cerebrovascular disease Flashcards by Evie Mander

what is the difference between a stroke and a TIA

TIA symptoms resolve within 24 hours

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what are the 2 types of stroke

haemorrhagic
ischaemic

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which is the more common type of stroke

ischaemic

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what is an ischaemic stroke

when blood supply in a cerebral vascular territory is reduced due to stenosis or complete occlusion of a cerebral artery

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what classification is used for the causes of ischaemic stroke

TOAST

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what is included in the toast classification

large artery atherosclerosis
cardioembolism
small vessel disease
stroke of other determined aetiology
stroke of undetermined aetiology

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what would make a stroke have undetermined aetiology

if there are > 2 potential causes identified or incomplete evaluation

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how do small vessel disease strokes present

as lacunar infarcts

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what causes small vessel disease strokes

lipohyalinosis

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what is a cryptogenic stroke

no identifiable cause even with extensive investigation

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what is a haemorrhagic stroke

where there is a rupture of a cerebrospinal artery

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name some risk factors for haemorrhagic stroke

trauma, neck manipulation
female gender
connective tissue disease, URTI, migraine

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name some risk factors for ischaemic stroke

age, male sex, FHx, hypertension, smoking, DM, AF

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what is the most common cause of a young stroke and why

patent foramen ovale
blood clots bypass the lungs and travel to the brain

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how would we identify a patent foramen ovale

transthoracic echocardiogram

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what is a penumbra

area of brain with reduced cerebral blood flow, but getting O2 and glucose from collateral arteries

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what are symptoms of a stroke affecting the anterior or middle cerebral artery

numbness, sudden muscle weakness

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where is broca’s area found

left frontal lobe

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what is a sign of a stroke affecting broca’s area

slurred speech

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where is wenicke’s area

left temporal lobe

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what is a sign that a stroke has affected wenicke’s area

difficulty understanding speech

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what is a sign of a posterior cerebral artery stroke

vision affected

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what are some general symptoms of a stroke

SUDDEN
weakness of limbs
facial weakness
dysphasia
visual or sensory loss

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what is a rare but classic presentation of basilar artery syndrome

locked in syndrome

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what movement can a patient with locked-in syndrome produce

blinking and vertical eye movements

what is the most severe type of stroke

total anterior circulation syndrome

what happens in TACS

anterior and middle cerebral arteries are involved

how do we define TACS (3)

- Contralateral hemiplegia or hemiparesis, AND - Contralateral homonymous hemianopia, AND - Higher cerebral dysfunction (e.g. aphasia, neglect)

what does PACS stand for

partial anterior circulation syndrome

what is PACS

anterior or middle cerebral artery is affected

how do we define PACS (2)

- 2 out of the 3 features present in a TACS OR - Higher cerebral dysfunction alone e.g. dysphagia

what does POCS stand for

posterior circulation syndrome

what does TACS stand for

total anterior circulation syndrome

what does POCS involve

vertebrobasilar arteries and associated branches supplying the cerebellum, brainstem and occipital lobe

how is POCS defined (5)

- Cerebellar dysfunction, OR - Conjugate eye movement disorder, OR - Bilateral motor/sensory deficit, OR - Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit, OR - Cortical blindness/isolated hemianopia

what are lacunar infarcts

small infarcts around deeper parts of the brain caused by occlusion of a single deep penetrating artery

which type of stroke has the best prognosis

lacunar infarcts

what are the 4 types of lacunar infarcts

pure motor pure sensory sensorimotor ataxic hemiparesis

what causes a pure motor stroke

infarction of the internal capsule, corona radiata or pons

presentation of a pure motor stroke

contralateral hemiparesis without sensory, visual or language impairment

what causes a pure sensory stroke

infarct in the thalamus

presentation of a pure sensory stroke

sensory deficits affecting one side of the body without motor deficits

which part of the brain is often affected in a sensorimotor stroke

thalamocapsular region

presentation of a sensorimotor stroke

combined motor and sensory deficits on the same side

what usually causes ataxic hemiparesis

infarct in the pons or internal capsule

how does ataxic hemiparesis present

weakness and incoordination on the same side

what should not be present in a lacunar infarct

visual field defects, higher cerebral dysfunction or brainstem dysfunction

what is a common general obs identified in patients following a stroke

elevated BP

what scoring tool is used to recognise a stroke in the ER and what score is clinically significant

ROSIER score >0 stroke is likely

how do we differentiate between types of stroke

CT head

what investigation should also be performed is thrombectomy is indicated

CT contrast angiography

what is primary management of ischaemic stroke

thrombolysis or thrombectomy

what is used to perform thrombolysis in stroke

alteplase

what is the mechanism of action of alteplase

tissue plasminogen activator

when is thrombolysis indicated for managing stroke

patients presenting within 4.5 hours with no contraindications

what are some contraindications for thrombolysis

previous haemorrhage or infarct, high BP, anticoags, surgery/head trauma, pregnancy

when is mechanical thrombectomy indicated in stroke patients

with anterior circulation strokes within 6 hrs posterior circulation strokes within 12 hours

what is used in patients with ischaemic stroke if hyper-acute management cannot be offered

aspirin 300mg once daily for 2 weeks

what is started for patients 24 hours after hyper-acute management of ischaemic stroke (and on what condition)

aspirin - given there has been a repeat CT to exclude new haemorrhage

when might decompressive craniectomy be considered in the management of stroke

within 48 hours in MCA strokes causing infarction of >50% of the teritory

what is used as secondary prevention in ischaemic stroke

antiplatelet therapy - clopidogrel

name some other secondary prevention interventions used for patients following a stroke

antihypertensives statins diabetic control smoking cessation

what is a TIA

transient ischaemic attack

how long do symptoms last in a TIA

<24 hours

what is the usual cause of a TIA

microemboli

what is often the first clinical sign of internal carotid artery stenosis

amaurosis fugax

what is amaurosis fugax

transient loss of vision in one eye

what is the general presentation of a TIA

sudden loss of function, usually lasting for minutes, with complete recovery and no evidence of infarction on imaging

what investigations are used in a suspected TIA

carotid duplex ultrasound ECG blood tests

management of a TIA

antiplatelet therapy - aspirin surgery and stenting for carotid stenosis