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Finals - Neurology > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

What are the 2 key features of a stroke

A
  1. Sudden onset of symptoms

2. Focal neurology

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2
Q

Causes of Strokes

A
  1. Ischaemic (vaso-occlusive_
    - 85% of cases
    - Thromboembolic
    - In situ blockage (small vessel - lacunar)
  2. Haemorrhagic
    - Considered in: Marked HTN, anticoagulants, prominent headache
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3
Q

What is a TIA

A

Cerebrovascular incident lasting <24 hours

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4
Q

What artery is occluded to cause Amaurosis Fugax

A

Ophthalmic branch of internal carotid

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5
Q

What is the significance of a TIA

A

Suggests active plaque

  • High risk of subsequent stroke
  • 50% of strokes after TIA are within a week
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6
Q

TIA - Investigations

A

Determine source

  • Carotid ultrasound
  • Echo
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7
Q

What level of artery occlusion indicates endarterectomy

A

> 70%

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8
Q

What are the clinical features of an Anterior Circulation stroke

A
  1. Contralateral Hemiplegia
  2. Homonymous Heminaopia
  3. Higher cerebral dysfunction
    - dysphagia/motor neglect depending on hemisphere
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9
Q

Difference between TACS + PACS

A

TACs

  • Occlusion of anterior + middle cerebral arteries
  • All 3 clinical features of an anterior stroke

PACs

  • Occlusion of anterior/middle cerebral artery
  • 2/3 clinical features of an anterior stroke
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10
Q

Clinical features of a Posterior circulation stroke

A

Vague, any combination is suggestive

  • Diplopia
  • Dysarthria
  • Dysphagia
  • Unsteadiness
  • Unilateral weakness
  • Bilateral vision loss
  • Amnesia
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11
Q

Posterior Circulation stroke prognosis

A

Tends to be catastrophic

Can lead to
- coma, pinpoint pupils, paresis, pyrexia

Can also lead to death

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12
Q

What is a Lacunar stroke

A

Small vessel occlusion

May cause internal capsule strokes
- pure motor or pure sensory deficits

Tends not to have ocular involvement

Better recovery

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13
Q

What is the gold standard investigation for suspected stroke

A

CT head

- determines whether ischaemic or haemorrhagic

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14
Q

What additional imaging can be done for ischaemic strokes

A
  • Carotid ultrasound
  • Echo

To determine cause

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15
Q

What additional imaging can be done for haemorrhagic strokes

A

Angiography

  • if clinical picture poor
  • if suspected subarachnoid haemorrhage
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16
Q

What is the acute management of ischaemic strokes

A

Thrombolysis (alteplase)
- if within 4 hours

Aspirin 300mg
- then 75-100mg for subsequent days

17
Q

What is the acute management for haemorrhagic strokes

A

Lower BP
Stop anticoagulants
Consider neurosurgical input
- for surgical drainage

18
Q

What is the additional acute management for both type of strokes

A
  • Move to stroke ward: appropriate nursing
  • Assess swallow: potentially NG tube
  • Physiotherapy: prevent contracture
19
Q

What is the long term management of strokes

A
  • Address cardiovascular risk factors
  • Carotid endarterectomy (occlusion >70%)
  • Managment/Prevention of disability: MDT
20
Q

What are the main causes of Subarachnoid Haemorrhages

A
  • Ruptured berry aneurysm (70%)

- AV malformation (10%)

21
Q

Subarachnoid Haemorrhage - Clinical Features

A
  • Thunderclap headache (classic)
  • Signs: none > meningism > coma
  • No focal neurology
22
Q

Subarachnoid Haemorrhage - Investigations

A
  • CT head (usually diagnostic)
  • Lumbar puncture >12hr after onset (if CT unclear)
  • Angiogram (locate aneurysm)
23
Q

What will a lumbar puncture show with a subarachnoid haemorrhage

A

Xanthochromia (presence of bilirubin)

24
Q

Subarachnoid Haemorrhage - Management

A

BP control

  • acutely maintain at 150
  • long term lower

Endovascular occlusion/Open surgical clipping

25
Q

Subarachnoid Haemorrhage - Prognosis

A

Poor

<40% have a good outcome

26
Q

Main causes of brain shrinkage

A
  • Old age
  • Dementia
  • Alcohol excess
27
Q

What is the pathophysiology of a Subdural haemorrhage

A
  • Venous blood leaks into subdural space
  • Osmotic effect: sucks fluid from extracellular space
  • Creates space-occupying lesion effect
  • Expands slowly over several weeks
28
Q

Subdural Haemorrhage - Clinical Features

A
  • History of trauma
  • Slow progression of focal neurology
  • Older patients less specific: ‘off-legs’
29
Q

Subdural Haemorrhage - Investigations

A 
CT head (diagnostic)
- remember old blood looks different
30
Q

Subdural Haemorrhage - Management

A

Surgical Drainage

- even in older patients

31
Q

Venous Sinus Thrombosis - Demographics

A
  • 75% are female

- Typically younger patients

32
Q

What are the 2 causes of Venous Sinus Thrombosis

A
  1. Local cerebral vein occlusion
    - Focal neurology
    - Highly epileptogenic
  2. Cerebral sinus occlusion
    - Focal neurology
    - Raised ICP (headaches)
33
Q

Venous Sinus Thrombosis - Clinical features

A
  • Wide variation - depends on which vein
  • Can be acute or subacute
  • Headache/papiloedema (sinus)
  • Seizures (vein)
  • Disorders of consciousness
34
Q

What is the diagnostic investigation for Venous Sinus Thrombosis

A

MRI with contrast angiography

35
Q

Management

A
  • Heparin
  • Local thrombolysis
  • Mannitol +/- acetazolamide (raised ICP)
  • Surgical removal

Finals - Neurology (6 decks)

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