Build Up to STROKE Flashcards
STROKE definition
✨ Abrupt onset of FOCAL NEUROLOGICAL DEFICIT
✨ which is DUE TO: Acute Focal HYPOPERFUSION (Duration > 24hrs)
✨ DUE TO VASCULAR ISSUE which can be DUE TO:
🎯 Thrombosis
🎯 Thromboembolism DUE TO:
✨ Artery to Artery Thromboembolism
✨ Cardioembolism (AFib)
Difference BETWEEN STROKE & TIA
TIA lasts < 24 hours
⭐ Very SUDDEN ONSET STROKE, most likely cause?
⭐ STROKE in Progression, most likely cause?
⭐ Very SUDDEN ONSET STROKE, most likely cause?
🎯 CARDIOEMBOLIC STROKE
⭐ STROKE in Progression, most likely cause?
🎯 THROMBOTIC STROKE
🎯 ARTERY TO ARTERY THROMBOEMBOLIC STROKE
⭐ Stroke presenting as LOSS of CONSCIOUSNESS & SEIZURES. MOST PROBABLE CAUSE
⭐ Stroke presenting as Increasing Headache. MOST PROBABLE CAUSE
⭐ Stroke presenting as LOSS of CONSCIOUSNESS & SEIZURES. MOST PROBABLE CAUSE
🎯 CARDIOEMBOLIC STROKE
⭐ Stroke presenting as Increasing Headache. MOST PROBABLE CAUSE
🎯 THROMBOTIC STROKE
🎯 THROMBOEMBOLIC STROKE
⭐ Stroke with FULL WEAKNESS at ONSET. MOST PROBABLE CAUSE
⭐ Stroke with Progessive WEAKNESS within 48-72hrs. MOST PROBABLE CAUSE
⭐ Stroke with FULL WEAKNESS at ONSET. MOST PROBABLE CAUSE
🎯 CARDIOEMBOLIC STROKE
⭐ Stroke with Progessive WEAKNESS within 48-72hrs. MOST PROBABLE CAUSE
🎯 THROMBOTIC STROKE
🎯 THROMBOEMBOLIC STROKE
⭐ Stroke with RED HEMORRHAGIC CLOT MOST PROBABLE CAUSE
⭐ Stroke with FIBRIN CLOT. MOST PROBABLE CAUSE
⭐ Stroke with RED HEMORRHAGIC CLOT MOST PROBABLE CAUSE
🎯 CARDIOEMBOLIC STROKE
⭐ Stroke with FIBRIN CLOT. MOST PROBABLE CAUSE
🎯 THROMBOTIC STROKE
🎯 THROMBOEMBOLIC STROKE
🌸 TYPES of STROKE
⭐ Based on Etiology
⭐ Based on Vessel involvement
⭐ Based on Etiology
1. Ischemic STROKE 85%
2. HEMORRHAGIC STROKE 15%
⭐ Based on Vessel involvement
1. Arterial 95%
2. Venous 1-5%
1st INVESTIGATION to do in a patient of STROKE
🎯 CT (to look for Bleeding)
⬇️
🎯 DWMRI Diffusion weighted MRI (To look for INFARCTION)
🎯 ADA MRI
🎯 Perfusion weighted MRI
CT shows NO BLEEDING in
First 24-48hrs
New definition of TIA
🎯 DW-MRI NORMAL ➕ REVERSED Dysfunction
A brief episode of NEUROLOGICAL Dysfunction caused by FOCAL BRAIN, Spinal Cord or Retinal Ischemia with clinical symptoms WITHOUT EVIDENCE of INFARCTION
Repeated Episodes of TIA
➕
Headache
➕
Amaurosis FUGAX
is classically ASSOCIATED with
INTERNAL CAROTID ARTERY Stroke
MAXIMUM RISK of Final STROKE after a TIA
Next 48 hours
Anterior Circulation TIA ASSOCIATED with
- Amaurosis Fugax
- C/L Weakness
- C/L Homonymous Hemianopia
- Aphasia
Posterior Circulation TIA ASSOCIATED with
- Crossed HEMIPLEGIA
- Lower CN palsy
Risk of STROKE Following TIA is measured by
- ABCD² Score
ABCD² Score
Age ≥ 60
Blood pressure > 140/90
Clinical Features of TIA
✨ Unilateral weakness 2
✨ Speech disturbance w/o weakness 1
