Clinical Stroke- Syndromes And Management Flashcards
What is a stroke
Sudden onset, focal dysfunction
What are the classification of stroke
Cerebral infarct
Intracerebral haemmorhage
Subarachnoid haemorrhage
How does a cerebral infarct happen
- When you get an infarct you block off a blood vessel
- Blood flow drops
- Blood flow less than 10ml/min/100g causes cytotoxic cell death and apoptosis which is irreversible
- Area in the brain dies off (called the core)
- Blood can flow in the area of the blocked vessel by collateral flow which can provide some perfusion
- If blood flow drops to 20-10ml/min/100g you get a penumbra which is when cells are not dead straight away but there is an electrical failure in potential reversible state
- If its in penumbra for a long time it can die off
What are the mechanism for an cerebral infarct
- Large artery disease
- Cardioembolic stroke
- Small artery disease
- Cyrptogenic stroke
- Other causes of stroke: carotid dissection, vasculits, endocarditis
What is large artery disease
This is when there is buildup of cholesterol plaque in large arteries, the plaque can rupture to occlude the vessel
What is a carotid dissection
You get trauma to the blood vessel and a haematoma within the wall, the haematoma can occlude the vessel or rupture into the vessela nd embolise distally
What are the carotid dissection symptoms
Horners syndrome: ptosis, meiosis, anhydrosis
Unilateral pain in face, head and neck
Anterioir ciruclation stroke syndrome
Why does horners syndrome occur in carotid dissection
Due to sympathetic supply of the eye travelling up the carotif which can become damaged when you have a haematoma
What is a cardioembolic stroke
When the blood clots form in the heart and then embolise to the brain. Can be caused by atrial fibirllation (poorly coordinated contraction causes formation of clots in the heart and can embolise to the brain)
What is small artery disease/lacunar stroke
When you get atherosclerosis in small arteries that involve the deep white matter and the brain stem.
Atherosclerosis occurs due to hypertension, diabetes, hyperlipidemia
What are the types of intracerebral haemorrhage
Primary
Secondary
What is primary intracerebral haemorrhage
Due to hypertension and amyloid angiopathy
What is secondary intra cerebral haemorrhage
Deu to a physical problem e,g tumour, impaired coagulation due to warfarin
What is a subarachnoid haemorrhage
Bleeding in the subarachnoid space that will come from berry aneurysm
What is a extradural haemmorhage
Usually a bleed from the middle meningeal artery when you get hit on the side of the head
What is the arterial supply of the brain by
2 internal carotid artery that come off from the common carotid artery
2 vertebral arteries
What does the 2 internal carotid artery and 2 vertebral artery connect to form
The circle of willis
What does the 2 vertebral arteries join together to form
The basilar artery
What does the internal carotif artery become
Middle cerebral artery
Anterioir cerebral artery
What area does the internal carotid artery supply
Anterioir brain
What area does the vertebrobasillar artery supply
Brainstem and cerebellum
What can stroke syndromes be seperated into
Anterioir circulation stroke- from carotid artery supply
Posterior circualtion stroke- from vertebrobascilar circulation
Lacunar stroke- small vessel disease that can be in anterior or posterir circulation
What are the causes of anterior circulartion stroke
Thrombotic occulisin- cardioembolic
Intracerebral haemmorhage secondary to vascular malformation and tumour
What are the signs in anterior circulation stroke
- Contralateral UMN hemiparesis or hemisensory loss e.g upgoing plantars in one feet and other feet normal
- High mental function problem e.g stuttering speech (expressive) or receptive i.e speaking garbage- this is if in dominant left cortex or if non dominant right cortex (difficulty performing a difficult task when motor is ok) e.g not knowing how to dress
- Hemianopia- due to visual pathway affected
What are the types of anterior circulation stroke
Partial- if 2/3
Total 3/3 or feature 2 on its own
What is lacunar syndrome
This can be anterior or posterior:
It can be:
Infarcts in pons and basal ganglia
Deep subcortical haemorrhage
What are the features of lacunar syndrome
Contralateral UMN hemiplegia
Contralateral hemisensory loss
Contralateral upgoing plantar
No cortical problem e.g higher cortical problem
What is posterior circulation syndrome due to
Vertebrobasillar occlusion- large vessel disease and cardiembolic
Or
Brainstem haemorrhage
What are the features of posterior circulation syndrome
Dizziness Vertigo Diplopia Dysphagia Ataxia Cranial nerve palsies Uni/bilateral weakness
What is a transient ischaemic attack
The person has a stroke that lasts less than 24 hours
What are the causes of TIA
Ishcaemia due to large vessel disease, small vessel disease or cardioembolic
