CBL - Stroke Flashcards
Describe the pathophysiological processes that can result in large vessel stroke [10]
- Large vessel strokes are usually due to vessel occlusion by thrombus.
- Potential sources of thrombus include embolism from plaques on atheromatous large vessels such as the carotid artery or aorta, or from a cardiac source.
- the site of arterial occlusion depends, in part, on the size of the thrombus, since it will lodge in an artery of comparable size.
- This occlusion impedes the passage of blood, thus reducing cerebral blood flow (CBF) to the brain territories distal to the clot.
- When blood flow drops below a critical threshold, a cascade of events is set in train which may ultimately result in cell death, which may occur by five major mechanisms, each of which with its own temporal course.
- These events are:
- excitotoxity
- peri-infarct depolarisation
- oxidative stress
- inflammation
- apoptosis
Name the classification system is used to classify different types of clinical presentations of stroke
Oxfordshire Community Stroke Project Classification (OCSP)
What are the different types of stroke? [6]
- Total anterior circulation syndrome (TACS)
- Partial anterior circulation stroke (PACS)
- Lacunar stroke (LACS)
- Posterior circulation stroke (POCS)
- Ischaemic stroke
- Haemorrhagic stroke
What are the symptoms of TOTAL anterior circulation syndrome (TACS)? [6]
ALL 3 must be present for diagnosis:
- Contra-lateral hemiparesis
- Contra-lateral hemianopia
- Higher dysfunction e.g.
- dysphasia
- visuospatial disturbances
- +/- contralateral hemisensory loss
What are the symptoms of PARTIAL anterior circulation stroke (PACS)? [7]
2 out of 3 symptoms must be present for diagnosis:
- Contra-lateral hemiparesis
- Contra-lateral hemianopia
- Higher dysfunction e.g.
- dysphasia
- visuospatial disturbances
OR when higher dysfunction alone is present: e.g. isolated dysphasia
What are the symptoms of lacunar stroke (LACS)? [5]
- Pure motor stroke/hemiparesis
- Ataxic hemiparesis
- Dysarthria/clumsy hand
- Pure sensory stroke
- Mixed sensorimotor stroke
What are the symptoms of posterior circulation stroke (POCS)? [5]
What are the differential diagnoses for acute stroke? [10]
- Migraine
- Seizure
- Hypoglycaemia, or other metabolic or toxic states
- Tumour or other space occupying lesion
- (onset typically more insidious)
- Cerebral metastases
- (can present acutely, especially if there is a bleed into a metastasis)
- Cerebral Venous Sinus thrombosis
- Inflammatory lesions such as demyelination
- (onset is not usually abrupt)
- Peripheral neuropathy and entrapment neuropathy
- Cardiovascular / syncope
- Functional Weakness
What investigations would you carry out on a patient with suspected stroke? [3]
- Bloods:
- FBC
- U&Es,
- CRP,
- LFTs
- Lipid profile,
- blood glucose,
- coagulation profile
- 12-lead ECG
- look for ischaemic changes or rhythm abnormalities (e.g. atrial fibrillation)
- Cranial imaging
- to distinguish between ischaemic stroke and haemorrhagic stroke
What are the roles of imaging in the investigation of stroke? [4]
- Exclude mimics:
- tumours,
- subdural haematoma
- Distinguish ischaemic stroke from haemorrhagic stroke
- Identify site of thrombus (CTa and MRa)
- Advanced imaging techniques may identify potentially salvageable tissue (CT and MRI perfusion imaging)
What is the immediate management of acute stroke? [2]
- Intra-venous thrombolysis
- alteplase
- mechanical thrombectomy
What secondary prevention drugs are used in stroke? [3]
- Antiplatelets:
- aspirin
- clopidogrel
- Statins
- Anti-hypertensives
- ACE inhibitor & thiazide diuretic
What is the target blood pressure in the management of stroke patients? [1]
below 140/85mmHg
What non-pharmacological therapies should stroke patients receive? [5]
- Physiotherapy
- Speech therapy
- Occupational therapy
- Smoking cessation
- Dietician
