Clinical aspects of stroke Flashcards

1
Q

What does middle cerebral artery supply?

A

supplies lateral hemisphere convexity and underlying cortex and wm

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2
Q

what does porterior cerebral artery supply?

A

medial temporal occipital parietal lobe

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3
Q

what do motor areas give rise to?

A

fibres that come down to coronradiata wmand converge interlal capsule

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4
Q

what affect can an infarct have on the motor system and why/

A

infarct can cause extensive motor deficit (face,arm leg) because fibres are closely packed in the subcortical region

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5
Q

what are clinical signs of ischaemic stroke due to total mca territory infraction

A

hemiparesis
drowsy
hemisensory loss
cortical signs - visual field loss, inattention, neglect

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6
Q

what clinical signs do you see on small deep lacunar infarct (ischaemic stroke)

A

hemiparesis

normal conscious level and no cortical signs

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7
Q

what clinical signs do you see on lower brainstem infarct (ischaemic stroke)

A

right tongue weakness
mild left hemiparesis
left sided sensory loss
no cortical signs

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8
Q

what % is ischameic/haemorrhage

A

80% - ischaemic - loss of blood flow/blockage

20* haemorrhage - bleeding within brain –> 15% primary intracerebral, 5% subarachnoid

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9
Q

What are mechanisms due to risk factors such as hypertension, alchohol, obesity etc. ?

A

small vessel occlusion or rupture
large artery-artery embolism
cardiac embolism
haemodynamic

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10
Q

main causes of ischaemic stroke - embolism (clot goes from one place to another)

A

thrombus, atheramatous material, vegetations
from the heart (atrial fibrillation, valvular heart disease, myocardial infarction)
from the extracranial carotid or vertebrobasilar vessels (atheroma, dissection)

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11
Q

main causes of ischaemic stroke - in situ thrombosis

A

small perforating vessel occlusion (lacunar)
large vessel occlusion
venous occlusion

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12
Q

what are rare causes of ischaemic stroke

A
dissection
vasculitis and SLE
drug
migraine
meningitis
endocarditis
atrial myxoma
antiphospholipid syndrome
Fabry's disease
moya-moya
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13
Q

what is seen on interal carotid artery dissection

A

rapid narrowing of lumen
crescent of blood in the vessel wall
small emboli in the carotid territory

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14
Q

what are symptoms of acute intracerebral haemorrhage and what do you see on CT

A

bright on CT
drowsiness
headache
hypertension

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15
Q

what are rare causes of intracranial haemorrhage

A

cerebral vasculitis
cerebral venous thrombosis
drug abuse
cerbral tumours

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16
Q

what tests do you do to find why the stroke happened

A

bloods
cardiac test
neck vessel imaging

17
Q

what is the most important modifiable risk factor for primary and secondary prevention

A

hypertension

18
Q

what is the treatment of acute stroke

A
drug therapy -->
thrombolysis within 3 hours
aspirin for ischaemic stroke (48 hours)
stroke unit care -->
maintain normal physiology
prevent/treat complications
rehabilitation
19
Q

what can thrombolysis for ishaemic stroke do?

A

in blocked vessel, blood flow goes down to 10ml and infarct can’t salvage
penumber is 10-20ml
surviving > 20ml
Alteplase (rtPA) treatment, improves recovery if given within 4.5 hours

20
Q

what are limitations of IV thrombolysis alone?

A

not good at restoring flow
narrow therapeutic time window
contraindications such as recent surgery, coagulation abnormalities, history of intracranial haemorrhage

21
Q

What can you do apart from thrombolysis

A

thrombectomy