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Systems Nervous System > Cerebral Infarction (Clinical) > Flashcards

Cerebral Infarction (Clinical) Flashcards

1
Q

What is the definition of a stroke?

A

The sudden onset of focal or global neurological symptoms caused by ischemia or hemorrhage and lasting more than 24 hours.

About 85% of strokes are ischemic.

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2
Q

What is a transient ischaemic attack?

A

TRANSIENT ISCHEMIC ATTACK (TIA)

is the term used if the symptoms resolve within 24 hours.

Most TIAs resolve within 1-60 min.

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3
Q

What are the causes of ischaemic stroke?

A

Larger artery atherosclerosis

Cardioembolic (e.g atrial fibrillation)

Small artery occlusion (lacune)

Undetermined/cryptogenic

Rare causes (arterial dissection, venous sinus thrombosis)

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4
Q

What are the haemorrhagic causes of stroke?

A

Primary intracerebral hemmorhage - no tumour or aneurysm (may be as a result of high blood pressure or amyloid angiopathy)

Secondary haemorrhage (subarachnoid haemorrhage, arteriovenous malformation)

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5
Q

Define ischaemic penumbra

A

The area surrounding an ischaemic event

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6
Q

What is the result of anoxia on cells?

A

Infarction - complete cell death leading to necrosis

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7
Q

How can further damage result from a stroke?

A

Edema (depending on size and location of the stroke)

Secondary haemorrhage into the stroke

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8
Q

What are the stages of pathogenesis of ischaemic stroke?

A
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9
Q

What are the non-modifiable risk factors for stroke?

A

–Previous stroke

–Being old

–Being male

–Having a horrible family history

  • Diabetes
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10
Q

What are modifiable risk factors for stroke?

A

Hypertension

Smoking

Cholesterol

Diet

High BMI
Sedentary

Alcohol

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11
Q

What is the most important modifiable risk factor for stroke?

A

Hypertension

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12
Q

What is the problem with chronic high blood pressure?

A

•Chronic hypertension worsens atheroma and affects small distal arteries.

Also a major risk factor in haemorrhagic strokes

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13
Q

Why does increased serum lipid increase stroke risk?

A

Due to blood vessel wall atheroma

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14
Q

What is the result of increased plasma level of LDL?

A

Excessive amounts of LDL within the arterial wall

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15
Q

What is the effect of hypertension, cigarette smoke and diabetes on LDL-C?

A

•Hypertension, cigarette smoke, and diabetes contribute to LDL-C deposition in arterial walls.

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16
Q

How does alcohl affect stroke risk?

A

Small amounts of alcohol reduces stroke risk

Heavy drinking increases stroke risk by 2.5 fold

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17
Q

What is the result of obesity on vascular disease?

A

Risk factor for vascular disease including stroke (especially abdominal obesity)

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18
Q

Other important risk factors

A

Imparied cardiac function (recent heart attack, atrial fibrilaltion)

Oral contraceptives (+HRT) with a high estrogen content. Progesterone only ok

Hypercoagulable states: malignancy, genetic

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19
Q

What comprises the anterior circulation of the brain?

A

2 internal carotid arteries

2 anterior cerebral arteries

2 middle cerebral arteries

20
Q

What comprises the posterior circulation of the brain?

A

2 vertebral arteries - 1 bassilar

3 pairs of cerebellar arteries

2 posterior cerebral arteries

21
Q

What are symptoms of ACA occlusion?

A

Contralateral:

Paralysis of foot and leg

Sensory loss over foot and leg

Impairment of gait and stance

22
Q

What are the symptoms of MCA occlusion?

A

Contralateral

  • Paralysis of face/arm/leg
  • Sensory loss of face/arm/leg
  • Homonymous hemianopia

Gaze paralysis to the opposite side

Aphasia if stroke on dominant (left side)

Unilateral neglect and agnosia for half of external space if non-dominant stroke (usually right side)

Agnosia - inability to interpret sensations and hence to recognise things

23
Q

Whcih part of the optical tract will a lesion cause a problem in 1 eye and 2 eyes?

A

Anything in front of the optic chiasm is a on eye problem

Behind the optic chiasm it is a two eye problem

24
Q

Left hemisphere lesion

A

Hemiplegia, homonymous hemianopia, dysphasia

25
Q

Right hemishphere lesion

A

Visual agnosia

Sensory agnosia

Anosagnosia (denial of hemiplegia)

Prosopagnosia (failure to recognise faces)

26
Q

What type of stroke affects the basal ganglia?

A

Lacunar stroke

27
Q

What are lacunar stroke syndromes?

A

No Cortical signs (dysphasia, neglect, hemianopia)

  1. Pure motor stroke
  2. Pure sensory stroke
  3. Dysarthria - Unclear articulation of speech
  4. Ataxic hemiparesis (weakness/clumsiness likely to be of the leg)
28
Q

Which part of the brain is associated with the posterior circulation of the brain?

A

Brainstem

Cerebellum

Thalamus

Occipital and medial temporal lobes

29
Q

What are symptoms of brainstem dysfunction?

A
  • Coma, vertigo, nausea, vomiting,

cranial nerve palsies, ataxia.

  • Hemiparesis, hemisensory loss
  • Crossed sensori-motor deficits
  • Visual field deficits
30
Q

What are treatments for stroke?

A

TPA - tissue plasminogen activator

31
Q

Wo is part of the multidisciplinary team in the stroke unit?

A
  • Clinical staff
  • Stroke nurses
  • Physiotherapists
  • Speech and Language therapists
  • Occupational therapists
  • Dietitian
  • Psychologist
  • Orthoptist
32
Q

What is the OCSP stroke classification?

A

Total Anterior Circulation Stroke (TACS)

Partial Anterior Circulation Stroke (PACS)

Lacunar Stroke (LACS)

Posterior Circulation Stroke (POCS)

33
Q

Look

A

Note that the lacunar stroke doesn’t have the 3rd box down because it is ‘devoid’ of cortical signs

34
Q

What stroke si the most lethal?

A

TACS

35
Q

What is the criteria before administering TPA?

A

Less than 4.5 hours from symptom onset

Disabling neurological defecit

Symptoms presont for more than 60 minutes (ensures it isn’t a TIA)

Consent

36
Q

What is the exclusion criteria for IV TPA?

A

Anything that increases the possibility of haemorrhage:

Blood on CT

Recent surgery

Recent episodes of bleeding

Coagulation problems

BP is greater than 185 systolic or greater than 110 diastolic

Glucose is less than 2.8 or greater than 22mmol/l

37
Q

How does the effectiveness of TPA change over time?

A

After 6 hours you can’t be sure thrombolysis is of any benefit

38
Q

What is the alternative to medical treamtment of stroke

A

Surgical - endovascular treatment

39
Q

What is the stroke recurrence rate within the first 2 weeks of a TIA

A

10%

40
Q

What are the likely treatments after a TIA occurs?

A

Antiplatelets

Antihypertensives

Statins + endarterectomy

41
Q

What are the investigations for stroke?

A

ESR is an inflammatory molecule

42
Q

What is secondary prevention for stroke?

A
43
Q

What are the differentials for stroke?

A

Bells palsy

Intracranial mass

Migraine

44
Q

What are the objectives of stroke care?

A

Reduce mortality

Reduce disability

Improve psychological status

Improve knowledge

Maximise quality of lofe

45
Q
A

Systems Nervous System (48 decks)

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