Ageing - Stroke Flashcards

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1
Q

definition of a stroke?

A

rapidly developing signs/symptoms of a focal or global loss of brain function

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2
Q

what are the ischaemic types of stroke?

A

atheroembolic
cardioembolic
small vessel thrombotic
other

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3
Q

what are the haemorrhagic types of stroke?

A

intradural

  • intracerebral
  • SAH

subdural

extradural

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4
Q

risk factors for stroke?

A
AF
thrombophilias
FHx
HT
smoking 
DM
dyslipidaemia
CVD
Hx of TIA/stroke
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5
Q

features of a stroke?

A
neglect 
language problems
visual field change
dipolopia
weak
aphasia/dysarthria 
loss of sensation
confusion
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6
Q

what are cerebellar signs?

A
dysdiadokenesis
ataxia
nystagmus
intention tremor
slurred/staccato speech
hypotonia
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7
Q

what occurs if broca’s area is damaged? where is it?

A

struggles to speak

frontal lobe

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8
Q

what occurs if wernicke’s area is damaged? where is it?

A

speaks but makes no sense

temporal lobe

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9
Q

what do small vessel thrombotic strokes affect? what are risk factors?

A

small penetrating arteries

HT, age, lipids

LACUNAR strokes

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10
Q

what are other causes of ischaemic strokes?

A

migraine
cocaine
shock
dissections

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11
Q

what are paradoxical emboli?

A

pass through PFO
DVT/PE in origin
gets into arterial circulation and causes large vessel cardioembolic stroke

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12
Q

causes of haemorrhagic stroke?

A

AVMs
hypertension
anticoagulants
cocaine

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13
Q

who gets extradurals? signs?

A

young person playing sport
fluctuating consciousness
LEMON

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14
Q

who gets subdurals? signs?

A

elderly
gradually declining consciousness
BANANA

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15
Q

what does the posterior cerebral artery supply?

A

occipital

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16
Q

what does the middle cerebral artery supply?

A

post central gyrus (sensory) parietal lobe

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17
Q

what does the anterior cerebral artery supply?

A

pre central gyrus (motor) in the frontal lobe

broca’s (frontal) and wernicke’s (temporal)

18
Q

what is the anterior circulation of the brain?

A

those branching from the internal carotids

anterior and middle cerebral

19
Q

in a POCS, what areas of the brain are involved?

A

cerebellum

brainstem.

20
Q

in TACS, what three criteria must be present?

A

homonymous hemianopia
unilateral weakness
high cerebral dysfunction

21
Q

compared to TACS, what must POCS have?

A

two of
homonymous hemianopia
unilateral weakness
high cerebral dysfunction

22
Q

for LACS, what criteria must be present?

A
ONE of
sensory stroke
motor stroke
sensory motor stroke
ataxic hemiparesis
23
Q

for POCS, what criteria must be present?

A
ONE of
eye movement problems
homonymous hemianopia
cerebellar signs
bilateral sensory/motor defecit 
CN palsy
24
Q

Ix for stroke?

A
FBC, U+E,s LFTs, lipids, BM
prothrombin time
PTT
ECG
CT head (white = blood)
25
Q

what Ix should be done after a stroke?

A

carotid doppler
ambulatory ECG
echo

26
Q

who gets carotid endartectomy?

A

> 70% narrowing on symptomatic side

27
Q

how long can thrombolysis be given after symptom onset?

A

4 and a half hours

28
Q

what is hyperacute stroke Tx?

A

AFTER head CT interpreted with no bleeds

thrombolysis (alteplase)
endovascular interventions (up to 6 hours)
aspirin 300mg

29
Q

what is non hyperacute stroke Tx?

A

clopidogrel
(aspirin + dypirimadole if can’t tolerate)
statins
HT control

swallow assessment
physio
OT

30
Q

what are stroke mimics?

A
hypo
MS
bell's palsy
migraine
sepsis
syncope
seizures
31
Q

what can be done as stroke prevention?

A
stop smoking 
wt loss
exercise
HT control
lipid control
reduce alcohol 
anticoag use
32
Q

definition of a TIA?

A

brief episode of neuro dysfunction caused by brain/retinal ischaemia

33
Q

what ophthalmology condition is classified as a stroke? how does it present?

A

CRAO (amaurosis fugax is the TIA)

painless visual loss in one eye

34
Q

why do TIAs resolve?

A

glial cells spared by transient ischaemia

tPA produced by own blood vessels

35
Q

causes of TIA?

A
atheroembolic
cardioembolic
small vessel
hypercoagulable
vasculitis
vasospasm
36
Q

Ix for TIA?

A
FBC, U+Es, LFTs, lipids, BM
prothrombin and APTT
ECG
opthalmoscopy 
MRI with diffusion 
carotid doppler
37
Q

Tx for a TIA?

A

anticoag (if cardioembolic)
antiplatelet (atherosclerotic/embolic)
e.g aspirin, clop, dipyrimadole

statin
HT control
lifestyle modifications

carotid endartectomy (≥70%)

38
Q

driving rules for stroke/TIA?

A

cant drive for 1 month after

39
Q

how does an anterior cerebral artery stroke present?

A

contralateral hemiparesis
sensory loss
worse lower limbs

40
Q

how does a middle cerebral artery stroke present?

A
contralateral hemiparesis
sensory loss
worse upper limbs 
homonymous hemianopia
aphasia
41
Q

how does a posterior cerebral artery stroke present?

A

homonymous hemianopia with macular sparing

42
Q

how does a lacunar stroke present?

A

isolated:

hemiparesis, sensory loss, ataxia