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control > L15/16 - stoke and TIA > Flashcards

L15/16 - stoke and TIA Flashcards

1
Q

stroke

A

An abrupt interruption of blood flow to part of the brain, depriving brain tissue of oxygen and nutrients - within minutes, brain cells begin to die

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2
Q

cerebral ischaemic stroke

A

acute focal neurological dysfunction caused by focal infarction at single or multiple sites of the brain or retina

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3
Q

intacerebral haemorrhage

A

acute neurological dysfunction caused by haemorrhage within the brain parenchyma or in the ventricular system

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4
Q

mechanisms of ischaemic stoke pathophysiology

A

embolism
thrombosis
hyperfusion

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5
Q

cardioembolism

A

A clot can leave the heart and lodge in brain

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6
Q

mechanisms of cardioembolism

A
  • Rhythm abnormalities
  • Valvulopathies (valvular disease)
  • Pathology in chambers (clots inside chambers)
  • Aortic arch (damage in arch and clots can dislodge)
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7
Q

large artery embolism

A
  • atherosclerosis
  • > 50% narrowing
  • dissection
  • mural thrombus
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8
Q

small vessel disease

A

clots form in small vessels

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9
Q

causes of small vessel disease

A

hypertension

diabetes

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10
Q

hypoperfusion

A
  • Difficulty with supply of blood to the brain
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11
Q

mechanisms of hypoperfusion

A
  • low systemic perfusion pressure

- cardiac pump failure

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12
Q

aetiology of intracerebrla haemorrhage

A
  • Hypertension
  • Vascular malformations (aneurysm, AVN)
  • Amyloid angiopathy
  • Tumours
  • Drug abuse (cocaine)
  • Anticoagulant and thrombolytic therapy
  • Vasculitis
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13
Q

FAST

A

face
arms
speech
time

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14
Q

F in FAST

A

can they move their face?

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15
Q

A in FAST

A

can they raise their arms?

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16
Q

S in FAST

A

can they say hello and their name?

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17
Q

T in FAST

A

time to call 999

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18
Q

common stroke symptoms

A
  • Slurred speech
  • Facial droop
  • Acute unilateral loss of strength or/and sensation
  • Acute monocular or binocular visual loss (complete or incomplete)
  • Aphasia
  • Ataxia and or vertigo
  • Double vision
  • Sudden decrease in level of consciousness
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19
Q

ICH treatment

A
  • reverse anticoagulants if taking
  • aggressive blood pressure management
  • surgical options
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20
Q

within how long should you act on an ICH before it could be fatal

A

first 6 hours

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21
Q

how to treat a patient with a venous thrombos

A

blood thinners

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22
Q

example of thrmobolysis treatment

A

Alteplase

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23
Q

mechanical thrombectomy

A
  • a thin tube is inserted into an artery, usually in the groin
  • fed to the site of the clot in or near the brain
  • a decide is inserted through the tube to catch the clot and pull it out
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24
Q

thrombolysis

A

medication it dissolve clot

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25
Q

stentriever

A
  • place stent across occlusion and leave for 10 mins
  • reperfuse brain
  • most clots will lyse naturally
26
Q

in which circulation is a thrombectomy more effective

A

anterior circulation

27
Q

what % of strokes are due to infarction

A

85

28
Q

what % of strokes are haemorrhagic

A

15

29
Q

TIA

A

Neurological Deficit lasting less than 24 hours attributable to cerebral or retinal ischaemia (MINI STROKE)

30
Q

length of TIAs

A

most TIAs last under 60mins

31
Q

causes of TIA

A

SAME AS STOKE

  • Carotid artery disease / large artery disease
  • Cerebral small vessel disease
  • Cardiac embolism (moving clot)
32
Q

what % of strokes are preceded by a TIA

A

20

33
Q

TIA mimics

A
  • Seizures
  • Syncope (loss of consciousness)
  • Hypoglycaemia
  • Migraine
  • Acute confusional states
34
Q

positive symptoms

A

flashing lights, limb shaking, tingling…etc

35
Q

negative symptoms

A

numbness, drooping…etc

36
Q

what type of symptoms are observed in a TIA

A

negative

37
Q

anterior circulation

A

internal carotid artery

38
Q

posterior circulation

A

vertebral-basilar system

39
Q

anterior circulation problems

A

dysphasia

amarausis fugax

40
Q

amarausis fugax

A
  • Person cannot see out of one of both eyes due to lack of blood flow to eyes
  • Cholesterol embolus in retinal artery (come up from carotid artery)
41
Q

posterior circulation problems

A
  • ataxis if cerebellum involved
  • diplopia
  • vertigo
  • bilateral symptoms if brainstem is affected
42
Q

how to assess either circulation

A
  • Visual field disturbance (hemianopia)
  • Hemiparesis
  • Hemisensory loss
43
Q

paresis

A

muscular weakness

44
Q

what is risk of TIA leading to stroke

A

5% of patients have a stroke after a week

45
Q

how to score TIA

A

ABCD2

46
Q

ABCD2

A 
age
BP
Clinical features
duration symptoms
diabetes
47
Q

age in ABCD2

A

1 if >60

48
Q

BP in ABCD2

A

1 for 140/90

49
Q

clinical features in ABCD2

A

2 for unilateral weakness

1 for speech disturbances

50
Q

duration in ABCD2

A
  • 2 for >60
  • 1 for 10-59 mins
  • 0 < 10 mins
51
Q

diabetes in ABCD1

A

1 yes

0 no

52
Q

at what score of ABCDE2 do we start to worry

A

4 - moderate

53
Q

treatment for TIA

A

polypill

54
Q

polypill

A

combination of:

  • statins
  • aspirin
  • antihypertensives
  • folic acid
55
Q

secondary vascular prevention

A

carotid endarterectomy

56
Q

carotid endarterectomy

A
  • removing ulcerated plaque
57
Q

risk of carotid endarterectomy

A
  • stroke/death 3-5% when opening the artery

- 12th nerve palsy

58
Q

why can carotid endarterectomy result in death

A

possibility that the plaque will dislodge and travel to the brain when opening up the artery

59
Q

why can carotid endarterectomy result in 12th nerve palsu

A

12th nerve is stretched when surgeon is opening up neck

60
Q

why is there no point doing aarotid endarterectomy after about 4 weeks

A

The longer you get away from the time of the TIA, there is a risk
As time goes on, plaques settle and if they have not had a stroke by then, they probably will not have one

61
Q

most effective medication for TIA

A

aspirin as stops platelets working

62
Q

which artery, if occluded, can a surgeon not get to

A

carotid

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