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PHTY3140 > L4: Cerebrovascular disease management - a medical perspective > Flashcards

L4: Cerebrovascular disease management - a medical perspective Flashcards

1
Q

What is the definition of a stroke?

A

The rapidly developing clinical signs of focal, or global disturbance of cerebral function lasting more than twenty-four hours or leading to death with no apparent cause other than vascular.

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2
Q

What is the definition of a transient ischaemic attack?

A

Clinical syndrome characterised by an acute loss of focal cerebral function or monocular function with symptoms lasting less than 24 hours and which is thought to be due to inadequate cerebral or ocular blood supply as a result of arterial thrombosis or embolism associated with arterial, cardiac or haematological disease

  • Often called a “mini” stroke –> but this is not minor
    • High risk for subsequent catastrophic strokes
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3
Q

____ causes 25% of chronic disability.

A

Stroke

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4
Q

The greatest risk faced by stroke and TIA patients is ______

A

another stroke

  • 15 times greater risk than the general population at 1 year
  • 9 times greater risk than the general population at 5 years
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5
Q

What are 5 pathogenesis of cerebral infarction (75-80% of all strokes)?

A
  1. Large artery thromboembolism 50%
    • extra cranial 40-45% (Usually carotid artery)
    • intracranial 5-10%
  2. Small artery disease 20-25%
  3. Embolism from the heart 20% (Atrial fibrillation is a massive risk for people with stroke)
  4. Non Atheromatous arterial disease 5%
  5. Blood Disease <5% (Causing hyper viscosity)
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6
Q

What are 3 pathogenesis of intracerebral haemorrhage?

A
  1. Arterial Disease
    1. Fibrinoid necrosis
    2. Amyloid angiopathy
    3. Vascular Malformations etc
  2. Raised Blood Pressure
    1. Acute Hypertension
    2. Alcohol
    3. Amphetamines etc
  3. Bleeding Diathesis
    1. Anticoagulants
    2. Antiplatelets
    3. Thrombolytic Therapy etc
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7
Q

What are 4 features in the diagnosis of stroke?

A
  1. Stroke or not?
    • onsider diseases mimicking stroke
    • Act medically as though the patient has a stroke and go for screening ASAP (to clear)
      • Time is important
      • Time lost is brain lost
      • Not when were they last seen? –> not as important
      • When they were last seen well? –> this is the question to ask
  2. Which pathological process?
    • infarction / haemorrhage
    • rupture of artery
    • thrombosis and / or embolism
  3. Which arterial area?
    • carotid or vertebrobasilar
    • named artery e.g. L MCA
  4. What aetiology?
    • hypertension
    • polycythaemia
    • structural heart disease
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8
Q

What are the 4 clinical featires of stroke and TIA?

A
  1. Loss of focal neurological function
  2. Of sudden onset
  3. Which is maximum at onset without spread or intensification
  4. Thought to be due to inadequate blood supply or haemorrhage
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9
Q

What are 4 motor symptoms of stroke?

A
  1. Weakness (hemiparesis)
  2. Simultaneous bilateral weakness (Uncommon)
  3. Difficulty swallowing (dysphagia)
  4. Imbalance (ataxia)
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10
Q

What are 5 speech /language disturbance symptoms of stroke?

A
  1. Difficulty understanding or expressing spoken language (dysphasia)
  2. Difficulty reading (dyslexia) or writing (dysgraphia)
  3. Difficulty calculating (dyscalculia)
  4. Slurred speech (dysarthria)
  5. Impaired voice (dysphonia)
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11
Q

What is a sensory (somatosensory) symptoms of stroke?

A
  1. Altered feeling on one side of body or face
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12
Q

What are 4 sensory (visual) symptoms of stroke?

A
  1. Loss of vision in one in whole or in part (monocular blindness)
  2. Loss of vision in half or quarter of visual field (hemianopia , quadrantanopia)
  3. Bilateral blindness
    • Uncommon except for basilar artery (single lesion in this artery can cause clinical blindness)
  4. Double Vision (diplopia)
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13
Q

What are the sensory changs in the anterior vascular area and brain stem after a stroke?

A

Anterior vascular area - sensory changes on 1 side

Brain stem- sensory loss on shoulder down and contralateral head up

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14
Q

What is a vestibular symptom of stroke?

A
  1. A spinning sensation (vertigo)
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15
Q

What are 2 behavioural/cognitive symptoms of stroke?

A
  1. Difficulty dressing, combing hair etc/geographic disorientation/ difficulty copying diagrams (visuo-spatial perceptual dysfunction)
  2. Forgetfulness (amnesia)
    • Uncommon but vascular dementia can occur due to various strokes

These can sometimes be worst than the motor deficits (can be extremely disabling)

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16
Q

What are 11 non-focal neurological symptoms after a stroke?

