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Neurology Week 3 2018/19 > 4: Stroke 2 - the sequel > Flashcards

4: Stroke 2 - the sequel Flashcards

1
Q

What is a stroke?

A

Loss of brain function secondary to cardiovascular disease

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2
Q

There are a lot of diseases which ___ stroke.

A

mimic

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3
Q

Which neurological symptom is most often mistaken for stroke?

A

Seizure

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4
Q

Which widespread infection affecting the major organs can mimic stroke?

A

Sepsis

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5
Q

What is more common - cerebrovascular disease or coronary artery disease?

A

Cerebrovascular disease

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6
Q

Which score is used to assess the likelihood that a patient has suffered a stroke?

A

ROSIER Score

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7
Q

What are the two general types of stroke?

A

Haemorrhagic

Infarction

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8
Q

What colour is

a) blood
b) infarcted tissue

on CT?

A

Blood is white, well enhancing

Infarcted tissue is black/grey

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9
Q

After which length of time is CT NOT sensitive for blood?

Which scan should you use instead after this period?

A

1 week

MRI

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10
Q

Which area of the brain circulation, when infarcted, carries the worst prognosis in stroke?

A

Anterior circulation

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11
Q

What happens to infarcted brain tissue in the weeks following a stroke?

A

Scarring

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12
Q

Which type of stroke has the best prognosis?

Which brain structures are affected?

A

Lacunar infarction

Basal ganglia, thalamus, brainstem

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13
Q

Which area of brain circulation, when infarcted, lead to cranial nerve palsies and blindness ?

A

Posterior circulation

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14
Q

In most people, which side of the brain is dominant?

A

Left side (most people are right-handed, remember everything is mirrored)

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15
Q

Which side of the brain is responsible for musical ability and ‘artistic awareness’?

A

Right side

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16
Q

Which disease processes are responsible for most ischaemic strokes?

A

Atherosclerosis > Thrombosis > Embolism

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17
Q

Which investigation can be used to view blood vessels for thrombosis?

A

CT / MR angiogram

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18
Q

Atherosclerosis affecting the ___ arteries and ___ vessels is the most common reason for ischaemic stroke.

A

coronary arteries and small vessels

19
Q

Small vessel disease tends to affect the ___ matter of the brain.

A

white matter

20
Q

Which arrhythmia commonly causes embolism of thrombi to the brain?

A

AF

21
Q

Why can MI cause embolism of clots to the brain?

A

Heart isn’t pumping - stasis - Virchow’s triad

Scar tissue also pings off

22
Q

People with ___ valves are more likely to have embolic events.

A

prosthetic valves

23
Q

Which congenital heart disease can cause a stroke?

A

Patent foramen ovale

Clots which would usually cause a PE can cross to the left side of the heart and travel to the brain

24
Q

What is an arterial dissection?

A

Rip in the tunica intima of an artery, allowing blood to get in

25
Q

What are two ways in which arterial dissection causes ischaemic stroke?

A

1. Bulging of blood in wall occludes lumen of vessel

2. Static blood coagulates and can ping off as thrombi

26
Q

What are two primary causes of haemorrhagic stroke?

A

Hypertension

Amyloid angiopathy

27
Q

What are some causes of secondary haemorrhagic stroke?

A

Tumour, aneurysm, trauma etc.

anything which causes bleeding in the cranial cavity

28
Q

___ ___ must be reduced in people with primary haemorrhagic stroke.

A

Blood pressure

29
Q

Bleeding into the cranial cavity causes an increase in what?

A

ICP

30
Q

Similarly to MIs, time means ___ brain tissue.

A

lost

31
Q

What is thrombolysis?

A

Use of drugs to break up clots

32
Q

What is a side effect of thrombolysis?

A

Increased bleeding risk

33
Q

The ___ and ___ of thrombolysis must be weighed up before starting it.

A

benefits and risks

because they’re at risk of bleeding elsewhere

34
Q

What are risk factors for thrombolysis complications?

A

Age

Time since stroke started

Co-morbidities

Hx previous stroke, hypertension

35
Q

The longer the delay in starting thrombolysis, the (more/less) beneficial it is.

A

less beneficial

36
Q

When should thrombolysis ideally be given to a stroke patient?

A

Within an hour of symptoms starting

37
Q

Why is a brain scan performed before thrombolysing a patient?

A

To check if it’s an ischaemic or haemorrhagic stroke

If it’s a haemorrhagic stroke, thrombolysis isn’t appropriate

38
Q

What is a thrombectomy?

Who carries it out?

A

Insertion of a wire to break up larger clots

Interventional radiologists

39
Q

Are thrombectomies currently carried out in Scotland?

A

Yes

But only in one centre in Edinburgh

40
Q

What other investigations are carried out for patients with suspected strokes?

A

BP

Blood cholesterol

ECG

41
Q

What is the ABCD of stroke prophylaxis?

A

Antithrombotic drugs: antiplatelets (aspirin) and anticoagulants (warfarin)

Blood pressure: antihypertensives e.g ACE inhibitors, CCBs

Cholesterol: statin

Diabetic control

Don’t smoke

42
Q

Which score is used to measure risk of stroke in AF patients?

A

CHAD2VASC

43
Q

What operation is performed to open up stenosed carotid arteries?

A

Carotid endarterectomy

Neurology Week 3 2018/19 (10 decks)

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