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Year 3 Elderly Medicine > 9 - Acute Stroke > Flashcards

9 - Acute Stroke Flashcards

1
Q

How long does a focal injury to the CNS have to last in order to fit the criteria for a stroke

A

> 24 hours

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2
Q

What are the two main causes of a stroke.

A

Infarction
Haemorrhage

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3
Q

What are clinically silent strokes?

A

When there is evidence of CNS injury on neuroimaging but no neurological deficit

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4
Q

What is a transient episode of neurological dysfunction - caused by focal brain, spinal cord or retinal ischaemia - without acute infarction?

A

TIA

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5
Q

How long do TIAs last?

A

<24 hours

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6
Q

What are the RF for stroke?

A
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7
Q

What is a focal neurological deficit?

A

A problem with nerve, spinal cord or brain function that affects a specific location (e.g. right arm, left face) or speech, vision or hearing.

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8
Q

What are the biggest risk factors for stroke?

A

Age
Hypertension
AF

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9
Q

What percentage of Ps with stroke have AF?

A

20%

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10
Q

If a P has AF and doesn’t have anticoagulation, how does this increase their stroke risk?

A

increased x5

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11
Q

Which risk score is used to determine the risk of stroke in Ps with AF?

A

CHADVASC

(CHA2DS2VASc)

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12
Q

What is the rough proportion of ischaemic and haemorrhagic strokes?

A

Roughly - 4/5ths are ischaemic and 1/5th are hemorrhagic

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13
Q

What are the main causes of ischaemic stroke?

A

Large artery atherosclerosis 20%
Cardioembolism 20%
Small vessel disease 25%

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14
Q

Name 4 types of ischaemic stroke

A

Total anterior circulation infarction (TACI)

Partial anterior circulation infarction (PACI)

Posterior circulation infarction (POCI)

Lacunar infarction

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15
Q

How do TACI and PACI present - which arteries are normally involved.

A

Both can present with hemiplegia +/- hemisensory loss, hemianopia, higher cerebral dysfunction (aphasia, neglect)

TACI - usually ICA or MCA occlusion

PACI - usually a branch artery occlusion

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16
Q

How does a POCI present?

A

Altered consciousness
Cerebellar or brain stem syndromes
Hemianopia

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17
Q
A
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18
Q

How does different cerebral anatomy affect patients?

A

Means that different types of strokes may present differently if the anatomy is different.

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19
Q
A
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20
Q

What are the clinical features of an anterior circulation stroke?

A
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21
Q

What are the clinical features of a posterior circulation stroke?

A
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22
Q

What are the clinical features of a lacunar infarct?

A

Because lacunar infarcts are small - you often get an isolated deficit.

23
Q

Name three types of intra-cerebral haemorrhage

A

Deep cerebral haemorrhage - often small and associated with HT

Lobar haemorrhages - usually larger

Cerebellar haemorrhage

24
Q
A
25
Q

What are the RF for intra-cerebral haemorrhage?

A

Hypertension
AVM
Cerebral amyloid angiopathy

26
Q

How do intra-cerebral haemorrhages present?

A

Often severe stroke sx
Often headache and reduced LOC
Can have rapid progression - may decompensate in front of you.

27
Q

What is the prognosis of an intra-cerebral haemorrhage?

A

50% mortality at 1m

28
Q

How do we diagnose a stroke?

A
29
Q

What questions do we need to ask in a Hx for stroke?

A
30
Q

What exams do we do for stroke Ps?

A

ABCDE
GCS
Neurological exam - deficit?
NIHSS (National Institutes of Health Stroke Scale)

31
Q

What imaging can be done for suspected stroke?

A

Non-contrast CT
CT Angiogram
CT perfusion
MRI

32
Q

What things can mimic a stroke?

A
33
Q

How are acute ischaemic strokes managed?

A
34
Q

What anti-platelet tx is given for acute ischaemic stroke?

A
35
Q

What is the window for thrombolysis?

A

4.5 hours within symptom onset

36
Q

What are the criteria for thrombectomy?

A
37
Q

How is intra-cerebral haemorrhage managed?

A
38
Q

What supportive management can be given for stroke?

A
39
Q

Which is the most commonly ordered scan for stroke?

A

Non-contrast CT

40
Q

What is CT angiography used for in stroke Ps?

A

To identify Ps suitable for thrombectomy

41
Q

What is cerebral amyloid angiopathy?

A

Amyloid is deposited in the blood vessels predisposing to haemorrhage and various congenital conditions

42
Q

Which artery do most strokes affect?

A

Middle cerebral artery

43
Q

What is the most common thrombolysis Tx?

A

IV Alteplase (tissue plasminogen activator)

Total dose = 0.9mg/kg (max 90mg)

44
Q

The infarcted region is surrounded by a swollen ischaemic area that doesn’t function but is structurally intact. What is this called?

What happens to this area following thrombolysis?

A

Ischaemic penumbra

It can regain function following revascularization after thrombolysis (if lucky)

45
Q

When is thrombolysis CI?

A

Rapidly improving stroke
Minor sx
Persistent HT
Pregnancy
Platelets <100k
Glucose <2.8 or >26.2
INR >1.7 on warfarin
PTT raised on heparin
Stroke or head trauma in past 3m
Prior Hx of intracranial haemorrhage
Major surgery in past 14 days
LP in last 7 days

46
Q

What percentage of Ps who have TIAs will go on to have strokes?

A

30% - 1/3 of these in the first year

47
Q

What pathology is associated with significant risk of recurrent stroke during the weeks following a TIA or stroke?

How is it treated?

A

High-grade symptomatic carotid stenosis

Carotid endarterectomy or carotid stenting

48
Q

Which is the most common location for an intracerebral haemorrhage?

A

Putamen (35-50%)

49
Q

What are the clinical features of subarachnoid haemorrhage?

A

Sudden, very severe headache (often occipital)

Associated vomiting, photophobia & neck stiffness

Seizures

Altered consciousness or coma

Beware sentinel headaches - 1-2w prior to the major bleed

50
Q

When scanning for blood on CT - is it immediately visible?

A

No = may not be visible in the first 12 hours, often have to rescan

51
Q

What is the cause of a subarachnoid haemorrhage?

A

An intracranial aneurysm (dilation of a cerebral BV which ruptures)

52
Q
A
53
Q

What lines the ventricles?

What does this produce?

A

Choroid plexus

Produces CSF

54
Q
A

Year 3 Elderly Medicine (20 decks)

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