerebral oedema following MCA stroke. Managing in hemicraniectomy

108
Q

What is intracerebral haemorrhage

A

Bleeding within brain parenchyma

109
Q

What is haemorrhagic stroke

A

Infarction secondary to haemorrhage

110
Q

What is the most common cause of intracerebral haemorrhage

A

HTN

111
Q

If over 60 what is the second-most common cause of intracerebral haemorrhage

A

Cerebral amyloid antipathy

112
Q

As a child, what is the most common cause of intracerebral haemorrhage

A

AV Malformation

113
Q

Give 3 other causes of intracerebral haemorrhage

A
  • Infection
  • Cocaine, amphetamine
  • Anticoagulant
  • Vasculitis
114
Q

How does intracerebral haemorrhage present clinically

A

Symptoms are identical to to ischaemic stroke. Except slowly progressive and worsen over minutes-hours

115
Q

Explain pathophysiology of HTN cause haemorrhagic stroke

A

Chronic HTN causes atherosclerosis of lenticulostriae arteries resulting in lipohyalinosis. This causes charcot-bouchard aneurysms to form which then rupture causing haemorrhage

116
Q

Explain pathophysiology of cerebral amyloid antipathy

A

Amyloid is deposited in leptomeningeal arteries - causing inflammation, micro aneurysms and haemorrhage

117
Q

What is first line investigation for haemorrhagic stroke

A

CT in 1h

118
Q

How does haemorrhage present on CT

A

Bright

119
Q

What is first-line management for all intracranial haemorrhage

A

Control BP if within 6-hours and Systolic is 150-220. Control with GTN patch and then IB labetaolol

120
Q

What BP target is aimed for first 7d following haemorrhagic stroke

A

130-140 systolic BP

121
Q

If individual on anticoagulation have a haemorrhage what is offered

A

Reversal

122
Q

how is warfarin reversed

A

Prothrombin complex and vitamin-K

123
Q

what factors does pro-thrombin complex replace

A

2 ,7, 9 10

124
Q

how can dabigatran be reversed

A

Idarucizumab

125
Q

when are individuals referred to neurosurgery for hemicraniectomy and clot evacuation

A 
brain herniation (cushing's reflex) 
posterior fossa bleed 
obstructive hydrocephalus 
cerebral haemorrhage with neurological deterioration
haemorrhage >3cm

Neurology (26 decks)

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