Cerebral Infarct / stroke Flashcards
what are the modifiable risk factors for stroke?
hypercholesterolaemia smoking alcohol hypertension diabetes OCP hyper coagulable states i.e. genetic, malignancy
what are the non-modifiable risk factors for stroke?
age
male
family history
previous stroke
why does chronic hypertension put you at risk of stroke?
chronic hypertension worsen atheroma and affected small distal arteries which are at high risk of small artery lipohyalinosis
what factors increases the deposition of LDL in vessel walls?
hypertension
smoking
diabetes
what are the symptoms associated with a stroke due to occlusion of the Anterior cerebral artery?
contralateral paralysis of foot and leg
sensory loss over foot and leg
impairment of gait and stance
what are the symptoms of a stroke caused by occlusion of the middle cerebral artery?
contralateral paralysis of the face/arms/leg
sensory loss of face/arms/leg
homonymous hemianopia
gaze paralysis to oppose side
aphasia if in dominant hemisphere
unilateral neglect and gnosis for half of external space if non-dominant stroke
if someone is right handed and they had occlusion of the MCA, what symptoms would they have?
left arm/face/leg paralysis/hemiplegia homonymous hemianopia unilateral neglect syndromes - visual agnosia - sensory agnosia - anosagnosia - prosopagnosia
what arteries are occluded in a lacunar stroke?
medial and lateral lenticulostraiate arteries
small branches of the MCA
what are the signs of a lacunar stroke?
no cortical signs
- pure motor
- pure sensory
- dysarthria
- ataxia hemiparesis
what are the cortical signs associated with stroke ?
dysphagia
neglect
hemianopia
what are the symptoms of stroke caused by occlusion of the posterior circulation?
coma vertigo nausea/vomiting CN palsies ataxia hemiparesis hemisensory neglect crossed sensori-motor deficits visual field deficits
what are the treatments for stroke?
aspirin
heparin
thrombolysis r-TPA
clot retrieval/ thrombectomy
what does the treatment TPA stand for?
tissue plasminogen activator
what investigations would you carry out if someone had a stroke?
CT/MRI head FBC (glucose, lipids, ESR) ECG (AF, LVH) ECHO carotid doppler USS cerebral angio/venogram hypercoaguable blood screen
what type of imaging is useful for subtle infarcts ?
diffusion weighted MRI
what treatment is given for secondary prevention?
anti-hypertensives anti-platelets lipid lowering drugs (STATIN) warfarin if AF carotid endarectomy
when is TPA given?
if symptoms are present for > 60 minutes but has to be given <4.5 hours after stroke
when would you not give TPA?
blood on CT recent surgery recent episodes of bleeding coagulation problems BP >185 systolic or >110 diastolic glucose<2.8 or >22mol/L
in which type of stroke must there be hemianopia?
lacunar
what type of stroke has the highest chance of death?
TACS
what are the main causes of early onset stroke?
arterial dissection - vertebral/carotid
cariogenic - AF, ASD, PFO
what are the differential diagnoses of stroke?
post ictal states i.e. Todd's paralysis hypoglycaemia intracranial massess vestibular disease bells palsy functional hemiparesis migraine demented patients with UTI's
what is the main risk of thrombolysis?
bleeding
what is a transient ischaemic attack?
temporary disruption in the blood supply to the brain causing neurological deficits but resolves within 24 hours
(most resolve within 2-60 mins)
what are the causes of ischaemic stroke?
large artery atherosclerosis cardioembolic i.e. AF small artery occlusion i.e. lacunae undetermined/cryptogenic arterial dissection venous sinus thrombosis
what are the causes of haemorrhage stroke?
primary intracranial haemorrhage
secondary intracranial haemorrhage
- subarachnoid
- arteriovenous malformation