A
  1. Generalised weakness and/or sensory disturbance
  2. Lightheadedness/faintness
  3. “Blackouts” with altered or loss of consciousness
  4. Incontinence of urine or faeces
  5. Confusion
  6. *Vertigo
  7. Tinnitus
  8. Dysphagia
  9. Dysarthria
  10. Diplopia
  11. Ataxia*

*Any of the following symptoms, if isolated*

17
Q

What are 6 common pitfalls in the diagnosis of stroke?

A
  1. Difficult in hyperacute stage
  2. Onset uncertain
  3. Neuroanatomical localising value of symptoms uncertain
  4. Symptoms are positive eg hemiballismus
    • Positive symptom –> due to loss of inhibition of movement (eg. swinging arm around)
  5. Patient does not recognise there is a problem
    • More dominant syndrome –> brain doesn’t recognise the problem (eg. they tell me that I have had a stroke) –> problems with management
  6. Symptoms are progressing over hours or even days
18
Q

What are 11 differential diagnosis of stroke?

A
  1. Metabolic/Toxic encephalopathy (drugs, hypoglycaemia,hyponatraemia
  2. Functional/Non neurological
  3. Epileptic seizure (Todd’s paresis)
  4. Hemiplegic migraine
  5. Structural lesion (SDH,Tumour,AVM)
  6. Encephalitis/Brain abscess
  7. Head injury
  8. Peripheral nerve lesion(s)
  9. Hypertensive encephalopathy
  10. Multiple sclerosis
  11.  Creutzfeldt-Jacob disease
19
Q

20% of cases in strokes are ______. What are 3 characteristics?

A

TACS (Total anterior circulation stroke)

20
Q

30% of cases in strokes are ______. What are 2 characteristics?

A

PACS (Partial anterior circulation stroke)

21
Q

25% of cases in strokes are ______. What are 5 characteristics?

A

Lacunar

22
Q

25% of cases in strokes are ______. What are 6 characteristics?

A

Posterior circulation stroke

23
Q

Which stroke type is most dangerous and less dangerous?

A
24
Q

What are 4 complications of stroke?

A
  1. General, due to immobility
  2. Local, due to paralysis
  3. Cerebral, due to brain damage
  4. Long Term, due to atherosclerosis
25
Q

What are 5 general (due to immobility) complications of stroke?

A
  1. bronchopneumonia
  2. bedsores
  3. constipation
  4. deep venous thrombosis
  5. pulmonary embolus
26
Q

What are 5 local (due to paralysis) complications of stroke?

A
  1. shoulder pain / limitation
  2. contractures
  3. falls and fractures
27
Q

What are 5 cerebral (due to brain damage) complications of stroke?

A
  1. epilepsy
  2. thalamic pain
  3. associated movements
28
Q

What are 2 long term (due to atherosclerosis) complications of stroke?

A
  1. further stroke
  2. myocardial infarction
29
Q

Why is it important to get the perfect time for rehab (not too late but not to early)?

A

Early rehab is generally ideal but not too early due to the disorder of cerebral disorientation –> increase infarct side –> worsening condition

30
Q

What is the benefit of thrombolysis therapy depending on time post stroke?

A
31
Q

What is a hemicraniectomy for stroke? When is it gone?

A
  • Treatment –> cut a whole in the skull –> let out the swelling so that it does not compress the brain (less brain damage)
  • Usually too much swelling –> compresses brain –> die
32
Q

What is the sucess of hemicraniectomy post stroke?

A
33
Q

Stroke is a ______syndrome with multiple aetiologies

A

heterogeneous

34
Q

What are the 3 treatment options after a stroke?

A
  1. Acute
  2. Secondary prevention
  3. Rehabilitation
35
Q

What is the best option for a stroke?

A

Primary prevention

36
Q

What was the “old” style treatment of stroke?

A
  1. No Specific Treatment
  2. Bed Rest
37
Q

What are 19 “new” treatment options for stroke?

A
  1. Primary Prevention
  2. Stroke Unit Management (Multi-disciplinary Team and Co-Ordinated Care)
  3. Better Imaging and Technology ( CT, CTA, CTP, MRI, MRA, CDS, Echocardiography &TOE)
  4. Blood Pressure Control
  5. Blood Glucose Control
  6. Lipid Management
  7. Antiplatelet Treatment
  8. Anticoagulation & NOACs
  9. Patent Foramen Ovale Detection
  10. Carotid Disease – CEA or Stent
  11. Detection of Atrial Fibrillation (Monitoring or Reveal Link Device Implant)
  12. Hemi-craniotomy (selected patients)
  13. Haemorrhage evacuation (selected patients)
  14. Thrombolysis
  15. Clot Retrieval
  16. Rehabilitation
  17. Support post discharge
  18. Public Education
  19. Ambulance / Emergency Services

PHTY3140 (28 decks)

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