Lecture 10 Neurologue Theme - Stroke Flashcards
What is the leading cause of stroke worldwide?
High systolic blood pressure.
Describe the epidemiology of stroke.
15 million strokes a year.
Over 90% of strokes burden is attributed to modifiable risk factors.
Numbers of people having a stroke has stayed the same due to treatment improving in the 70+ years population.
UK incidence of strokes in younger people is not reduced.
More strokes being treated before lifelong consequences.
Mortality is higher in women and there is an aged-related increase in mortality.
What is an ischaemic stroke caused by?
Blood vessel occlusion by thrombosis or embolus.
Accounts for around 80% of all strokes.
What can major iscahmeic strokes be classified into?
Divided in 4 ways dependent on the rule of quarters.
25% arterial (embolic) occlusion
25% cardioembolic
25% small vessel disease (lacunar)
25% uncertain
What is a transient ischaemic attack (TIA)?
A minor ischaemic stroke with resolution within 24 hours.
1/10-15 will have an ischaemic stroke within 2 weeks of a TIA so is a common precursor to a more severe stroke.
Hard to identify on imaging.
Describe the cerebral blood supply.
Circle of Willis - carotid arteries come up the neck and one part goes up the back and the spine and the others go up internally to the brain. They meet to form the circle of Willis and allows for the brain to still get blood if one of the input arteries becomes blocked.
CoW sits at the base of the brain, just in front of the midbrain.
Describe what the symptoms may be if a person has a stroke on the right side of the brain.
Paralysis of a limb if the stroke involves the motor cortex.
Long term memory and problem solving affected if in the frontal lobe.
Visual perception problems if the ventral temporal lobe is affected.
In the posterior occipital lobe, if the primary visual cortex is affected then there is left sided visual neglect.
Describe what the symptoms may be if a person has a stroke on the left side of the brain.
Speech problems if stroke involves Broca’s area.
Aphasia where speech can be generated but is not understandable and the person can’t understand others speech if Wernicke’s area is involved.
What is a hemorrhagic stroke?
Accounts for around 20% of strokes.
A rupture of a blood vessel preventing blood from getting to the brain (a brain bleed).
Tend to occur more often in younger age groups than ischaemic stroke. Severe medical emergency can be caused by head trauma.
What can hemorrhagic strokes be subdivided into?
Intracerebral
Subarachnoid
Subdural
Epidural
Dependent on where the bleed is in the brain.
What is a major risk factor for hemorrhagic stroke?
Elevated systolic BP but as age increases risk of hemorrhagic stroke decreases and is replaced by the risk of ischaemic stroke.
What is a carotid atheroma?
10-20% of ischaemic strokes due to atheroma forming in the internal carotid or an atheroma passing along the internal carotids to the brain.
Presence of the atheroma usually goes unnoticed but can be detected by a routine Doppler ultrasound screening.
What is a Doppler ultrasound?
Listens to the carotid arteries in the neck and can detect ischaemia, thinning and narrowing of the arteries.
How would you treat a carotid atheroma?
Carotid endarterectomy (CEA) where surgically the atheroma is removed through direct incision of the carotid and atheroma removal.
Surgeon goes into the neck and the carotid artery and carefully removes the plaque to reopen the artery.
Describe pharmacological therapy approaches for treating stroke.
Focuses on the underlying risk factors.
Lowering blood pressure, blood lipids with anticoagulants to prevent and reduce atheroma formation.
Antihypertensives.
Diuretics.
