2. Stroke Flashcards
What is a stroke?
Sudden neurological event of vascular origin
What is a TIA?
Transient Ischaemic Attack
Signs and symptoms of stroke but resolves in less than 24 hours
What is a CVA?
Sudden death of brain cells due to a lack of oxygen
Infarction is due to either ischaemia or haemorrhage
Where do emboli tend to lodge?
Points of stenosis eg. atherosclerosis
Bifurcation of vessels
Classify the causes of strokes
Atherosclerosis Small vessel disease Cardioembolism Other Dissection
What are the causes of dissection?
Trauma, RTA
Fibromuscular dysplasia
What additional symptoms can be caused by dissection?
Horner’s syndrome
What are the risk factors that affect the vessel wall to cause an increased risk of stroke?
Hypertension Smoking Atherosclerosis Hyperlipidaemia Diabetes
What are the causes of embolism resulting in stroke?
Coronary heart disease
Atrial fib
LV hypertrophy
Valve disease
What radiology is the first to detect ischaemia?
MRI shows ischaemic change within mins
CT scan can exclude haemorrhage but takes 3 hours to become visible
Which artery do perforating vessels arise from?
Middle cerebral artery
Why are perforating vessels said to have a ‘design flaw’?
No collaterals
High pressure as no capillaries between arteries and veins
What name is given to aneurysm formation in perforating vessels?
Charcot-Bouchard
How does small vessel disease appear on radiology?
Ischaemic white change
Wide peri-vascular spaces
Old micro-haemorrhages showing as black spots
Deep white matter infarcts
What disease is associated with berry aneurysms?
Polycystic kidney
What are the main causes of haemorrhagic stroke?
Hypertension
Anti-coagulants
Which parts of the brain are most likely to be affected by a hypertensive stroke?
Basal ganglia and thalamus as supplies by penetrating arteries
Where are aneurysms most common?
Anterior circle of Willis
What are the causes of intracerebral haemorrhage?
Hypertension and anticoags Amyloid (alzheimers), aneurysms Arteriovenous malformations Tumours, trauma Cocaine, cavernomas
What symptom is associated with spontaneous subarachnoid haemorrhage?
Worst headache of your life
What investigations should be done if a patient presents with ‘worst headache of their life’?
Neuro exam Look for subarachnoid blood on CT -yes: angio to find cause -no: LP for xanthochromia (yellow CSF), then angio Surgery or interventional radiology
What group of patients is a decompressive craniectomy done in?
Young patients where high ICP isn’t controlled with other methods
