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Semester 5 - Neuro > 14 - Stroke 2 > Flashcards

14 - Stroke 2 Flashcards

1
Q

In terms of sensory information, what is the role of the thalamus?

A

It relays information from the DCML and spinothalamic fibres to the post-central gyrus of the parietal lobe.

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2
Q

How might a thalamic infarct present?

A

PURE SENSORY STROKE

Contralateral loss of all sensory modalities

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3
Q

What are the 4 Oxfordshire community stroke project classifications of lacunar syndromes?

A

1) TACS - total anterior
2) PACS - partial anterior
3) POCS - posterior
4) LACS - lacunar

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4
Q

What is a TACS, and what are the clinical features?

A

Total Anterior Circulation Syndrome:

  • Hemiparesis +
  • Higher cortical dysfunction ie neglect/dysphasia +
  • Homonymous hemianopia
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5
Q

What blood vessels are usually affected to cause a TACS?

A
  • Internal carotid artery OR

- Proximal MCA

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6
Q

What is the most common cause of a TACS?

A

Cardiac emboli due to AF

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7
Q

What is a PACS, and what are the clinical features?

A

Partial Anterior Circulation Syndrome:

Isolated higher cortical dysfunction
OR
2 of:
- Hemiparesis
- Higher cortical dysfunction
- Hemianopia
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8
Q

Which blood vessel is usually affected to cause a PACS?

A

Branch of MCA

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9
Q

What is the most common cause of a PACS?

A

Large vessel disease

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10
Q

What is a POCS, and what are the clinical features?

A

Posterior Circulation Syndrome

- Isolated hemianopia
OR
- Brainstem signs
OR
- Cerebellar signs
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11
Q

Occlusion of which blood vessels can result in a POCS?

A
  • Vertebral artery
  • Basilar artery
  • Cerebellar arteries
  • PCA
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12
Q

What is a LACS, and what are the clinical features?

A

Lacunar Syndrome

  • Pure motor stroke OR
  • Pure sensory stroke OR
  • Sensorimotor stroke OR
  • Ataxic hemiparesis OR
  • Clumsy-hand dysarthria
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13
Q

If you suspect a stroke, what is the first imaging that should be done, and why?

A

Non-contrast CT head

  • Exclude haemorrhage to allow thrombolytic therapy if ischaemic stroke
  • Exclude stroke mimics ie tumour
  • Fast, inexpensive, readily available
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14
Q

What may be seen on an immediate CT head following an ischaemic stoke?

A

Hyperdense segment of vessel due to thrombus/embolus

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15
Q

What imaging modality is most specific and sensitive for the diagnosis of ischaemic stroke?

A

MRI head

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16
Q

What is the goal of CT perfusion imaging following ischaemic stroke?

A
  • Identifies patients for reperfusion therapy

- Accurate diagnosis of ischaemic stroke

17
Q

What is the goal of CT angiography imaging following a stroke?

A
  • Identifies thrombus and may guide intra-arterial thrombolysis or clot retrieval
  • Evaluate carotid and vertebral arteries to investigate stoke aetiology
18
Q

What are some stroke differentials?

A
  • Hypoglycaemia
  • Epilepsy
  • Migraine
  • Intracranial tumour
  • Intracranial infection
  • Sepsis
  • Syncope
  • Dementia
  • Bell’s palsy
19
Q

What bloods would you order when managing ischaemic stroke?

A
  • FBC
  • U&Es
  • INR
  • Glucose
  • LFTs
  • TFTs
20
Q

If no contraindications, thrombolysis should be administered within what time frame following ischaemic stroke?

A

< 4.5 hrs, ensuring haemorhagic stroke has been excluded

21
Q

What are the 6 major contraindications of thrombolysis?

A
  • Major recent haemorrhage
  • Active peptic ulcer
  • Recent trauma/surgery
  • Hx of cerebral haemorrhage
  • Coagulation defects
  • Uncontrolled hypertension
22
Q

If patient is receiving thrombolysis post-ischaemic stroke, when should aspirin be commenced, at what dose for how long?

A

24hrs after symptoms started, 300mg PO OD for 14 days

23
Q

What investigations might you do after an ischaemic stroke to investigate the cause?

A
  • ECG
  • ECHO or 24hr tape
  • HbA1c
  • Cholesterol
  • Autoimmune screen
  • Doppler
  • CT angiography
24
Q

What medications are commonly given as long term prophylaxis after an ischaemic stroke?

A
  • Clopidogrel 75mg PO OD

- Atorvastatin

25
Q

What are the common causes of haemorrhage stroke?

A
  • Hypertensive + anticoagulation
  • Hypertensive + vascular abnormality ie aneurysm
  • Hypertensive + tumour
  • Cerebral amyloid angiopathy (Alzheimer’s)
  • Drugs (cocaine/amphetamines)
  • Thrombocytopenia
26
Q

If a patient on Warfarin has had a haemorrhage stroke, what can you do to minimise the bleed?

A

Reverse warfarin:

- IV vit K 10mg + Prothrombin complex concentrate 50units/kg

27
Q

Which DOAC can be reversed and what is the name of the reversal agent?

A

Dabigatran

Reversal agent = Idarucizumab IV 5mg bolus

Semester 5 - Neuro (14 decks)

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