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Y2 Neurology > Cerebral Infarction > Flashcards

Cerebral Infarction Flashcards

1
Q

what % of stroke patients will die within a year?

A

1/3rd

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2
Q

what type of stroke is more common?

  1. ischaemic
  2. haemorrhagic
A
  1. ischaemic (85%)
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3
Q

what is the definition of a stroke?

A

the sudden onset of focal or global neurological symptoms caused by disruption of blood supply (ischemia or hemorrhage) and lasting more than 24 hours.

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4
Q

what are the main causes of ischaemic strokes?

A

atherosclerosis
cardioembolism
small artery occlusion
cryptogenic

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5
Q

what is the most common cause of a haemorrhagic stroke?

A

primary intracerebral haemorrhage

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6
Q

what percentage of strokes are haemorrhagic ?

A

15%

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7
Q

is the incidence of the different types of strokes the same over the world?

A

no

- in asia there is a slightly higher number of haemorrhagic strokes

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8
Q

what are the advantages of CT scans?

A

cheap
fast
can show bone very well

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9
Q

what are the pros and cons of MRI scans?

A

pros

  • show more detail
  • can show soft tissue very well
  • very good for ischaemic strokes
  • uses no radiation

cons
- takes longer

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10
Q

why is it good to do scans when the diagnosis is unclear?

A

good to get a diagnosis and to plan the treatment of the patient

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11
Q

how many deaths are there in the UK per year due to stroke?

A

67,000

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12
Q

state the cascade of ischaemia

A
  1. failure of cerebral blood flow
  2. interruption of blood supply
  3. can result in hypoxia
  4. prolonged hypoxia and result in anoxia
  5. anoxia results in infarction and necrosis
  6. further damage from oedema
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13
Q

what is ischaemic penumbra ?

A

the area of damage around the ischaemic core

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14
Q

what are the non modifiable risk factors of stroke?

A
  • age
  • male
  • family history
  • previous stroke
  • genetics
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15
Q

what are the modifiable risk factors of stroke?

A 
hypertension 
smoking 
cholesterol 
diet 
alcohol 
high BMI
diabetes
cardiac problems
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16
Q

what does high lipid levels increase the risk of?

A

Atheroma

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17
Q

what artery supplies the face, mouth and hand of the homunculus ?

A

middle cerebral artery

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18
Q

what artery supplies the arm, trunk and legs of the homunculus ?

A

anterior cerebral artery

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19
Q

what artery supplies the brocas area?

A

middle cerebral artery

20
Q

what are the symptoms of a MCA occlusion ?

A

contra-lateral

  • paralysis of face,arm,leg
  • sensory loss
  • homonymous hemianopia
  • aphasia if dominant side is affected (left)
21
Q

what main areas of the brain are affected with a MCA occlusion ?

A

brocas area
wernickes area
auditory area
sensory and motor areas

22
Q

with a MCA occlusion which direct do the eyes gaze?

A

gaze towards the damaged side of the brain

and away from the paralysis

23
Q

what is visual agnosia ?

A

when you can see one side of the lecture hall and not the other

24
Q

what is sensory agnosia ?

A

when you can only feel one finger when the doctor was touching both sides of your body

25
Q

what is anosagnosia?

A

neglect one side of their body

- refuse to believe one of their arms was there

26
Q

what is prosopagnosia ?

A

failure to recognise faces

27
Q

what is a good test to get the patient to do to test for neglect syndrome ?

A

ask them to draw a clock face and they will draw all the numbers on one side

28
Q

what occurs during lacunar strokes ?

A

the small artery branches off the middle cerebral artery have a much smaller diameter compared to the MCA
therefore the high blood pressure can cause the small more fragile artery to rupture

29
Q

what area of the brain tends to be affected by lacunar strokes ?

A

basal ganglia

30
Q

what are the symptoms of lacunar strokes ?

A

pure motor and sensory symptoms

- no cortical signs e.g. visual or speech problems

31
Q

what are the symptoms of brain stem dysfunction due to a PCA occlusion ?

A 
coma 
vertigo 
nausea
cranial nerve palsy 
ataxia 
hemiparesis 
hemisensory loss 
visual field defects
32
Q

what three things should be done in the acute management of an ischaemic stroke?

A
  • restore blood supply
  • prevent extension of damage
  • protect vulnerable brain tissue
33
Q

what members of staff are involved with stroke patients ?

A 
stroke nurses 
physiotherapists 
speech and language therapists 
occupational therapists 
dietitian 
psychologist 
orthoptist
34
Q

what are the four classifications of strokes ?

A

TACS
PACS
LACS
POCS

35
Q

what classification of stroke has the highest death rate?

A

TACS

- total anterior cerebral stroke

36
Q

what are the 4 criteria for TPA?

A

symptoms onset <4.5 hrs
symptoms present >60mins
disabling neurological deficit
consent obtained

37
Q

what does TPA stand for?

- treatment for strokes

A

tissue plasminogen activator

38
Q

what are some contraindications for TPA?

A 
haemorrhage possibility on CT scan 
recent surgery 
recent episodes of bleeding 
coagulation problems 
warfarin, aspirin 
high BP >185/110
glucose <2.8
39
Q

what is the trial called which showed that thrombectomy reduces death and disability form stroke?

A

ESCAPE

40
Q

is it important to plan secondary prevention for TIA patients ?

A

yes

- TIA patients have a high risk of stroke

41
Q

what are some secondary prevention managements which can be used in stroke patients ?

A

anti platelets
anti hypertensives
statins
warfarin for AF

42
Q

state some causes of TIAs

A
  • atherosclerotic narrowing
  • cardioembolism
  • hypercoaguable state
  • arterial dissection
  • venous sinus thrombosis
43
Q

what investigations should be done for stroke patients ?

A 
routine bloods 
- FBC, Glucose, Lipids, ESR
CT/ MRI 
- infarct, haemorrhage 
ECG 
- AF, LVH 
Echocardiogram 
- valves, ASD 
Carotid doppler US 
- stenosis
Cerebral angiogram 
- vasculitis 
Hyper-coagulable blood screen
44
Q

what are some differential diagnoses for strokes ?

A 
hypoglycaemia 
Bell's palsy 
vestibular disease 
migraine 
demented patients with UTIs
Intracranial masses
45
Q

what are the objectives of stroke care?

A
  • reduce mortality
  • reduce disability
  • improve care of patients and care givers
  • improve patient and care givers knowledge
  • maximise QOL

Y2 Neurology (52 decks)

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