10.1 Strokes Flashcards
Define a Thrombus
A blood clot formed in situ within the vasculature impeding blood flow
Define an Embolus
Blood clots, fatty deposit or air bubble carried in the blood stream that lodges in a vessel
Define an Infarct
Area of dead tissue resulting from disrupted blood supply
Define a Haemorrhage and state the 3 types
Escape of blood from a ruptured vessel
- Primary – no structural anomaly
- Secondary – aneurysm, vascular malformation or tumour
- Haemorrhagic transformation of an infarction
Define a Transient Ischaemic Attack (TIA)
Focal CNS disturbances caused by vascular events that last <24hrs and with no lasting deficit
Define a stroke
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
What is the key difference between a TIA and stroke
TIA <24hrs
Stroke >24hrs
Where are TIAs most common and give 3 common symptoms
90% in the carotid artery territory
- Motor and/or sensory disturbance
- Visual disturbance
- Amaurosis fugax
List 4 presenations of a TIA in the vertebral arteries
Vertigo, diplopia, dysarthria, limb weakness
Give 2 signs of a stroke on examination (CVS related)
Atrial Fibrillation and carotid bruit
Give 4 Investigations used to diagnose a TIA
Blood tests – FBC, ESR, CRP, BM,
CXR
ECG +/- 24hr tape
Transoesophageal echo
Carotid angiography/USS
CT or MRI brain
What is ABCD2 and how do we calculate this?
Estimates the risk of stroke after a suspected transient ischemic attack
Each + in a catagory = points
Give the catagories ABCD2 and how many points each is
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
List the risk for stroke for the following ABCD2 scores:
- 0-3
- 4-5
- 6-7
- 0-3 = 1% LOW risk
- 4-5 = 4%
- 6-7 = 8% HIGH risk
What define LOW vs HIGH risk for a stroke after a TIA
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)
List 3 ways we manage a patient who is ‘low risk’ for a stroke
1) Aspirin 300mg daily
2) Specialist assessment within a week
3) Address risk factors immediately
List 2 ways we manage a patient who is ‘high risk’ for a stroke
1) Aspirin 300mg daily
2) Specialist assessment within 24hrs
* neuroimaging, carotid imaging, ECG, ECHO,
What is a non-disabling stroke
MRI evidence of a stroke but no permanent damage
Give 3 types of strokes in order of how common each is
1) Infarct – 85%
- 50% thrombotic
- 35% embolic
2) Haemorrhagic – 10%
3) SAH–5%
Give the MAIN clinical feature of a stroke + 4 others
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
Give 4 acute managements for a stroke
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
Give 4 ongoing management strategies for a stroke
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%)
Give 4 long-term management strategies
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
Give 4 modifiable risk factors for stroke
HTN, smoking, AF, diet, ETOH, BMI, physical exercise, cholesterol
Give 4 non-modifiable risk factors for stroke
Age, sex, race, family history
A stroke of the Anterior cerebral artery would show what signs?
Contralateral sensory/motor loss usually lower limbs (upper limbs spared)
+ Frontal lobe signs
- Incontinence
- Broca’s aphasia if dominant lobe
- personality change
A stroke of the Middle cerebral artery would show what signs in general?
State other signs seen if the dominant vs non-dominat hemisphere was affected
General: contralateral hemiplegia – face and arms (leg spared)
Dominant hemisphere: global dysphasia
Non-dominant hemisphere: neglect of contralateral body
A stroke of the Posterior cerebral artery would show what signs in general?
Usually visual upset homonymous hemianopia with macular sparing
Perforating branches to thalamus will also cause pain syndrome and/or movement disorders
Stroke of the cerebellar arteries will cause what symptoms
Uncoordinated movements of the limbs or trunk, difficulty walking, problems with balance, abnormal reflexes, Intention tremors
A stroke in the basilar arteries will affect what structure
Brainstem, cranial nerve, cerebellar- bilateral
devastating!! :(
State what areas will be affected in stroke of the following teritories:
- Frontal
- Parietal
- Temporal
- Occipital
- Cerebellar/brain stem
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
Give the 4 classification of strokes that we can use to predict outcome
TACI = total anterior circulation stroke
PACI = partial anterior circulation stroke
LACI = lacunar circulation infarct
POCI = posterior circulation infarct
List 4 things we should do for young people who have a stroke
1) full coagulation profile
2) thrombophilia screen
3) autoimmune screen
4) blood cultures
Give 4 conditions that may mimic a stroke
- Hypoglycaemia
- Neuropathies – e.g. Bell’s palsy
- Migraine aura
- Transient global amnesia
- Labyrinthitis
- Alcohol intoxication
What is the onset of spinal cord infarcts and where does it most commonly occur?
Quick onset
95% are anterior (sparing vibration and JPS)
The syndrome experienced in a spinal cord infarct depends on what?
Upon spinal level of infarction. May include motor/sensory loss, loss of sphincter control
What is the stroke dilemma?
Haemorrhagic stroke: important balance between giving anticoagulants and bleeding risk
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