Ageing - Stroke Flashcards
definition of a stroke?
rapidly developing signs/symptoms of a focal or global loss of brain function
what are the ischaemic types of stroke?
atheroembolic
cardioembolic
small vessel thrombotic
other
what are the haemorrhagic types of stroke?
intradural
- intracerebral
- SAH
subdural
extradural
risk factors for stroke?
AF thrombophilias FHx HT smoking DM dyslipidaemia CVD Hx of TIA/stroke
features of a stroke?
neglect language problems visual field change dipolopia weak aphasia/dysarthria loss of sensation confusion
what are cerebellar signs?
dysdiadokenesis ataxia nystagmus intention tremor slurred/staccato speech hypotonia
what occurs if broca’s area is damaged? where is it?
struggles to speak
frontal lobe
what occurs if wernicke’s area is damaged? where is it?
speaks but makes no sense
temporal lobe
what do small vessel thrombotic strokes affect? what are risk factors?
small penetrating arteries
HT, age, lipids
LACUNAR strokes
what are other causes of ischaemic strokes?
migraine
cocaine
shock
dissections
what are paradoxical emboli?
pass through PFO
DVT/PE in origin
gets into arterial circulation and causes large vessel cardioembolic stroke
causes of haemorrhagic stroke?
AVMs
hypertension
anticoagulants
cocaine
who gets extradurals? signs?
young person playing sport
fluctuating consciousness
LEMON
who gets subdurals? signs?
elderly
gradually declining consciousness
BANANA
what does the posterior cerebral artery supply?
occipital
what does the middle cerebral artery supply?
post central gyrus (sensory) parietal lobe
what does the anterior cerebral artery supply?
pre central gyrus (motor) in the frontal lobe
broca’s (frontal) and wernicke’s (temporal)
what is the anterior circulation of the brain?
those branching from the internal carotids
anterior and middle cerebral
in a POCS, what areas of the brain are involved?
cerebellum
brainstem.
in TACS, what three criteria must be present?
homonymous hemianopia
unilateral weakness
high cerebral dysfunction
compared to TACS, what must POCS have?
two of
homonymous hemianopia
unilateral weakness
high cerebral dysfunction
for LACS, what criteria must be present?
ONE of sensory stroke motor stroke sensory motor stroke ataxic hemiparesis
for POCS, what criteria must be present?
ONE of eye movement problems homonymous hemianopia cerebellar signs bilateral sensory/motor defecit CN palsy
Ix for stroke?
FBC, U+E,s LFTs, lipids, BM prothrombin time PTT ECG CT head (white = blood)
what Ix should be done after a stroke?
carotid doppler
ambulatory ECG
echo
who gets carotid endartectomy?
> 70% narrowing on symptomatic side
how long can thrombolysis be given after symptom onset?
4 and a half hours
what is hyperacute stroke Tx?
AFTER head CT interpreted with no bleeds
thrombolysis (alteplase)
endovascular interventions (up to 6 hours)
aspirin 300mg
what is non hyperacute stroke Tx?
clopidogrel
(aspirin + dypirimadole if can’t tolerate)
statins
HT control
swallow assessment
physio
OT
what are stroke mimics?
hypo MS bell's palsy migraine sepsis syncope seizures
what can be done as stroke prevention?
stop smoking wt loss exercise HT control lipid control reduce alcohol anticoag use
definition of a TIA?
brief episode of neuro dysfunction caused by brain/retinal ischaemia
what ophthalmology condition is classified as a stroke? how does it present?
CRAO (amaurosis fugax is the TIA)
painless visual loss in one eye
why do TIAs resolve?
glial cells spared by transient ischaemia
tPA produced by own blood vessels
causes of TIA?
atheroembolic cardioembolic small vessel hypercoagulable vasculitis vasospasm
Ix for TIA?
FBC, U+Es, LFTs, lipids, BM prothrombin and APTT ECG opthalmoscopy MRI with diffusion carotid doppler
Tx for a TIA?
anticoag (if cardioembolic)
antiplatelet (atherosclerotic/embolic)
e.g aspirin, clop, dipyrimadole
statin
HT control
lifestyle modifications
carotid endartectomy (≥70%)
driving rules for stroke/TIA?
cant drive for 1 month after
how does an anterior cerebral artery stroke present?
contralateral hemiparesis
sensory loss
worse lower limbs
how does a middle cerebral artery stroke present?
contralateral hemiparesis sensory loss worse upper limbs homonymous hemianopia aphasia
how does a posterior cerebral artery stroke present?
homonymous hemianopia with macular sparing
how does a lacunar stroke present?
isolated:
hemiparesis, sensory loss, ataxia
