Cerebrovascular incl stroke Flashcards
what congenital heart defect is a risk factor for stroke
patent foramen ovale
what is the definition of a stroke
focal/global loss of brain function lasting longer than 24hours
what feature distinguishes stroke and TIA
TIA lasts less than 24hr
what are the 2 main categories of stroke
infract/ischaemic and haemorrhagic
what is the commonest type of stroke? (85%)
infarct
what pathological finding is found on histology in strokes indicating acute neuronal injury (non-specific)
red neurons
ischaemic strokes are further split into categories based on their cause, name these
cardioembolic
atheroembolic/thrombotic
small vessel disease
what type of ischaemic stroke causes a fibrin dependent red thrombus and leukoariaosis
cardioembolic
what type of ischaemic stroke cause a platelet dependent white thrombus
atheroembolic
what is one of the most common sites of atheroembolic strokes
internal carotid bifurcation
arteriosclerosis, microaneurysms, vasculitis and amyloidopathies cause what type of ischaemic stroke
small vessel disease
what is the major risk factor for cardioembolic stroke
atrial fibrillation
where does the thrombus form in cardioembolic strokes
left ventricle
rheumatic heart disease and prosthetic valves are associated with what type of ischaemic stroke
cardioembolic
does hypertension cause a primary or secondary haemorrhagic stroke
primary
do AV malformations cause a primary or secondary haemorrhagic stroke
secondary
do aneurysms cause a primary of secondary haemorrhagic stroke
secondary
arteriosclerotic small vessel disease is most associated with which intracranial blood vessel
middle cerebral artery
5% of strokes are due to what type of intracranial haemorrhage?
SAH
what is the watershed area?
where the territory of 2 arteries meet (less well perfused)
what is the main cause of wedge infarcts in the watershed area?
hypovolaemic shock
what is the commonest visual field defect cause by a stroke
homonymous hemianopia
how would a stroke of the middle cerebral artery present
contralateral face & arm weakness.
dominant side: receptive/expressive dysphagia
how would a stroke of the anterior cerebral artery present
contralateral leg weakness + sensory loss
how would a vertebrobasilar stroke present
vertigo, ataxia, dysarthria, dysphasia
DON’T FORGET TO LOOK UP IMAGES OF SCANS FOR HOW TO IDENTIFY HAEMORRHAGIC AND ISCHAEMIC STROKES!!
DO IT
investigations for a ptx presenting with stroke like symptoms
CT ECG carotid US FBC CRP BP BG lipids
if a carotid US is +ve when investigating stroke, what test should you do next?
carotid angiogram
what test should you do if you suspect a patent foramen ovale?
bubble echo
when investigating stroke, if someone has had symptoms for more than 10 days what imaging modality should you do
MRI not CT
would an MCA infarct stroke appear hyper or hypodense
hyperdense
anterior circulation syndrome can affect which arteries?
anterior cerebral or middle cerebral arteries (both originate from IC)
how is anterior circulation syndrome categorised?
TACS total or PACS partial
TACS is 3/3 and PACS is 2/3 of what signs
- homonymous hemianopia
- cortical sign e.g. dysphagia, neglect
- ipsilateral motor loss of two of face/arm/leg (+- sensory)
lacunary syndrome is due to small deep infarcts, these often effect what type of blood vessel supplying what region of the brain?
penetrating artery
basal ganglia
how does lacunar syndrome present
pure motor deficit to 2 of face/arm/leg
OR
pure hemisensory
an isolated homonymous hemianopia is due to what type of stroke
POCS
a bilateral motor/sensory deficit is due to what type of stroke
POCS
cortical blindness is due to what type of stroke
POCS
what type of stroke is a cerebellar stroke?
POCS
locked in syndrome is due to a POCS stroke of what region of the brain
pons
management of an ischaemic stroke
thrombolysis if <4.5hours.
if over; antiplatelet aspirin
what are the 2 methods of thrombolysis
IV tPA or EVT
side effects of thrombolysis
bleeding eg. intracranial, stomach ulcer, veneflon site
long term management of an ischaemic stroke
after 2 weeks of aspirin, begin long term clopidogrel
what is the method of DVT prevention in stroke
intermittent pneumatic compression
for patients with AF, following a stroke, what medication should you switch aspirin to?
edoxaban
what drugs are options for HTN Mx post stroke
perindopril
indapamide
amlodipine
management of patent foramen ovale to prevent stroke risk
long term aspirin
management of carotid stenosis
carotid endarterectomy
what is one of the differentiating factors in the presentation of vascular dementia and alzeihmer’s? (excluding history of CVD)
vascular dementia has a more abrupt onset
what condition are charcot-bouchard microaneurysms associated with
long standing HTN
