Cerebrovascular disease Flashcards
What assessment tool should be used in A&E to determine whether patient has likely had a stroke or not?
The ROSIER score
How is CT used to determine which type of stroke a patient has had?
Poor at picking up acute ischaemic lesions but can clearly show haemorrhagic lesions
What four components should be used to describe a stroke?
Type of stroke
Size of stroke
Laterality of stoke
Cause of stroke
Which is the most severe type of stroke?
Total anterior circulation
What are the symptoms of a total anterior circulation stroke?
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss
Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)
What are the symptoms of a partial anterior circulation stroke?
2 out of 3 features of:
Higher dysfunction - dysphasia or visuospatial disturbances
Homonymous hemianopia
Motor and Sensory Defects (>2/3 of face, arm, leg)
Or:
Higher dysfunction alone
Partial motor or sensory defect
What areas of the brain may be affected by a lacunar stroke?
Basal ganglia
Thalamus
White matter
Internal capsule
What is the most common type of lacunar stroke?
Pure motor stroke/hemiparesis
Usually occurs with infarction of the posterior limb of the internal capsule, which carries the descending corticospinal tracts
Which type of stroke has the best prognosis?
Lacunar stroke
What symptoms might be caused by a posterior circulation stroke?
Cranial nerve palsies
Bilateral motor and/or sensory deficits
Conjugate eye movement disorders
Isolated homonymous hemianopia
Cortical blindness
Cerebellar deficits without ipsilateral motor/sensory signs
Which hemisphere is dominant in most people?
Left hemisphere
Which side of the body will be affected by a stroke in the left hemisphere?
Right side
Which side of the body will be affected by a stroke in the right hemisphere?
Left side
What higher functions does the left hemisphere of the brain have?
Spoken language
Reasoning
Number skills
Written language
What higher functions does the right side of the brain have?
Music
Creativity
Spacial orientation
What might a CVA in the dominant hemisphere cause?
Defecits in language (Brocas and Wernickes areas)
What might a CVA in the non-dominant hemisphere cause?
Neglect - spacial awareness
What is the more common type of stroke?
Ischaemic
What is the most common cause of cardioembolic origin of stroke?
Atrial fibrillation
What investigations should be done to detect thromboembolic stroke?
Full Lipid Profile
Blood Pressure
Carotid Scan
ECG
What are the two main causes of ischaemic stroke?
Thrombosis i.e. from atherosclerotic carotid
Embolism of cardiac origin i.e. AF, infective endocarditis, prosthetic heart valve
What are the causes of haemorrhagic stroke?
Hypertension
Arteriovenous malformation
Cocaine/amphetamine use
Trauma
What score is used to determine risk of subsequent stroke following TIA?
ABCD2
