Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 4 TCDs > Ageing: Acute Limb Weakness > Flashcards

Ageing: Acute Limb Weakness Flashcards

1
Q

What is the initial management of suspected/confirmed TIA? (2)

A
  1. 300mg aspirin

2. Refer for specialist assessment within 24h of symptoms onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What 2 forms of imaging are used in patients with a TIA?

A
  1. MRI
    - to determine location of ischemia
    - detect hemorrhage/alternative pathologies
    - more sensitive than CT
  2. Carotid ultrasound
    - everyone with TIA is considered a candidate for carotid endarterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the cut-off criteria for performing carotid endarterectomy in patients that have had a TIA/non-disabling stroke? (1)

A

Symptomatic carotid stenosis from 50-99% warrant surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What imaging is used in a patient with an acute stroke presentation?

A

Non-enhanced CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What 4 pharmacological treatments are offered for patients with acute stroke?

A
  1. Alteplase (within 4.5h of onset of stroke symptoms)
  2. Thrombectomy (within 6h of symptom onset)
  3. 300mg Aspirin
  4. Proton Pump Inhibitor (as required for dyspepsia caused by aspirin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 12 components of the NIHSS (National Institute of Health Stroke Scale)?

A
  1. Level of consciousness
  2. Patient knows month + own age
  3. Patient opens/closes eyes on command
  4. Best gaze (horizontal eye movements only)
  5. Visual field testing
  6. Facial paresis (show teeth or raise eyebrows + close eyes)
  7. Motor function of arms + legs
  8. Limb ataxia
  9. Sensory by pinprick
  10. Language
  11. Dysarthria
  12. Extinction + inattention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does each score of the NIHSS indicate?

A 
0 = no stroke symptoms
1-4 = minor stroke
5-15 = moderate stroke
16-20 = moderate to severe stroke
21-42 = severe stroke

**When assessing for stroke thrombolysis standard guidelines are:
NIHSS should be > 5 and < 25 but final decision remains clinical based

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 4 common origins of emboli

A
  1. Cardiac
  2. Carotid
  3. Paradoxical (i.e. Patent foramen ovale)
  4. Aortic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does a clot look like on a CT brain scan?

A

Hyperdense artery with hypodense parenchymal changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What 2 regions are most profoundly affected by acute occlusion of the internal carotid artery to the M1 segment of the middle carotid artery?

A
  1. Basal ganglia (caudate + lentiform nucleus)
    - supplied by perforating end arteries with no collateral circulation
  2. Insular cortex
    - most distant part of cortex from ACA or PCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 4 inclusion criteria for thrombolysis administration (alteplase)?

A
  1. Symptoms of acute stroke
  2. Onset of symptoms in last 4.5h
  3. Measurable deficit on NIHSS
  4. Absence of hemorrhage on CT scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 13 factors that would prevent thrombolysis from being administered?

A
  1. Symptoms of SAH
  2. Head trauma/brain or spinal surgery/stroke in last 3mo
  3. Major surgery in last 2wk
  4. History of intracranial hemorrhage
  5. Evidence of active bleeding in last 21d
  6. Aortic dissection
  7. Arterial puncture within 7d
  8. Recent lumbar puncture in last 10d
  9. Pregnancy
  10. Systolic BP > 185 and/or diastolic BP > 110mmHg
  11. Bacterial endocarditis
  12. Platelet count 1.4 on warfarin
  13. Heparin/new oral anticoagulant within last 48h or INR > 1.4 on warfarin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 2 complications of thrombolysis in acute stroke?

A
  1. 6% risk of hemorrhage
  2. 7% risk of angioedema

Risk increases by treatment with ACE inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 4 stroke mimics?

A
  1. Seizures
  2. Sepsis
  3. Syncope
  4. Hypoglycemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In acute stroke, what are the 2 strongest predictors of outcome?

A
  1. Age

2. Stroke severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 2 most common causes of an ischemic stroke?

A
  1. Embolus

2. Thrombus

17
Q

What part of the brain is affected in a TACS stroke (total anterior circulation stroke)?

A

Large cortical stroke

ACA or MCA

18
Q

What 3 clinical signs must be present to diagnose a TACS?

A

All 3 of the following:

  1. Unilateral weakness (and or sensory loss) of face, arm and leg
  2. Homonymous hemianopia
  3. Higher cerebellar dysfunction (dysphasia, visuospatial disorder)
19
Q

What part of the brain is affected in a PACS stroke (partial anterior circulation stroke)? (2)

A

Cortical stroke

MCA/ACA

20
Q

What criteria leads to a PACS stroke diagnosis?

A

2 of the following:

  1. Unilateral weakness (and or sensory loss) of face, arm and leg
  2. Homonymous hemianopia
  3. Higher cerebellar dysfunction (dysphasia, visuospatial disorder)
21
Q

What part of the brain is affected in a POCS stroke (posterior circulation stroke)?

A

Posterior circulation

22
Q

What criteria leads to a POCS stroke diagnosis?

A

1 of the following:

  1. Cerebellar or brainstem syndrome
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
23
Q

What part of the brain is affected in a LACS stroke (lacunar syndrome)?

A

Subcortical stroke due to small vessel disease

24
Q

What criteria leads to a LACS stroke diagnosis?

A

1 of the following:

  1. Unilateral weakness (and or sensory loss) of face, arm or leg
  2. Pure sensory stroke
  3. Ataxic hemiparesis
25
Q

What are 5 risk factors for hemorrhagic stroke?

A
  1. Hypertension
  2. Cerebral amyloid angiopathy
  3. Aneurysms
  4. Cerebral arteriovenous malformations
  5. Brain tumours
26
Q

What are 6 modifiable risk factors for ischemic stroke?

A
  1. Diabetes
  2. Hyperlipidemia
  3. Atherosclerosis
  4. Hypertension
  5. Smoking
  6. Obesity
  7. AF
27
Q

Describe the ischemic cascade simply in 4 steps

A
  1. ATP-reliant ion transport pumps fail because of lack of O2 (anaerobic)
  2. Intracellular calcium levels get too high
  3. Release of glutamate is triggered
  4. Excitotoxicity leads to neuron death
28
Q

How can neurons die after a stroke? (3)

A
  1. Cytotoxic oedema
  2. High calcium level-related causes
  3. “Cell suicide” via mitochondrial apoptotic factors
29
Q

How can neurons die after a stroke?

A
  1. Cytotoxic oedema
  2. High calcium level-related causes
  3. “Cell suicide” via mitochondrial apoptotic factors
30
Q

Mr Terry Henry is a 68 year old an who presents to the acute stroke service with onset of left arm weakness 3 hour ago. On examination he has power 2/5 in his left upper limb. Power 4/5 in his left leg with a hemisensory loss on the left side. His speech, visual fields an cranial nerves are normal. According to the Oxford/ bamford classifaction what type of stroke has he had?

A

Lacunar stroke

  • he has unilateral weakness of arm and leg but no other features (hemianopia or higher cerebral deficits). He has no cerebellar signs.

Year 4 TCDs (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions