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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
What are individuals with TIA at highest risk of and when is this most common
Ischaemic stroke - more common in first few days following TIA
26
What scoring system was used to predict individuals with TIA risk of developing ischaemic stroke
ABCD2
27
What is an ischaemic stroke
Occlusion cerebral blood vessel causing tissue infarction
28
Wha % of strokes are ischaemic
85
29
What is the main cause of ischaemic strokes
Thrombus
30
What are other causes for ischaemic stroke
Embolus Global cerebral hypo perfusion Hyper coagulable state
31
What causes thrombotic stroke
Atherosclerosis of cerebral blood vessels
32
Where are thromboses most likely to form
Branching-points
33
Which artery to embolic strokes most commonly affected
MCA
34
What causes embolic strokes
Clots from atrium
35
What causes a paradoxical embolus
Patent foramen ovale - enables thrombus from DVT to pass to cause stroke
36
What causes global cerebral hypo perfusion
- Bilateral carotid artery stenosis | - Global hypoperfusion
37
What other causes of stroke
- Polycythaemia - Thrombophilia - COCP - HRT - Sickle Cell - Vasculitis - Arterial Dissection
38
What are 3 risk factors for embolic ischaemic stroke
AF Endocarditis Patent FO
39
What are modifiable risk factors for ischaemic thrombotic stroke
Cardiovascular RF: Smoking, HTN, Alcohol. DM, PVD, CAD,. COCP
40
What are non modifiable risk factors for thrombotic ischaemic stroke
Male Age FH
41
How does occlusion ACA present clinically
Hemiplegia (usually) of the leg and hemiparesis (weakness) of the arm
42
How will MCA occlusion present
- 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
43
Where does the ophthalmic artery originate
Internal carotid artery
44
What causes amaurosis fugax
Clot in opthalmic which passes to occlude central retinal artery
45
If a patient with a stroke has hemianopia, what vessels must be affected
PCA or MCA
46
How do PCA strokes present
Homonymous hemianopia with macula sparing. May not present acutely but can present to opticians with history bumping into things
47
Why does MCA cause homonymous hemianopia
Due to ischaemia Meyer's loop and Baum's loop
48
Where is broccas areas
Pars opercularis, Pars triangularis
49
Where is Wernicke's area
Superior temporal gyrus
50
What do the vertebrobasilar arteries supply
Occipital Lobe Cerebellum Brain Stem
51
What is weber syndrome also known as
Medial Midbrain Syndrome
52
What causes weber syndrome
Occlusion branches PCA than innervate midbrain
53
How does weber syndrome present clinically
- Ipsilateral CN3 palsy = Lateral Gaze Palsy | - Contralateral hemiparesis
54
What causes marie-fox syndrome
Occlusion anterior-inferior cerebellar artery (AICA)
55
What is Marie-fox syndrome also known as
Lateral pontine syndrome
56
What causes Marie-Fox Syndrome
- Ipsilateral: Gait ataxia, Weakness, Vertigo, Facial Paralysis, Hearing Loss, Horner's Syndrome - Contralateral: loss pain, temperature. And weakness
57
What is Wallenberg syndrome also known as
Lateral Medullary Syndrome
58
What causes a lateral medullary syndrome
Occlusion PICA
59
How does Wallenberg syndrome present clinically
Ataxia and Nystagmus Ipsilateral: facial numbness, dysphagia, Horner Contralateral: sensory loss in limbs
60
What causes locked in syndrome
Bilateral basilar artery occlusion
61
How does locked in syndrome present
- Paralysis all voluntary muscles | - Eye movements and blinking
62
What classification is used to determine presentation strokes
Oxford Stroke Classification
63
What % of strokes are TACI
15%
64
What does TACI strokes involve
ICA: ACA and MCA
65
What is the presentation of TACI
All 3 Of: Homonymous hemianopia Hemiparesis face, arm and leg Higher cortical dysfunction
66
What % of strokes are PACI
25
67
What is a PACI
Occlusion of MCA or ACA
68
Describe clinical presentation of PACI
2 Of: Homonymous hemianopia Hemiparesis face, arm and leg Higher cortical dysfunction
69
What % of strokes are lacunar infarcts
15
70
What causes lacunar infarcts
occlusion arteries supplying basal ganglia, thalamus, internal capsule
71
What is the Oxford stroke criteria for lacunar infarcts
One of: 1. Pure Sensory Stroke 2. Ataxic hemiparesis 3. Unilateral weakness face, arm and leg
72
What % of strokes are posterior-circulation infarcts
25%
73
What causes a POCI
Occlusion vertebrobasilcar artery
74
How does a POCI present clinically
One of: 1. Cerebellar/Brain-stem syndrome 2. LOC 3. Isolated homonymous hemianopia
75
What is an isolated homonymous hemianopia
No other symptoms
76
What is Weber Syndrome
Medial Midbrain Syndrome - | Perforators of PCA
77
What is Marie Foix syndrome
Lateral Pontine Syndrome - | AICA
78
What is Wallenberg syndrome
Lateral Medullary Syndrome - | PICA
79
Explain distinguishing between ischaemic and haemorrhagic strokes from clinical presentation
Cannot distinguish solely on clinical presentation, require CT. However, haemorrhagic more often have nausea, vomitting, headaches and seizures.
