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Nervous System > Cerebral Infarction > Flashcards

Cerebral Infarction Flashcards

1
Q

What percentage of strokes are ischaemic and what percentage are hemorrhagic?

A

85% ischaemic

15% haemorrhagic

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2
Q

Causes of ischaemic stroke

A

Large artery atherosclerosis
Cardioembolic event e.g. atrial fibrillation
Small artery occlusion
Cryptogenic
Rarer causes e.g. arterial dissection, venous sinus thrombosis

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3
Q

Causes of haemorrhagic stroke

A

Primary intracerebral haemorrhage
Secondary haemorrhage
Subarachnoic haemorrhage
Arteriovenous malformation

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4
Q

What causes ischaemia in the brain?

A

Failure of cerebral blood flow to a part of the brain, caused by an interruption of the blood supply resulting in varying degrees of hypoxia

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5
Q

Effects of hypoxia in the brain

A

Stresses brain metabolism
Causes anoxia if prolonged
Anoxia causes infarction which results in the clinical presentation of stroke

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6
Q

Modifiable risk factors for stroke

A 
Hypertension 
Smoking 
Hypercholesterolaemia 
Diet 
High BMI 
Sedentary lifestyle 
Excessive alcohol consumption 
Oral contraceptive pill
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7
Q

Non-modifiable risk factors for stroke

A

Previous stroke
Increasing age
Male
Family history
Impaired cardiac function e.g. recent MI
Hyper-coagulable states e.g. due to malignancy/genetics

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8
Q

How can hypertension cause a stroke?

A

Chronic hypertension worsens atheroma and affects small distal arteries
Major risk for hemorrhagic stroke

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9
Q

How does smoking increase the risk of stroke?

A

Smokers have a 2-fold increased risk of cerebral infarction and 3-fold increased risk of subarachnoid haemorrhage
Smoking may also worsen cardiac risk factors

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10
Q

How does hyperlipidaemia increase the risk of stroke?

A

Increased serum lipids cause blood vessel wall atheroma

Increased plasma levels of LDLs result in excessive amounts within the arterial wall

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11
Q

How does alcohol increase the risk of stroke?

A

Small amounts decrease risk, but heavy drinking increases the risk by a 2.5-fold

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12
Q

Possible aetiologies for stroke

A 
Atherosclerotic narrowing 
Embolic - cardiac source 
Artery - arterial embolism 
Hypercoagulable state 
Arterial dissection 
Venous sinus thrombosis
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13
Q

What is a stroke?

A

Sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage, lasting more than 24 hours

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14
Q

What is a transient ischaemica attack?

A

Sudden onset of focal or global neurological symptoms which resolves within 24 hours

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15
Q

Clinical presentation of anterior cerebral artery occlusion

A

Contralateral paralysis of foot and leg
Contralateral sensory loss over foot and leg
Contralateral impairment of gait and stance

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16
Q

Clinical presentation of middle cerebral artery occlusion

A

Contralateral paralysis of face, arm and leg
Contralateral sensory loss of face, arm and leg
Contralateraly homonymous hemianopia
Gaze paralysis to opposite side
Aphasia if stroke occurs on dominant side
Unilateral neglect and agnosia for hal of external space if non-dominant stroke

17
Q

Clinical presentation of right hemisphere stroke

A 
Left-sided hemiplegia 
Left-sided homonymous hemianopia 
Left-sided neglect syndromes
Visual agnosia 
Sensory agnosia 
Anosagnosia 
Prosopagnosia
18
Q

Clinical presentation of lacunar stroke syndromes

A 
Devoid of cortical signs - no dysphasia, neglect, hemianopia 
Pure motor stroke 
Pure sensory stroke 
Dysarthria 
Ataxic hemiparesis
19
Q

Anatomy involved in posterior circulation stroke

A

Brainstem
Cerebellum
Thalamus
Occipital and medial temporal lobes

20
Q

Clinical presentation of posterior circulation stroke

A 
Coma
Vertigo 
Nausea 
Vomiting 
Cranial nerve palsies 
Ataxia 
Hemiparesis 
Hemisensory loss 
Crossed sensorimotor deficits 
Visual field defects
21
Q

Acute ischaemic stroke therapies

A 
Restore blood supply 
Prevent extension of ischaemic damage 
Protect vulnerable brain tissue
CT head 
Aspirin 
Heparin 
Neuroprotectant
Tissue plasminogen activator 
Intra-arterial therapy e.g. thrombectomy
22
Q

What are the criteria for tissue plasminogen activator use in acute ischaemic stroke?

A

< 4.5 hours from symptom onset
Disabling neurological deficit
Symptoms present > 60 minutes
Consent

23
Q

Exclusion criteria for use of tissue plasminogen activator in acute ischaemic stroke

A 
Blood on CT 
Recent surgery 
Recent episodes of bleeding 
Coagulation problems 
BP > 185 systolic or > 110 diastolic 
Glucose < 2.8 or > 22mmol/L
24
Q

When is it best to use thrombectomy?

A

For removal of large vessel occlusive/ischaemic stroke

25
Q

Treatment for symptomatic internal carotid artery stenosis

A

Cardiac endarterectomy

26
Q

Investigations for stroke

A 
FBC, glucose, lipids, ESR 
CT/MRI head 
ECG 
Echo 
Carotid doppler ultrasound 
Cerebral angiogram/venogram 
Hyper coagulable blood screen
27
Q

Agents used in secondary prevention of stroke

A 
Antihypertensives 
Anti-platelets 
Lipid lowering agents 
Warfarin for AF 
Carotid endarectomy
28
Q

Differential diagnoses for stroke

A 
Post-ictal states e.g. Todd's paralysis 
Hypoglycaemia 
Intracranial masses 
Vestibular disease 
Bell's palsy 
Functional hemiparesis 
Migraine 
UTIs in patients with dementia
29
Q

Management of stroke after initial medical/surgical intervention

A

Prevention of recurrence
Prevention of complications
Rehabilitation
Re-integration into community

30
Q

Objectives of stroke care

A

Reduce mortality
Reduce residual disability amongst survivors
Improve psychological status of patients and care-givers
Improve patient/carer knowledge
Maximise quality of life

31
Q

Who might be involved in the rehabilitation of a stroke patient? (members of multidisciplinary team)

A 
Clinical staff
Specialised stroke nurses 
Physiotherapists 
Speech and language therapists 
Occupational therapists 
Dietician 
Psychologist 
Orthoptist

Nervous System (44 decks)

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