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2ND YEAR SYSTEMS: Neuro > Cerebral infarction/understanding Stroke > Flashcards

Cerebral infarction/understanding Stroke Flashcards

1
Q

Definition of stroke

A

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

85% are ischaemic - clot stops blood supply to an area of the brain

15% haemorrhagic - blood leaks into brain tissue

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2
Q

Define TIA

A

term used if the symptoms resolve within 24 hours.

Most TIAs resolve within 1-60 min

warning sign - 10% stroke recurrence within first 2 weeks of TIA

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3
Q

Causes of ischaemic stroke

A

Large artery atherosclerosis (carotid) - plaque etc

Cardioembolic (AF) -Valve disease or LV thrombus

small artery occlusion

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4
Q

Causes of haemorrhagic stroke

A
  1. primary intracerebral haemorrhage 70%

2. secondary haemorrhage 30%- subarachnoid haemorrhage or anteriovenous malformation

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5
Q

Risk factors of stroke: modifiable and non-modifiable

A 
Modifiable:-
Hypertension - most important modifiable RF
smoking
Obesity
Exercise/physical activity
Diet/High cholesterol
Drugs
diabetes
Non-modifiable:-
Previous stroke
Age
Male
Family history
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6
Q

What can chronic hypertension exacerbate?

A

atheroma and increases involvement of smaller distal arteries

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7
Q

What does Hypertension, cigarette smoke and diabetes contribute to?

A

LDL-C deposition in arterial walls - low-density lipoprotein ‘bad’ cholesterol

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8
Q

Other risk factors

A

other cardiac causes - recent heart attack etc

oral contraceptives with high estrogen content

hyper-coagulable states - malignancy, genetic

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9
Q

Anterior circulation in the brain

A

2 internal carotid arteries
2 anterior cerebral arteries
2 middle cerebral arteries

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10
Q

Posterior circulation in the brain

A

2 vertebral arteries - 1 basilar

3 pairs of cerebellar arteries

2 posterior cerebral arteries

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11
Q

What are the borderzone anastomoses?

A

between peripheral branches of anterior, middle and posterior cerebral arteries

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12
Q

Functions of frontal lobe

A 
memory
voluntary eye movement
motor control of speech (dominant)
motor cortex 
urinary continence
emotion and personality
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13
Q

If the Middle cerebral artery is affected then what type of weakness is more common

A

face and arm weakness

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14
Q

If the anterior cerebral artery is affected then what type of weakness is more common

A

leg weakness

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15
Q

Clinical presentations of stroke

A 
Sudden onset loss of function:
Motor (clumsy or weak limb)
Sensory (loss of feeling)
Speech: Dysarthria/ Dysphasia
Neglect / visuospatial problems
Vision: loss in one eye (amaurosis fugax) or hemianopia
Gaze palsy

ataxia/vertigo/incoordination

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16
Q

True or false: Abnormal movements and severe headache is unusual after stroke?

A

True

17
Q

What is the Oxford Community Stroke Project Classification (OCSP)

A

A clinical classification tool that predicts the site and size of the infarct on CT

18
Q

What are the 4 classes of stroke

A

Total Anterior Circulation Stroke (TACS)

Partial Anterior Circulation Stroke (PACS)

Lacunar Stroke (LACS)

Posterior Circulation Stroke (POCS)

19
Q

What does agnosia mean

A

inability to process sensory information

20
Q

Name some neglect syndromes/agnosias

A

Visual agnosia

Sensory agnosia

Anoagnosia (denial of hemiplegia - paralysis of
one side)

Prosopagnosia - failure to recognise faces

21
Q

Effects of Total Anterior Circulation Syndrome (TACS)

A

3/3 of effects:- Complete hemiparesis/numbness

Loss of vision on one side (hemianopia)

Loss of awareness on one side (inattention) non-dominant

or dysphasia dominant

22
Q

What is TACS often caused by?

A

blocked Carotid or middle cerebral artery

23
Q

Effects of Partial Anterior Circulation Syndrome (PACS)

A

2 of 3 TACS criteria

or
One higher cortical deficit:
Inattention or dysphasia

or
Monoparesis

24
Q

Lacunar syndrome (LACS)

A

Subcortical stroke
=> secondary to small artery disease/perforation

Movement and sensation pathways

Weakness/numbness of:
Face + arm + leg
Or Face + arm
Or Arm + leg

May have dysarthria - difficult with articulation of speech

Ataxic hemiparesis - weakness and ataxia on the same side

No affect on higher function
Will not have dysphasia, inattention or hemianopia

25
Q

What does the term ‘higher functions’ mean?

A

higher-order capacities of the human brain can be captured under the terms “cognition” and “behavior.”

Things like intellectual function, memory, speech and language, complex perception, orientation, attention, judgment, planning, and decision-making.

26
Q

Effects of Posterior circulation syndrome (POCS)

A

Any posterior artery - can affect cerebellum and cerebrum

Combination of symptoms including:
Loss of balance/coordination
Vertigo
Double vision
Dysarthria
Visual loss (hemianopia)
27
Q

What does basilar artery occlusion cause?

A

ischaemia in pons

Predominantly motor/oculomotor signs/symptoms

bilateral but asymmetrical

Alteration in level of consciousness common

28
Q

Which class of stroke has the highest and lowest mortality rates at 1 year?

A 
highest = TACS 60%
lowest = LACS 11%
29
Q

Which class of stroke has the highest recurrence rate at 1 year

A

POCS 20%

30
Q

What are some stroke mimics?

A 
seizures
syncope (hypotension)
sepsis
sugar levels
severe migraine
space occupying lesions
demyelination
31
Q

Migraine aura

A

Due to cortical spreading depression

Visual disturbances
scintillating scotomata, geometric (especially zigzag) patterns, positive symptoms (like a kaleidoscope, running water etc)

can include sensory, motor or speech disturbance

Headache onset can be >1hour after the end of the aura or no headache

32
Q

What is hoover’s sign?

A

test hip extension in one leg = weak

test contralateral hip flexion against resistance and the other leg’s hip extension has now become strong

33
Q

Acute ischaemic stroke treatment tries to…

A

restore blood supply

prevent extension of ischaemic damage

protect vulnerable brain tissue

34
Q

Who works in stroke units?

A 
Clinical staff
Stroke nurses
Physiotherapists
Speech and Language therapists
Occupational therapists
Dietician
Psychologist
Orthoptist
35
Q

What is the strict criteria regarding tissue plasminogen activator (tPA) use for stroke

A

< 4.5 hours from symptom onset.

Disabling neurological deficit.

Symptoms present > 60 minutes.

Consent obtained.

36
Q

When would you not give IV TPA

A

if patient has blood on CT scan

has had recent surgery

recent episodes of bleeding

coagulation problems

BP >185 systolic or >110 diastolic

37
Q

Why is time so important when treating stroke

A

time = brain tissue

benefit from TPA declines with time

38
Q

Investigations for stroke

A

Routine blood tests (FBC, glucose, lipids, ESR…)

CT or MRI head scan (infarct vs. hemorrhage)

ECG + Holter (?AF, LVH)

Carotid doppler, ultrasound (?stenosis)

maybe an ECHO, cerebral angiogram/venogram or hypercoagulable blood screen

39
Q

secondary prevention of stroke

A

Anti-hypertensives

anti-platelets

lipid lowering agents
warfarin for AF

Carotid endarterectomy

2ND YEAR SYSTEMS: Neuro (32 decks)

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