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Lucy Knox - Year 2 > 202 - Stroke > Flashcards

202 - Stroke Flashcards

1
Q

What is a stroke?

A

A neurological deficit related to an atraumatic vascular event

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2
Q

What are the key clinical features of a stroke?

A 
Focal deficit
Negative phenomena (loss of movement..)
Related to vascular anatomy
Sudden onset
Identifiable vascular risk factors
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3
Q

What do you expect to see on CT after an ischaemic stroke?

A

May look normal early on
Later - loss of grey-white matter differentiation
Hypo-density of area affected

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4
Q

What do you expect to see on CT after hemorrhagic stroke?

A

Area affected lights up bright white early on, then turns more dense/dark in time

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5
Q

What is used to make an ischaemic stroke light up in MRI?

A

Diffusion weighting scan

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6
Q

What makes MRI better than CT in an acute stage of ischaemic stroke?

A

Ischaemia can be seen earlier

Subtle patholoigy seen

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7
Q

What imaging modalities are used to image cerebral vessels?

A

USS of carotids
MRA / CTA
MRV /CTV
Catheter angiogram

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8
Q

What treatment is used post stroke to reduce the consequences of it?

A

Thrombolysis

Rehab

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9
Q

What is thrombolysis? When can it be used?

A

Clot busting - ONLY ISCHAEMIC STROKES
for blocked vessels
Use IV rTPA, only if <3hrs since onset

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10
Q

What is a risk of doing thrombolysis?

A

There is a 6% risk of causing ICH

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11
Q

What is targeted to reduce the risk or recurrence of a stroke?

A

Bp, Diabetes, smoking, weight, coagulability

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12
Q

After a carotid embolic stroke, what blood thinning products are used long term?

A

Antiplatelets - ASA (aspirin) + clopidogrel

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13
Q

After a cardio-embolic stroke + CVST what blood thinning products are used long term?

A

Warfarin anticoagulation

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14
Q

Is surgery an option after a stroke to reduce reoccurrence?

A

Yes - vascular surgery - carotid endartectomy, stenting

But high risk!

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15
Q

What % of strokes are haemorrhagic?

A

15%

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16
Q

What occurs in a haemorrhagic stroke?

A

A vessel in the brain bursts open and bleeds

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17
Q

What are the 3 main types of haemorrhagic stroke

A

PICH - Primary intracerebral haemorrhage
SAH - Sub arachnoid haemorrhage
CVST - Cerebral venous sinus thrombosis

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18
Q

What are the key features of a PICH?

A

Very acute
Headache
? LOC

  • Pt may have high Bp, be on anticoagulation therapy
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19
Q

Why may you have LOC in a PICH?

A

Increased intracranial pressure - get cushings reflex - Bp auto reflex - heart pumps slowly, which causes pulse to drop and for the patient to feel faint

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20
Q

What are the key features of a SAH?

A

Sudden thunderclap headache
Meningism - photophobia, stiff neck
LOC
Wide spread of blood

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21
Q

What are the key features of a CVST

A 
DVT of brain - get secondary bleeding
Has no respect for arterial territories
Raised ICP
Can be subacute / evolving
Rare but devestating
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22
Q

What are the patient demographics for a CVST?

A

Younger patients, on the pill

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23
Q

What are the risk factors for a CVST?

A

infection, dehydration, malignancy, heart failure

24
Q

What % of strokes are ischaemic?

A

85%

25
Q

What happens in an ischaemic stroke?

A

A blocked vessel causes reduced availability of oxygen and nutrients to the area it supplies
- signs depend on the location

26
Q

What are the typical areas that an ischaemic stroke affect?

A 
TAC - total anterior circulation
LAC - Lacunar stroke
PAC - Partial anterior circulation
POC - Posterior circulation
MCA - Middle cerebral artery
27
Q

What blood vessels are affected in a TAC stroke?

A

Middle and anterior cerebral artery

28
Q

What are lacunar vessels, affected in a lacunar stroke

A

Small perforating vessels - eg. in the internal capsule

29
Q

What blood vessels are occluded in a POC stroke?

A

Basilar and vertebral

30
Q

If a pt had a MCA in the L cerebral hemisphere, what signs might you see?

A

Acute R hemiparesis
Dysphasia
No LOC

31
Q

What risk factors are there for ischaemic stokes?

A 
hypertension
AF (or other heart disease)
Diabetes
Hyperlipidaemia  
Smoking 
...
32
Q

What signs do you see in a brainstem stroke?

A

Ataxia - staggering, wide stance gait
Diplopia
Dysarthria
Hemiparesis - crossed motor signs as neurones cross before the lower CN leave.

33
Q

What is dysarthria?

A

Slurred speech

34
Q

What is a TIA?

A

Transient Ischaemic Attack
- Transient neurological episode
Symptoms <24hrs
Usually 10 mins

35
Q

What is amarosis Fugax?

A

The feeling of the curtains coming down over your eyes

36
Q

What does amarosis Fugax suggest?

A

TIA - Carotid circulation or anterior circulation issue

37
Q

How do you calculate risk of something being a TIA?

A 
ABCDD
A ->60
B sBP >140, dBP >90
C Hemi-paresis and slurred speech
D 60 bad news
D Diabetes
38
Q

How much of the resting cardiac output does the brain recieve?

A

20%

39
Q

What is the brains blood flow in mls/100g/minute?

A

50 mls/100g/minute

40
Q

How does the brain distribute its blood flow?

A

Varies according to metabolic rate

By cerebral perfusion pressure and tone of vessels

41
Q

What occurs to the brain in profound hypotension?

A

Cerebral blood flow (CBF) inadequate - impaired metabolism - decrease in neuronal activity + neuronal loss.

42
Q

What occurs to the brain in profound hypertension?

A

Hyperaemia causes cerebral oedema and hypertensive encephalopathy

43
Q

What affects the autoregulation of the brain’s blood flow?

A

Age, trauma, stroke, High pCO2

44
Q

What is hypoxia?

A

O2 depravation

45
Q

What is ischaemia?

A

Poor/impaired blood flow

46
Q

Why do neurones get damaged with ischaemia?

A

They are obligate aerobes

47
Q

How long until irreversible damage occurs to hypoxic neurones?

A

5-7 minutes without O2

48
Q

What is global ischaemia int he brain?

A

Generalised reduction in perfusion

Due to: cardiac arrest, shock, severe low BP

49
Q

What does global cerebral ischaemia cause?

A

Confusion
focal deficits
diffuse neuronal hypoxia

50
Q

What external factors alter the effect of global cerebral ischaemia?

A

Degree + duration
Temperature
Blood glucose

51
Q

What do ischaemic neurones look like (pathology)

A

Loss of organelles
Loss of nucleus
Pink cytoplasm
Rarefied neutropil

52
Q

Why is there a danger when the brain is reperfused after a stroke?

A

If reperfusion occurs too quickly it can cause damage due to the O2 free radicals that have been produced.

53
Q

Which 3 arteries supply the brain?

A

Anterior cerebral
Middle Cerebral
Posterior Cerebral

54
Q

What artery supplies the MCA and ACA?

A

The internal carotid

55
Q

What artery supplies the PCA?

A

Vertebral - basilar - PCA

Lucy Knox - Year 2 (17 decks)

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