Duration of symptoms
> 10 min-59 min: 1
≥ 60 min: 2
Diabetes
Interpretation of ABCD² Score
Low Risk: 0-3
Moderate Risk: 4-5
High Risk: 6-7
TOAST Classification used for
Watershed Zones of Brain
TOAST Classification
⭐ Cause of VENOUS STROKE (CVT)
⭐ Cause of ARTERIAL STROKE
⭐ Cause of VENOUS STROKE (CVT)
🎯 HYPERCOAGULABLE STATE
⭐ Cause of ARTERIAL STROKE
🎯 15%: Hemorrhagic Stroke: ICH > SAH
🎯 85%: ISCHEMIC Stroke
⚡⚡ MOST COMMON TYPE OF STROKE WORLDWIDE
⚡⚡ MOST COMMON TYPE OF STROKE IN INDIA
⚡⚡ MOST COMMON TYPE OF STROKE WORLDWIDE
🎯 CARDIOEMBOLIC STROKE
⚡⚡ MOST COMMON TYPE OF STROKE IN INDIA
🎯 ARTERY TO ARTERY EMBOLIC STROKE (Mostly from Carotid artery)
NIHS SCORE used for
Stroke
Pathogenesis of STROKE
🎯 CEREBRAL AUTOREGULATION FAILURE
HEMORRHAGIC transformation is characteristic of
CARDIOEMBOLIC STROKE
EARLY SIGNS of STROKE in CT
- Hyperdense MCA sign (within 6 hrs)
- Insular Ribbon Sign: Loss of Grey White Matter differentiation at Insule (6-48hrs)
- Obscuration of Lentiform nucleus
Causes OF THROMBOTIC STROKE
🎯 THROMBOSIS of LARGE VESSELS
✨ Atherosclerosis (Hypertension > DM)
✨ Aortic Dissection
✨ Takayasu arteritis
✨ FMD
✨ APLA
High RISK CARDIAC Disease for Stroke
- Atrial Fibrillation
- MS & AS (can cause A fib)
- Prosthetic valves
- Sick Sinus Syndrome
- Recent MI
- DILATED cardiomyopathy
⚡⚡ MOST IMPORTANT ⚒️ RISK FACTOR for STROKE
- HYPERTENSION
- Atrial Fibrillation
- Carotid Stenosis
Small Vessel Stroke is known as
LACUNAR STROKE
LACUNAR INFARCTION
✨ Lipo-hyalinotic OCCLUSION of
✨ 30-300 micron vessel with
✨ 3mm to 2cm INFARCTION
Lacunar stroke Seen in
⚡⚡ MOST IMPORTANT RISK FACTOR for LACUNAR STROKE
Elderly ♀️ > ♂️
⭐ HYPERTENSION
Manifestation of LACUNAR STROKE
- Pure Motor Hemiparesis
- Pure Sensory Hemiparesis
- Dysarthria with Clumsy Hand
- Ataxic Hemiparesis
- Sensorimotor Hemiparesis
⭐ PURE MOTOR LACUNAR STROKE Occurs DUE to INVOLVEMENT of
⭐ PURE SENSORY LACUNAR STROKE Occurs DUE to INVOLVEMENT of
⭐ PURE MOTOR LACUNAR STROKE Occurs DUE to INVOLVEMENT of
🎯 Lenticulo-striate BRANCH of MCA
✨ INTERNAL CAPSULE
⭐ PURE SENSORY LACUNAR STROKE Occurs DUE to INVOLVEMENT of
🎯 Small Thalamo-Perforaters of PCA
(OR) Lenticulostriate branch of MCA
✨ VPL Thalamus
Ataxic HEMIPARESIS DUE TO
⭐ LESION at
⭐ VESSELS Involved
⭐ Basipontine lesion
(OR)
Internal Capsule
⭐ Perforaters of BASILAR ARTERY
Dysarthria with Clumsy Hand
⭐ LESION at
⭐ VESSELS Involved
⭐ Basipontine lesion
⭐ Perforaters of BASILAR ARTERY
Development of ATAXIC HEMIPARESIS
⭐ LESION at BASIPONTINE Region
⬇️
✨ Hemiparesis: Corticospinal Tract damaged (CST)
✨ Ataxia: Cortico-ponto-cerbellar pathway
Both on OPPOSITE SIDE
Dysarthria with Clumsy Hand
Cerebellar Ataxia
(slow scanning Staccoto Speech)
