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Neuro finals KTB > Cerebrovascular disease > Flashcards

Cerebrovascular disease Flashcards

1
Q

Define stroke and TIA

A

Stroke: acute neurological deficit lasting >24 hours, caused by cerebrovascular aetiology
TIA: acute neurological deficit caused by ischaemia without evidence of infarction

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2
Q

What are the causes of stroke?

A 
85% ischaemic: thrombotic > embolic 
1) Small vessel atherosclerosis -> lacunar infarction
2) Large vessel atherosclerosis -> TACS, PACS, POCS
3) Embolic 
4) Miscellaneous: vasculitis, PFO, etc
5) Cryptogenic 
10% haemorrhagic 
5% subarachnoid haemorrhage
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3
Q

Name some risk factors for stroke

A
  • Hypertension
  • Smoking
  • T2DM
  • Hyperlipidaemia
  • AF
  • Previous TIA or stroke
  • Other PVD or IHD
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4
Q

What are the different types of ischaemic stroke and how do they present?

A

Circulation:
ACA: contra leg > arm weakness, face sparing
MCA: contra arm > leg weakness, facial droop (forehead sparing), slurred speech, visual deficit
PCA: visual deficit
Lacunar (small vessels around BG, pons, thalamus)

Bamford/Oxford classification:

  • TACS: 1) unilateral weakness 2) homo hemianopia 3) higher cerebral dysfunction (dysphasia, hemispatial neglect)
  • PACS: 2 of the above only
  • POCS: any of CN lesion, bilateral sense/motor, conjugate eye movement disorder, cerebellar dysfunction, isolated homo hemianopia
  • LACS: no loss of higher cerebral function eg. pure motor, pure sensory
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5
Q

Describe the process of diagnosis for acute stroke

A
  • History and examination suggestive
  • Bloods: FBC, U+Es, glucose, clotting, trop
  • ECG and CXR
  • Imaging: non-contrast CT ASAP
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6
Q

Describe the management of acute stroke

A
  • A to E
  • Make the patient NBM
  • IV access and bloods
  • Immediate non-contrast CT head
  • > infarction confirmed. Consider CTA if eligible for thrombectomy
  • Aspirin 300mg and PPI
  • Candidate for thrombolysis: alteplase
  • Or thrombectomy or conservative Mx
  • Admit to acute stroke unit for monitoring and rehab
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7
Q

Describe the management of stroke after acute Mx

A

1) RF control: statin, control BP, reduce HbA1c
2) Antiplatelet: Aspirin 300mg for 2 weeks
-> clopi 75mg or aspirin 75 + dipyridamole MR 200mg
OR warfarin if chronic AF/cardioembolic stroke
3) Carotid endarterectomy (if >70% stenosis)
4) Rehab: MDT with OT, PT, SALT

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8
Q

What tools can be used for diagnosing/managing stroke?

A

ROSIER- Dx of stroke in ED

NIHSS- determine severity

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9
Q

What is the anti platelet/anticoagulation treatment of choice in stroke?

A

Acute: aspirin 300mg for 2 weeks
After 2 weeks: clopidogrel 75mg
-Alternative: aspirin 75mg + dipyridamole 200mg OR aspirin only
-If AF: warfarin aim INR 2.5 or DOAC

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10
Q

What type of thromboprophylaxis should be given to stroke patients?

A

IPCs - intermittent pneumatic compression

Not LMWH or TEDS

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11
Q

What are some contraindications to thrombolysis?

A
  • BP >185/110
  • ?bleed
  • Hx of intracranial bleed
  • Recent LP within 7 days
  • Recent arterial puncture within 7 days
  • Major head trauma, brain, spinal surgery within 3 mos
  • Heparin within 48 hours, current warfarin INR >1.7

Caution if:

  • Surgery within 2 weeks
  • Pregnancy
  • Stroke within 3 months
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12
Q

What are the different treatment options for ischaemic stroke?

A

Conservative: not eligible for thrombolysis or thrombectomy
Medical (Thrombolysis)
Surgical (thrombectomy): proximal ACS within 6 hours of presentation (can extend window with CT perfusion scan)

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13
Q

Name some complications of stroke

A
  • Aspiration pneumonia
  • Haemorrhagic transformation
  • VTE
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14
Q

What is the risk of stroke after TIA?

A

10% in the next 7 days

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15
Q

Describe the diagnosis of TIA

A

Diagnosis is clinical

  • If symptoms resolved: TIA
  • If symptoms ongoing: use NIHSS to determine if thrombolysis is needed
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16
Q

Describe the management of TIA

A
  • Immediate referral to ED (if in community)
  • Bloods: FBC, U+Es, clotting, glucose, lipids
  • Loading dose aspirin 300mg
  • ECG
  • CT head if on anticoagulation
  • Carotid USS
  • Refer to TIA clinic to be seen within 24 hours

-> confirmed: switch aspirin to clopi, start high dose statin, anticoagulation if AF

17
Q

What are some signs and symptoms of TIA?

A 
Anterior circulation:
-Amaurosis fugax
-Dysphasia
Posterior circulation: 
-Isolated homonymous hemianopia
-Vertigo
-Diplopia
-Bilateral limb weakness
18
Q

How should strokes be investigated after acute managment?

A

Bloods: basic bloods, clotting, lipids, HbA1c
ECG: 24 hour tape
Imaging: echo, carotid doppler, MRI (to confirm stroke, usually if CT NAD)
Extra: if no clear aetiology
-> bubble echo, extended tape (7 days), vasculitic screen

Neuro finals KTB (8 decks)

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