Cerebral Infarction Flashcards
What is a big prognostic factor in stroke?
Ageing
What is a stroke?
Sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting >24 hours
What % of strokes are ischaemic
85%
What % of strokes are hemorrhagic?
15%
What is a TIA?
Mini stroke
Symptoms resolve within 24 hours
What does stroke risk increase with?
Age
What is the FAST approach?
Facial weakness
Arm weakness
Speech
Time - call 999
Why are MRI’s not often used as imaging even though they are better for imaging strokes?
Because they take time
And are impractical for such an acute situation
How does blood show on CT?
White
Why is CT good for imaging stroke?
Blood shows up white
Good for distinguishing ischaemic and haemorrhagic
What causes ischaemic stroke?
Failure of cerebral blood flow to a part of the brain
Interruption of the blood supply to the brain
What is anoxia?
No oxgen
What are the non-modifiable risk factors for stroke?
Previous stroke
Being old
Male
Bad FH
What is the most important modifiable risk factor for stroke?
Hypertension
What are the modifiable risk factors for stroke?
Hypertension High lipid levels Alcohol and obesity Smoking DM
What is necrosis?
Cell death
What effect does chronic hypertension have of the brain?
Worsens atheroma
Affect small distal arteries
By what fold does DM increase the incidence of stroke?
By 3 fold
By what fold does smoking increase the incidence of cerebral infarction?
2 fold
By what fold does smoking increase the incidence of sub-arachnoid haemorrhage?
3 fold
Which factors contribute to LDL-C deposition in the arterial walls?
Hypertension
Smoking
DM
How do small amounts of alcohol affect your stroke risk?
Decreases it
How does heavy drinking affect you stroke risk?
Increases it
Which OCP increases stroke risk?
Oestrogen content ones only
Describe the anterior circulation of the brain
2x ICA
2x anterior cerebral artery
2x middle cerebral artery
Describe the posterior circulation of the brain
2x vertebral arteries
3 pairs of cerebellar arteries
2x posterior cerebral arteries
How is the anterior circulation of the brain connected to the posterior circulation of the brain?
By the circle of willis
What are the symptoms of ACA occlusion?
Contralateral paralysis of foot and leg
Sensory loss over foot and leg
Impairment of gait and stance
What are the symptoms of MCA occlusion?
Contra-lateral paralysis of face/arm/leg sensory loss face/arm/leg homonymous hemianopia Gaze paralysis to the opposite side Aphasia stroke - if on dominant side Unilateral neglect and agnosia for half of external space - non-dominant side
Which type of stroke has the worst prognosis?
TACS
What is TPA?
Tissue plasminogen activator
What is the function of TPA?
Anticoagulant
Breaks down blood clots
What is the cut off time of use of TPA?
<4.5 hours
What is included in the exclusion criteria for IV TPA?
Anything that increases probability of haemorrhage
i.e blood on CT, recent surgery, recent bleeding episode, coagulation problems
BP >185 systolic or >110 diastolic
Glucose <2.8 or >22 mmol/L
Who are some of the member of the disciplinary team involved in dealing with stroke patients?
Clinical staff Stroke nurse Physio Speech and language therapist Occupational therapists Dietician Psychologists Orthoptist
What is the treatment for stoke?
IV TPA
Aspirin
Thrombectomy
What is TIA a warning sign of?
Stroke
What blood test investigations are carried out for stroke?
FBC
Glucose
Lipids
ESR
What other investigations are carried out for stroke?
CT MRI ECG Echo Carotid doppler Cerebral angiogram Hyper-coagulable blood screen
What treatments can be given as secondary prevention?
Anti-hypertensives Anti-platelets Lipid lowering drugs Warfarin for AF Carotid endarectomy
