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Neurology > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

Risk factors for intracranial haemorrhage

A

Head injury

Hypertension

Aneurysms

Ischaemic stroke can progress to haemorrhage

Brain tumours

Anticoagulants e.g. warfarin

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2
Q

Presentation of intracranial haemorrhage

A

Sudden onset headache is key feature

Seizures

Weakness

Vomiting

Reduced consciousness

Other sudden onset neurological symptoms

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3
Q

What is a transient ischaemic attack?

A

Sudden onset focal neurological deficit of vascular aetiology, with symptoms typically lasting less than 1 hour, and no evidence of acute infarct on imaging

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4
Q

Risk factors for TIA

A

Diabetes mellitus

High cholesterol

Hypertension

Smoking

Family history of cardiovascular disease/stroke

Atrial fibrillation is a risk factor for cardio-embolic TIAs

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5
Q

Presentation of TIA

A

Sudden onset, focal neurological deficit

Features resolve typically within 1 hour

Unilateral weakness or sensory loss

Aphasia or dysarthria

Ataxia, vertigo, or loss of balance

Visual problems (amaurosis fugax, diplopia, homonymous hemianopia)

Absence of headache

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6
Q

Investigations in TIA

A

MRI to assess territory

Carotid imaging

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7
Q

Management of TIA

A

Immediate antithrombotic therapy - 300mg aspirin

Secondary prevention for CV disease

Refer to stroke specialist

Advise not to drive until they have seen specialist

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8
Q

Define cerebral infarction (stroke)

A

Sudden onset focal neurological deficit of vascular aetiology, with symptoms lasting >24 hours (or with evidence of infarction on imaging)

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9
Q

Risk factors for stroke

A

Cardiovascular disease

Previous stroke or TIA

Atrial fibrillation

Carotid artery disease

Hypertension

Diabetes

Smoking

Vasculitis

Thrombophilia

Combined contraceptive pill

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10
Q

Aetiology of stroke

A

85% ischaemia/infarction

15% intracranial haemorrhage

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11
Q

Clinical features of stroke

A

Typically asymmetrical

Sudden weakness of limbs

Sudden facial weakness

Sudden onset dysphasia (speech disturbance)

Sudden onset visual or sensory loss

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12
Q

Which areas do total anterior circulation infarcts involve?

A

Middle and anterior cerebral arteries

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13
Q

Which areas do partial anterior circulation infarcts involve?

A

Smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

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14
Q

Which areas do lacunar anterior circulation infarcts involve?

A

Perforating arteries around the internal capsule, thalamus and basal ganglia

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15
Q

Which areas do posterior anterior circulation infarcts involve?

A

Vertebrobasilar arteries

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16
Q

How do LACIs present?

A

One of:

Unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all three

Pure sensory stroke

Ataxic hemiparesis

17
Q

How do POCIs present?

A

One of:

Cerebellar or brainstem syndromes

Loss of consciousness

Isolated homonymous hemianopia

18
Q

Investigations in stroke

A

Diffusion-weighted MRI

Carotid USS

19
Q

Management of stroke

A

Admit to specialist stroke centre

Exclude hypoglycaemia

Immediate CT brain to exclude intracerebral haemorrhage

Aspirin 300mg stat (continue for 2 weeks)

Thrombolysis with alteplase

20
Q

Thrombolysis vs. thrombectomy

A

Within 4.5hrs - thrombolysis with alteplase

> 4.5hrs and within 24hrs - thrombectomy

21
Q

Thrombolysis contraindications

A

Previous intracranial haemorrhage

Seizure at onset of stroke

Intracranial neoplasm

Suspected subarachnoid haemorrhage

Stroke/traumatic brain injury in last 3 months

LP in last 7 days

GI bleed in last 3 days

Active bleeding

Pregnancy

Oesophageal varices

Uncontrolled HTN

22
Q

Stroke secondary prevention

A

Clopidogrel 75mg OD

Anti-hypertensive 2 weeks post-stroke

Atorvastatin 20-80mg OD

Treat modifiable risk factors

Surgery if ipsilateral carotid artery stenosis

23
Q

Causes of subarachnoid haemorrhage

A

Intracranial aneurysm

Arteriovenous malformation

Pituitary apoplexy

Arterial dissection

Mycotic (infective) aneurysms

Perimesencephalic (an idiopathic venous bleed)

24
Q

Clinical features of subarachnoid haemorrhage

A

Sudden onset thunderclap (or baseball bat) occipital headache

Nausea and vomiting

Meningism(photophobia, neck stiffness)

Coma

Seizures

Sudden death

ECG changes includingST elevationmay be seen

25
Q

Investigations in subarachnoid haemorrhage

A

CT head

LP - used to confirm if CT negative

26
Q

What will LP show in subarachnoid haemorrhage?

A

Xanthochromia

27
Q

Management of subarachnoid haemorrhage

A

Refer to neurosurgery

Bed rest, well-controlled BP

Coil/clip

28
Q

Complications of subarachnoid haemorrhage

A

Re-bleeding (10%)

Vasospasm

Hyponatraemia

Seizures

Hydrocephalus

Death

Neurology (20 decks)

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