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Neuro > ISCHAEMIC STROKE > Flashcards

ISCHAEMIC STROKE Flashcards

1
Q

What is Ischaemic stroke

A

When a clot occludes the brain leading to ischaemia and infarction presenting focal symptoms and reversible oedema

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2
Q

How would you distinguish ischaemic stroke vs haemorrhage stroke

A

Urgent CT/MRI

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3
Q

How long does a stroke last

A

longer than 24 hours

<24 = TIA

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4
Q

What is the ischaemic penumbra

A

The area around the ischaemic event that can be reversed with thrombolysis as there is no necrosis

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5
Q

What are the causes of IS

A 
Artherothromboembolism
-From carotid = carotid bruit
Cardioembolism
-AF
-Post MI
-Valve disease
Hyperviscosity and Hypoperfusion
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6
Q

What are the risk factors for IS

A 
Age
HTN
Hyperlipidemia
Smoking
Diabetes
AF
TIA history
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7
Q

What is the classification system used in Stroke

A

Bamford/Oxford classification

  • TACI (Total Anterior)
  • PACI (Partial Anterior)
  • LACI (Lacunar)
  • POCI (Posterior)
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8
Q

How would you define a TACI (Total anterior)

Anterior and middle cerebral arteries

A

Contralateral Hemiplegia/hemiparesis
Contralateral Homonymous Hemianopia
Aphasia

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9
Q

How would define a PACI (Partial anterior)

Anterior OR Middle cerebral arteries

A

Any two TACI or Aphasia alone

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10
Q

How would you define a LACI (Lacunar)

Small deep arteries of internal capsule/thalamus

A

Purely motor/sensory or sensorimotor or ataxia

NO Vision defect/Aphasia/Brainstem dysfunction

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11
Q

How would you define a POCI (Posterior)

Vertrobasilar arteries supplying cerebellum, brainstem and occipital lobe

A 
Cerebellar syndrome
OR eye movement disorder
OR bilateral sensorimotor deficit
OR ipsilateral CN palsy
OR cortical blindness/hemianopia
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12
Q

What are the presentations of a cerebral infarct

A 
Contralateral Sensory loss (Hemiparesis)
Contralateral Hemiplegia (Floppy limb)
UMN facial weakness
Dysphagia
Hemianopia
Spatial deficit
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13
Q

What are the presentations of a brainstem infarct

A 
Quadriplegia (4 Limb paralysis)
Numb face
Dysarthria/Aphasia
Vertigo/n+v
"Locked in" aware with no movement - Basilar
Coma
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14
Q

What are the presentations of a lacunar infarct

A

Sensory loss
Weakness
Ataxic Hemiparesis
Dysarthria

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15
Q

What is the immediate management of a patient with IS

A 
IV Alteplase (4.5 hours)
Aspirin if after
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16
Q

How would you manage a patient with IS

A 
IV Alteplase (<4.5 hours)
Antiplatelet therapy
-300mg Aspirin for two weeks and then Clopidogrel
If AF = DOAC (Rivoroxaban/apixaban)
Mechanical Thrombectomy
17
Q

What is the most specific sign of stroke

A

Pronator drift
-Arms to ceiling sees pronating on affected side (Palm faces down)

-Affected arm pronates(palms face down) when asked to lift them

18
Q

How would you investigate stroke

A

NCCT Head
Ischemic= Normal
Haemmorhagic = HYPERDENSE BLOOD

19
Q

What does a lacunar stroke affect

A

Lenticulostriate arteries supplying BG, Internal capsule, Thalamus, PONS….

20
Q

What are the presentations of a patient with a stroke

A

Focal neurology depending on what is affected
Raised ICP

21
Q

State the 4 results of Increased ICP

A

Increase pressure on skull, brain and vessels -> NECROSIS
CSF obstructed -> HYDROCEPHALUS
Midline shift -> TENTORIAL HERNIATION
Coning -> BRAINSTEM COMPRESSION

22
Q

If a patient is on DOAC, what is the course of action when presented with stroke

A

Treat as haemorrhage until proven different

23
Q

How do you manage a patient with haemorrhagic stroke

A

Neuro referral w/ IV mannitol
Atorvastatin with Ramipril

24
Q

What is given to a patient to decrease ICP

A

IV Mannitol

25
Q

What causes and ischaemic stroke

A

Blood vessel blockage by atherothrombo-embolism

26
Q

What causes a haemorrhagic stroke

A

Ruptured blood vessel leading to reuced blood flow due to trauma, HTN and berry aneurysms

27
Q

What type of stroke is most common

A

IS = 85%
HS = 15%

28
Q

What are the two types of haemorrhagic strokes

A

Intracerebrlal = Bleeding in brain
Subarachnoid = Bleeding on brain surface

Neuro (27 decks)

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