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Week 202 - Stroke > Disease and clinical features > Flashcards

Disease and clinical features Flashcards

1
Q

Definition of a stroke

A

Neurological deficit related to a non-traumatic vascular event

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2
Q

What is the difference between a stroke and a transient ischaemic attack?

A

TIA is a neurovascular event with symptoms lasting less than 24 hours

Stroke more severe

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3
Q

What are the two main categories of stroke and what is the prevalence of each?

A

Ischaemic ~ 80% (Embolic, “in situ” thrombotic)

Haemorrhagic ~ 20%

note: subdural and extradural haemorrhage is excluded

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4
Q

What are usually the cardinal features of stroke?

A

Sudden onset

Identifiable risk factors

Focal clinical deficit (as opposed to global)

Negative clinical phenomena results, i.e. loss of function

Symptoms relate to arterial anatomy (calibre/site)

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5
Q

What is the annual incidence of strokes in the UK?

A

100,000 / year

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6
Q

What are the risk factors for embolic stroke?

A

Atheromatous disease

  • smoking
  • family Hx
  • diabetes
  • hypertension

Cardiac causes

  • AF
  • endocarditis
  • shunts (patent foramen ovale, atrial septal defects)
  • cardiomyopathy

Low cardiac output states

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7
Q

What are the risk factors for “in situ” thrombotic stroke?

A

Atheromatous disease

Hyperviscosity e.g. polycythaemia (excess RBCs)

Vasculitis e.g. RA, SLE, amphetamine/cocaine abuse

Thrombophilic states e.g. Factor V Leiden, pregnancy, OCP

Increased alcohol intake

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8
Q

What are the risk factors for haemorrhagic thrombotic stroke?

A

Hypertension

Anticoagulation

Thrombolysis

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9
Q

What are the risk factors for venous stroke?

A

Dehydration

Infectionn

Heart failure

Thrombophilia and thrombophilic states

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10
Q

What are some of the demographic risk factors for stroke?

A

Increased risk with age

Male > Female

Asian and african populations are more risk than caucasians

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11
Q

List the different type of strokes classified by its anatomy

A

Total anterior circulation strokes

Posterior anterior circulation strokes

Posterior circulation strokes

Watershed strokes

Lacunar strokes

Venous strokes

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12
Q

What arteries cause a total anterior circulation stroke?

A

Anterior cerebral artery and middle cerebral artery

Also Ophthalmic artery if oclusion occurs in internal carotid artery

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13
Q

What causes a partial anterior circulation stroke?

A

Any part of region supplied by ACA or MCA

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14
Q

What causes a posterior circulation stroke?

A

Any part of region supplied by PCA (via basillar artery)

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15
Q

What is a watershed stroke?

A

Occurs at a watershed (area where arteries join) between PCS and ACS

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16
Q

What is a lacunar stroke?

A

Small stroke affecting areas supplied by lenticulostriate arteries (from MCA) in pons, basal ganglia, thalamus +/- internal capsule

17
Q

What is a venous stroke?

A

Causes by venous thrombosis and resultant “backing up” of blood in cerebral arteries

  • often don’t respect arterial territories e.g. may produce signs associated with ACS and PCS by affecting regions of both territories
18
Q

What are the typical presenting features of an Anterior Circulation Stroke?

A

Hemiplegia (if affecting motor cortex on one side, mostly MCA)

Language dysfunction

Apraxia if damage to pre-motor cortex/supplementary motor area

Insognia due to damage to posterior parietal cortex (integrates sensory info and inputs to motor areas)

More specific MCA signs

  • hemianaesthesia
  • hemianopia
19
Q

What is apraxia?

A

Inability to carry out complex tasks

20
Q

What is insognia?

A

Denial of non-dominant side of body

21
Q

What is hemianopia?

A

Loss of vision to one side of both eyes

22
Q

What are the typical presenting features of a Posterior Circulation Stroke?

A

Bilateral visual loss

Diplopia

Dysarthria

Unsteadiness

Dysphagia

Amnesia

23
Q

What are the typical presenting features of an internal capsule stroke (lacuna stroke in internal capsule)?

A

Most common stroke

Pure motor hemi/monoplegia

Pure sensory hemianaesthesia

24
Q

What are the signs and symptoms of a cerebral infarction?

A

Contralateral hemiplegia/paresis (+/- aphasia if dominant hemisphere) developing over minutes/hours

  • limbs firstly flaccid and areflexic
  • become less weak and hyperreflexic over days/weeks

No headache (usually)

No loss of consciousness

25
Q

What are the signs and symptoms of a brainstem infarction?

A

Variable depending on area infarcted

May cause coma

26
Q

What are the signs and symptoms of a ruptured aneurysm?

A

Thunderclap headache

Stiff neck (at/from site of aneurysm)

Raised intracranial pressure

27
Q

What are the aims of investigations for a stroke?

A

Confirm stroke

Distinguish between mechanisms of stroke

Look for underlying cause of disease/risk factors and direct therapy

28
Q

What general investigations should be done if suspected stroke?

A

Bloods

  • FBC = look for infection/blood disorders
  • ESR/CRP = look for infection
  • Lipids

ECG

Imaging

  • CXR = look at heart, lung infection etc.
  • CT/MRI = to determine mechanism of stroke
29
Q

What specific tests may be used to guide treatment?>

A

Blood vessel imaging, e.g.

  • MR/CT
  • angiograms/venograms
  • catheter angiogram
  • USS carotids

Heart imaging, e.g. echo to look for thrombi, endocarditis

Thrombophilia testing

30
Q

Describe the acute management for strokes?

A

Assess swallowing and consider feeding tube if increased aspiration risk

Anti DVT measures - TEDs and heparin (if no haemorrhage)

Reverse cause of stroke

31
Q

How should an infarction stroke be treated acutely ?

A

Thrombolysis is beneficial in:

  • ischaemic and venous stroke
  • < 3 hours from symptom onset
    note: rule out haemorrhage first, CI in certain patients

Aspirin and other antiplatelets to reduce risk of further stroke if not able to treat with thrombolysis

32
Q

Which patients are CI for thrombolysis treatment?

A

Patients on warfarin

Post-surgical

Known to have aneurysms

Pregnant

33
Q

How should a haemorrhage stroke be treated acutely?

A

Rapid BP lowering

Surgical intervention?

  • beneficial in accessible haemorrhages
  • to reduce intracranial pressure
34
Q

What is the long term management for stroke patients?

A

Rehabilitation

  • speech and language
  • physiotherapy
  • OT
  • social work

Risk factor modification, i.e.

Antiplatelet therapy (usually aspirin and dipyridamole)

Anticoagulants in cardioembolic/venous strokes

  • heparin then warfarin
  • not before within first two weeks of infarct

Antihypertensive therapy

  • aim for long-term blood pressure below 140 systolic
  • diuretics, beta blockers, ACE-inhibitors, Ca-channel blockers etc.

Carotid endarterectomy

  • for patients with internal carotid stenosis >70% with related symptoms
  • stenting may be an alternative
35
Q

How is vasculitis treated?

A

Immunosuppression

  • glucocorticoids
  • others
36
Q

What may be the effect of multiple cerebral infarcts?

A

Multiple-infarct dementia including Binswanger’s disease

Week 202 - Stroke (2 decks)

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