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ETA 5: NERVOUS SYSTEM > 10.1 Strokes > Flashcards

10.1 Strokes Flashcards

1
Q

Define a Thrombus

A

A blood clot formed in situ within the vasculature impeding blood flow

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2
Q

Define an Embolus

A

Blood clots, fatty deposit or air bubble carried in the blood stream that lodges in a vessel

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3
Q

Define an Infarct

A

Area of dead tissue resulting from disrupted blood supply

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4
Q

Define a Haemorrhage and state the 3 types

A

Escape of blood from a ruptured vessel

  • Primary – no structural anomaly
  • Secondary – aneurysm, vascular malformation or tumour
  • Haemorrhagic transformation of an infarction
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5
Q

Define a Transient Ischaemic Attack (TIA)

A

Focal CNS disturbances caused by vascular events that last <24hrs and with no lasting deficit

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6
Q

Define a stroke

A

A syndrome of rapidly developing clinical signs of disturbance of brain function, lasting >24hrs and with no apparent cause other than that of vascular origin

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7
Q

What is the key difference between a TIA and stroke

A

TIA <24hrs

Stroke >24hrs

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8
Q

Where are TIAs most common and give 3 common symptoms

A

90% in the carotid artery territory

  • Motor and/or sensory disturbance
  • Visual disturbance
  • Amaurosis fugax
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9
Q

List 4 presenations of a TIA in the vertebral arteries

A

Vertigo, diplopia, dysarthria, limb weakness

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10
Q

Give 2 signs of a stroke on examination (CVS related)

A

Atrial Fibrillation and carotid bruit

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11
Q

Give 4 Investigations used to diagnose a TIA

A

Blood tests – FBC, ESR, CRP, BM,

CXR

ECG +/- 24hr tape

Transoesophageal echo

Carotid angiography/USS

CT or MRI brain

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12
Q

What is ABCD2 and how do we calculate this?

A

Estimates the risk of stroke after a suspected transient ischemic attack

Each + in a catagory = points

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13
Q

Give the catagories ABCD2 and how many points each is

A

Age >60years = 1 point

BP>140/>90=1point

Clinical features

  • any weakness = 2 points
  • no weakness but speech disturbance = 1 point

Duration

  • 60mins+ = 2 points
  • 10-59mins = 1 point
  • <10mins = 0 points

Diabetic = 1 point

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14
Q

List the risk for stroke for the following ABCD2 scores:

  • 0-3
  • 4-5
  • 6-7
A
  • 0-3 = 1% LOW risk
  • 4-5 = 4%
  • 6-7 = 8% HIGH risk
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15
Q

What define LOW vs HIGH risk for a stroke after a TIA

A

Low risk = score 1-3 (or over a week since symptoms)

High risk = score 4+ (or crescendo = 2 in a week or AF or already on anticoagulation)

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16
Q

List 3 ways we manage a patient who is ‘low risk’ for a stroke

A

1) Aspirin 300mg daily
2) Specialist assessment within a week
3) Address risk factors immediately

17
Q

List 2 ways we manage a patient who is ‘high risk’ for a stroke

A

1) Aspirin 300mg daily
2) Specialist assessment within 24hrs
* neuroimaging, carotid imaging, ECG, ECHO,

18
Q

What is a non-disabling stroke

A

MRI evidence of a stroke but no permanent damage

19
Q

Give 3 types of strokes in order of how common each is

A

1) Infarct – 85%

  • 50% thrombotic
  • 35% embolic

2) Haemorrhagic – 10%
3) SAH–5%

20
Q

Give the MAIN clinical feature of a stroke + 4 others

A

Main: Sudden onset neurological deficit +

Hemiparesis, homonymous hemianopia, sensory loss, dysphasia, right hemisphere (neglect of contralateral limbs), constructional apraxia, face involvement, clumsiness, confusion, difficulty walking

21
Q

Give 4 acute managements for a stroke

A

1) ABCDEFG
2) CT brain (acute infarcts not visible in the acute phase)
3) Thrombolysis within 4.5hours
4) Clot retrieval
5) Swallow protection - NBM

22
Q

Give 4 ongoing management strategies for a stroke

A

1) admission to specialist stroke units
2) medication: aspirin 300mg daily for 2 weeks then 75mg daily
3) speech and language assessment (SALT)
4) nutrition
5) blood pressure (only if hypertensive emergency)
6) blood sugar
7) aim for stable BM control
8) oxygen (only if sats <95%)

23
Q

Give 4 long-term management strategies

A

1) physiotherapy: early mobilisation reduces depression, muscle wasting and pneumonia
2) occupational therapists: help with mobility and care in the home/community
3) carotid endarterectomy
4) modification of risk factors

24
Q

Give 4 modifiable risk factors for stroke

A

HTN, smoking, AF, diet, ETOH, BMI, physical exercise, cholesterol

25
Q

Give 4 non-modifiable risk factors for stroke

A

Age, sex, race, family history

26
Q

A stroke of the Anterior cerebral artery would show what signs? (4 things)

A
  1. Contralat leg motor + sensory clartation
  2. Incontinence
  3. Brocas aphasia
  4. Personality changes
27
Q

A stroke of the Middle cerebral artery would show what signs? (3 things)

A
  1. Face + Arm hemiplegia
  2. Global aphasia
  3. Neglect of contralat body
28
Q

A stroke of the Posterior cerebral artery would show what signs? (2 things)

A
  1. Homonymous hemianopia w Macular sparing
  2. Pain syndrome
29
Q

Stroke of the cerebellar arteries will cause what symptoms

A

Uncoordinated movements of the limbs or trunk, difficulty walking, problems with balance, abnormal reflexes, Intention tremors

30
Q

A stroke in the basilar arteries will affect what structure

A

Brainstem, cranial nerve, cerebellar- bilateral

devastating!! :(

31
Q

State what areas will be affected in stroke of the following teritories:

  • Frontal
  • Parietal
  • Temporal
  • Occipital
  • Cerebellar/brain stem
A

Frontal – motor area, Broca’s, disinhibition

Parietal – sensory, superior optic radiation,

Temporal – Wernicke’s area, memory, optic radiation

Occipital – visual cortex

Cerebellar/brain stem – motor/sensory tracts, cranial nerves, cerebellar signs

32
Q

Give the 4 classification of strokes that we can use to predict outcome

A

TACI = total anterior circulation stroke

PACI = partial anterior circulation stroke

LACI = lacunar circulation infarct

POCI = posterior circulation infarct

33
Q

List 4 things we should do for young people who have a stroke

A

1) full coagulation profile
2) thrombophilia screen
3) autoimmune screen
4) blood cultures

34
Q

Give 4 conditions that may mimic a stroke

A
  1. Hypoglycaemia
  2. Neuropathies – e.g. Bell’s palsy
  3. Migraine aura
  4. Transient global amnesia
  5. Labyrinthitis
  6. Alcohol intoxication
35
Q

What is the onset of spinal cord infarcts and where does it most commonly occur?

A

Quick onset

95% are anterior (sparing vibration and JPS)

36
Q

The syndrome experienced in a spinal cord infarct depends on what?

A

Upon spinal level of infarction. May include motor/sensory loss, loss of sphincter control

37
Q

What is the stroke dilemma?

A

Haemorrhagic stroke: important balance between giving anticoagulants and bleeding risk

38
Q

???

A

ETA 5: NERVOUS SYSTEM (18 decks)

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