80
What causes lacunar strokes
Small vessel disease
81
What causes small vessel disease
Hyaline arteriosclerosis, which is caused by hypertension
82
Outside of hospital what screening tool is used to identify stroke
FAST
83
What is the FAST tool
Face = is it drooped on one side
84
In hospital, what scoring system is used to identify stroke
ROSIER (Recognition of stroke in emergency room)
85
What ROSIER score requires assessment by stroke specialist
>2
86
What is first-line investigation in suspected stroke cases
CT Head in one hour
87
If ischaemic stroke, what other imaging should be ordered
CTA
88
What is gold-standard for ischaemic strokes and why is it not used
MRI - due to time consuming and not safe to put unstable patient in scanner
89
What is first line for ischaemic strokes
Aspirin (300mg)
90
What time frame should aspirin (300mg) be given
Within 24h of haemorrhagic stroke exclusion
91
How long is aspirin continued for
2W
92
What should be given with aspirin (300mg)
PPI
93
What is second-line for stroke
Thrombolysis
94
What are prerequisites for thrombolysis
Within 4.5 hours symptom onset
95
What are 5 absolute CIs to thrombolysis
- 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
When may thrombolysis be considered up to 24h afterwards
Posterior circulation stroke and imaging shows salvageable brain-tissue
97
What is important regarding anti-platelets after thrombolysis
Do not give anti platelets for 24-hours
98
In addition to thrombolysis, what are individuals offered to manage stroke
Thrombectomy
99
What are the criteria for thrombectomy
6h stroke <3 on modified rankin scale >5 on NIHSS
100
What time-frame can an individual receive thrombectomy
Up to 6h afterwards
101
What are other important points concerning management of stroke patients
NBM - until screened by SALT. May require NG tube Interpneumatic compression stockings for VTE prophylaxis
102
Explain measures for secondary prevention of stroke
- Anti-HTN (Aim 130/80) - Statin - Control Diabetes - Carotid endartectomy if stenosis - Lifestyle: diet, exercise, smoking cessation.
103
What are two neurorehabillitaiton scales used
Rankin | Barthel
104
What is a respiratory condition that may result from stroke
Aspiration pneumonia
105
What is greatest risk 1-2d after ischaemic stroke
Haemorrhagic transformation
106
What can happen after MCA strokes
Malignant MCA Syndrome
107
Explain malignant MCA syndrome
Neurological deteriorations - due to to cerebral oedema following MCA stroke. Managing in hemicraniectomy
108
What is intracerebral haemorrhage
Bleeding within brain parenchyma
109
What is haemorrhagic stroke
Infarction secondary to haemorrhage
110
What is the most common cause of intracerebral haemorrhage
HTN
111
If over 60 what is the second-most common cause of intracerebral haemorrhage
Cerebral amyloid antipathy
112
As a child, what is the most common cause of intracerebral haemorrhage
AV Malformation
113
Give 3 other causes of intracerebral haemorrhage
- Infection - Cocaine, amphetamine - Anticoagulant - Vasculitis
114
How does intracerebral haemorrhage present clinically
Symptoms are identical to to ischaemic stroke. Except slowly progressive and worsen over minutes-hours
115
Explain pathophysiology of HTN cause haemorrhagic stroke
Chronic HTN causes atherosclerosis of lenticulostriae arteries resulting in lipohyalinosis. This causes charcot-bouchard aneurysms to form which then rupture causing haemorrhage
116
Explain pathophysiology of cerebral amyloid antipathy
Amyloid is deposited in leptomeningeal arteries - causing inflammation, micro aneurysms and haemorrhage
117
What is first line investigation for haemorrhagic stroke
CT in 1h
118
How does haemorrhage present on CT
Bright
119
What is first-line management for all intracranial haemorrhage
Control BP if within 6-hours and Systolic is 150-220. Control with GTN patch and then IB labetaolol
120
What BP target is aimed for first 7d following haemorrhagic stroke
130-140 systolic BP
121
If individual on anticoagulation have a haemorrhage what is offered
Reversal
122
how is warfarin reversed
Prothrombin complex and vitamin-K
123
what factors does pro-thrombin complex replace
2 ,7, 9 10
124
how can dabigatran be reversed
Idarucizumab
125
when are individuals referred to neurosurgery for hemicraniectomy and clot evacuation
``` brain herniation (cushing's reflex) posterior fossa bleed obstructive hydrocephalus cerebral haemorrhage with neurological deterioration haemorrhage >3cm ```

Neurology (26 decks)

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