Cerebrovascular Disease Flashcards
What is a stroke?
A rapidly developed condition of focal/global loss of brain function.
What is the most common cause of a stroke?
Infarction
Asides from infarction, what are other causes of stroke?
Subarachnoid haemorrhage
Intracerebral haemorrhage
What are the potential causes of a cerebral haemorrhage?
Hypertension
Amyloid angiopathy
Structural abnormality
What is the first-line imaging in those suspected to have suffered a stroke?
CT brain
Can take time to appear in infarction (hyperacute scan will be normal).
What form of imaging is second-line to CT scan in stroke?
MRI scan
What is the aim of stroke treatment?
Reperfuse the affected tissue.
Time = Tissue.
What 3 signs should be tested for in a suspected stroke?
Facial weakness
Arm weakness
Speech problems
What is the main method of treatment in stroke?
Thrombolysis
When is thrombolysis contraindicated?
Intracerebral haemorrhage
Atrophy
High BP
Diabetes
Why should CT always be performed prior to thrombolysis therapy in suspected stroke?
To ensure causation is a clot and not a haemorrhage.
What is endovascular therapy?
The physical removal of a clot. Does not involve any drug treatment.
Should antiplatelets be given in stroke?
Yes
If thrombolysed, wait 24 hrs and CT scan for any damage prior to initiation.
How should a mild stroke be managed long-term?
Aspirin and clopidogrel - 3 weeks.
Give a single antiplatelet therapy thereafter.
What is used to prevent DVT in those immobilised by a stroke?
Intermittent pneumatic compression.
What are TIAs?
Transient episodes of temporary arterial occlusion.
Lasts less than 24 hours.
What is the difference between a stroke and a TIA?
Stroke lasts > 24 hours.
TIA lasts < 24 hours.
When is a diagnosis of TIA made?
Following the cessation of symptoms.
Why is it important to manage a TIA effectively?
It can lead to a stroke within a few days.
How is a TIA investigated?
Carotid imaging
ECG
Blood tests
How is a TIA managed?
Antiplatelet therapy
Statin therapy
Should hypertension be treated in those with an infarct stroke?
No, as this may be the factor allowing the brain to be perfused.
Should hypertension be treated when giving thrombolysis?
Yes, as this may result in haemorrhage.
If systolic >150mmHg in case of primary intracerebral haemorrhage, what should be given?
Antihypertensives for atleast 7 days.
IV GTN can be used for rapid relief.
What is used to reverse the effects of warfarin?
Vitamin K
Where does an intracerebral haemorrhage occur?
Within the brain parenchyma.
What is the most common cause of intracerebral haemorrhage?
Trauma.
What is amyloid angiopathy?
The deposition of amyloid in the blood vessel walls, weakening them.
This disrupts the blood brain barrier.
Where are intracerebral haemorrhages linked to hypertension typically seen?
Basal ganglia
What are focal symptoms seen in ICH?
Paresis Dysphagia/Aphagia Numbness Seizure Visual symptoms
What are global symptoms seen in ICH?
Headache
Nausea + Vomiting
Reduced GCS
Pupils
How is ICH treated?
Surgery
What are the 3 categories of the GCS?
Eye response
Verbal response
Motor response
How is ICH diagnosed?
Digital subtraction angiography is gold standard.
What do Hounslow’s units differentiate between?
Calcium deposits and blood.
Where is the most common area for a cerebral artery aneursym?
Anterior communicating artery
What is the appearance of a cavernoma?
Has a characteristic ‘pop-corn’ appearance.
What does haemosiderin presence indicate?
Multiple cavernoma
