Clinical Aspect Of Stroke Flashcards
What is a stroke?
Disturbance of cerebral function with symptoms lasting longer than 24 hours due to an issue of vascular Origin, caused by ischaemia or haemorrhage.
What is a transient ischaemic attack?
Blood supply from the carotid and vertebra-basilar arteries to the brain is temporarily disrupted which results in a sudden focal loss of neurological function that lasts up to 24 hours. Patients make a full recovery and diagnosis is made retrospectively.
Cannot see infarction on imaging.
What is a mimic?
Non-vascular medical conditions which present with similar symptoms as a stroke.
What are chameleons?
Stroke which masquerades as an alternative condition.
What are the symptoms of stroke?
Weakness, sensory loss and disturbance
Vertigo
Dysarthria
Sudden focal neurological deficit
What is the focal neurological dysfunction?
Lesion affecting a specific region of the brain which has an acute onset, and more prevalent in patients with vascular risk factors.
What is the sex presentation of stroke?
Men generally have more strokes; women have more mimics
What is assessed in taking a stroke history?
Risk factors for atherosclerosis and cardiac disease
Family history
Recent physical trauma
Illegal drug use
What is the blood supply to the regions of the brain responsible for consciousness?
Vertebra-basilar arteries- these also supply blood to the regions involved in vision and balance coordination.
What are the hospital assessment tools for stroke?
ROSIER: Recognition Of Stroke In Emergency Room
NIHSS: National Insitute of Health Stroke Scale
These are used in a neurological exam to determine if a stroke has occurred and its severity.
What are the pre-hospital assessment tools for stroke?
FAST: Face, Arms, Speech, Time
BE-FAST: Balance, Eyes, Face, Arms, Speech, Time
What is the presentation of stroke and ICA?
Issues with speech
Vomiting
Visual disturbances
Loss of consciousness
How is a stroke or TIA diagnosed?
Imaging, where TIA is absent on imaging.
What do you look for in imaging for a stroke?
4 Ps:
Perfusion
Pipes: Blood vessels to assess atherosclerosis or haemorrhage
Penumbra
Parenchyma: assess early signs of stroke and rule out haemorrhage
What is penumbra?
Tissue at risk of necrosis if ischaemia continues.
What are the types of imaging used for stroke?
MRI and CT scans which are beneficial because they have a minimal misdiagnosis rate, LOWER in MRIs. Doppler artery ultrasound is used to view the internal carotid artery.
What are the important structural areas in the frontal lobe?
Contains Broca’s area in the dominant hemisphere for expressive speech. It is responsible for bladder and bowel control and contralateral movements of the limbs. This area is supplied by the anterior and middle cerebral artery.
What are the important structural areas in the parietal lobe?
Contains the post central gurus for the somatosensory cortex, and visual pathways. Parietal lobe on the dominant hemisphere is responsible for calculations while on the non-dominant lobe it is important for body image concept and environmental awareness. It is supplied by the anterior and middle cerebral artery.
What are the important structural areas in the temporal lobe?
Contains the auditory cortex and is important for memory and learning. Wernicke’s area is located here for speech comprehension. Olfactory sensation and visual pathways are present here. It is supplied by the middle cerebral artery and anterior choroidal artery.
What are the important structural areas in the occipital lobe?
Important for vision, in the calcarine sulcus. It is supplied by the posterior cerebral artery.
What is the importance of the cerebellum?
Motor learning, cognitive function, balance and coordination. It receives blood supply from the superior cerebellar artery, anterior inferior cerebellar artery and posterior inferior cerebellar artery.
