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Year 2 Neuro (JK) > Cerebral infarction (clinical) > Flashcards

Cerebral infarction (clinical) Flashcards

1
Q

Define stroke

A

The sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting >24 hours

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2
Q

Are most strokes ischaemic or haemorrhagic?

A

ischaemic

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3
Q

Define transient ischaemic attack

A

Symptoms resolve within 24 hours and usually within 1-60mins

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4
Q

Some causes of ischaemic stroke

A 
large artery atherosclerosis 
small artery occlusion - lacunar 
cardioembolic eg AF
undetermined/cryptogenic 
rare eg arterial dissection
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5
Q

Haemorrhagic stroke causes

A

primary intracerebral haemorrhage

secondary eg subarachnoid haemorrhage or arteriovenous malformation

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6
Q

Is MRI or CT preferred in stroke?

A

CT

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7
Q

Ischaemia

A

Failure of cerebral blood flow to part of the brain caused by interruption of blood supply to brain

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8
Q

Why is hypoxia clinically important in stroke?

A

stresses cell metabolism
can lead to anoxia and infarction/necrosis
penumbra

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9
Q

What is the penumbra?

A

Area surrounding ischaemic event

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10
Q

What can further damage in a stroke result from?

A

oedema

secondary haemorrhage into stroke

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11
Q

Modifiable risk factors of stroke

A

hypertension
smoking
diet/alcohol/lifestyle
diabetes

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12
Q

Non modifiable risk factors of stroke

A

male
age
family history
previous stroke

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13
Q

What can chronic hypertension cause in relation to stroke?

A

worsens atheroma

affects small distal arteries

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14
Q

Small artery lipohyalinosis - what is it?

A

build up of vessel wall - aneurysm and microclots

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15
Q

Some other risk factors for stroke

A

OCP/HRT - oestrogen
impaired cardiac function
malignancy
genetic

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16
Q

Anterior circulation to brain

A

2 ICA –> 2 ACA and 2 MCA

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17
Q

Posterior circulation to brain

A

2 vertebral –> 1 basilar
3 pairs of cerebellar arteries
2 PCA

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18
Q

2 connections of arterial blood supply in the brain

A

circle of willis - anterior and posterior communicating arteries
borderzone anastomoses - between peripheral branches of cerebral arteries

19
Q

symptoms of ACA occlusion (contralateral - 3)

A

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

20
Q

Symptoms of MCA occlusion (contralateral and others)

A

contralateral - paralysis of face, arm, leg
sensory loss of face, arm, leg
homonymous hemianopia
gaze paralysis to opposite side
aphasia if stroke on left side
unilateral neglect and agnosia if on right side

21
Q

Agnosia

A

Inability to process sensory information

22
Q

3 signs left hemisphere is affected

A

hemiplegia
homonymous hemianopia
dysphasia

23
Q

3 signs right hemisphere is affected

A

left hemiplegia
left homonymous hemianopia
agnosia

24
Q

4 agnosias if right side of brain affected

A

visual
sensory
anosagnosia
prosopagnosia

25
Q

anosagnosia

A

denying of hemiplegia

26
Q

prosopagnosia

A

failure to recognise faces

27
Q

What are lacunar strokes devoid of?

A

cortical signs eg dysphasia, hemianopia

28
Q

Anatomy within posterior circulation of brain

A

brainstem, cerebellum, thalamus

occipital and medial temporal lobes

29
Q

List some symptoms of brainstem dysfunction

A

coma, vertigo, nausea, vomiting, ataxia, cranial nerve palsy, hemiparesis, visual field defects

30
Q

3 aims of acute ischaemic stroke therapies

A

restore blood supply
prevent extension of ischaemic damage
protect vulnerable brain tissue

31
Q

List some potential treatments used in stroke

A

aspirin, heparin, tPA, thrombectomy, neuroprotectant

32
Q

List some of the staff in stroke units

A

OT, SLT, physiotherapist, stroke nurses, dietician, psychologist, orthopist, clinical staff

33
Q

Orthopist?

A

For double vision

34
Q

4 types of stroke

A

TACS
PACS
LACS
POCS

35
Q

Which is the most devastating stroke?

A

TACS

36
Q

What are the MUSTS when using TPA

A

consent
symptoms present more than 60 mins but less than 4.5 hours
disabling neurological deficit

37
Q

Contraindications for TPA use

A 
blood on CT 
coagulation problems 
recurrent bleeding 
recent surgery 
high bp
glucose too high or low
38
Q

Investigations of stroke

A 
blood - FBC, ESR, glucose, lipids
CT/MRI 
ECG 
Echo 
carotid Doppler ultrasound 
cerebral angiogram/venogram 
hypercoagulable blood screen
39
Q

Mural thrombus

A

thrombus formed in heart chamber

40
Q

atrial myxoma

A

non cancerous tumour in heart

41
Q

Giant cell arteritis - investigation

A

tender over temporalis

ESR, temporal artery biopsy

42
Q

secondary prevention of stroke

A 
anti-hypertensives 
lipid lowering agents
anti-platelets
warfarin 
carotid endartectomy
43
Q

Some other conditions that look like stroke but aren’t

A

bells palsy
migraine
hypoglycaemia

44
Q

Management and aims of care

A 
rehab and reintegration 
quality of life 
knowledge and improve psychological status 
prevent recurrance 
reduce mortality and disability

Year 2 Neuro (JK) (50 decks)

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