Lecture 10.1: Stroke Flashcards
What is a Stroke?
Brain injury caused by the sudden disruption of blood flow to the brain which can be due to Infarction or Haemorrhage
What is an Infarction?
Tissue death or necrosis due to inadequate blood supply to the affected area
What is a Haemorrhage?
Acute loss of blood from a damaged blood vessel
What percentage of Strokes are due to infarctions? What are the 2 types of infarctions?
- 85%
- 50% thrombotic
- 35% embolic
What percentage of Strokes are haemorrhagic?
10%
What percentage of Strokes are due to Subarachnoid Haemorrhage?
5%
What is a Thrombus?
A blood clot formed in situ within the vasculature impeding blood flow
What is an Embolus?
Blood clots, fatty deposit or air bubble carried in the blood stream that lodges in a vessel
What is a Primary Haemorrhage?
Escape of blood from a ruptured vessel with no structural anomaly
What is a Secondary Haemorrhage?
Escape of blood from a ruptured vessel with aneurysm, vascular malformation or tumour
What is a Teritary Haemorrhage?
Escape of blood from a ruptured vessel with haemorrhagic transformation of an infarction
What is a Transient Ischaemic Attack (TIA)?
Focal CNS disturbances caused by vascular events that last <24hrs and with no lasting deficit, “mini stroke” is caused by a temporary disruption in the blood supply to part of the brain
Clinical Symptoms of Stroke in Anterior Circulation (5)
- Left hemisphere - Language trouble
- Right hemisphere – Neglect
- Weakness
- Partial visual loss
- Numbness
Clinical Symptoms of Stroke in Posterior Circulation (4)
- Blindness
- Diplopia
- Bilateral weakness
- Vertigo
Modifiable Risk Factors of Strokes (8)
- Hypertension
- Cardiac Diseases (AF)
- Diabetes
- High Cholesterol
- TIA
- Physical Inactivity
- Smoking
- High Intake of Alcohol
Investigations for Stroke (9)
- ECG: Atrial Fibrillattion or flutter
- Echo: Check for clots
- Ultrasound of the carotid artery < 70% stenosis
management with medication - 70% symptomatic - Carotid endarterectomy / Stent
- HBA1C
- Lipid profile
- CBC
- Coagulation profile
Carotid Artery Stenosis Treatment
- Surgery with angioplasty and a stent
- Lifestyle Changes
- Medication
What is Ischaemic Penumbra?
Defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core
Penumbra Imaging
Acute Management of a Stroke (4)
▪ CT Brain
▪ Thrombolysis (within 4.5hours)
▪ Clot Retrieval
▪ Swallow Protection (NBM)
Why is a CT Brain done during Stroke Management
- Excludes haemorrhages and stroke mimics (e.g.
tumour)
Ongoing Management of a Stroke (6)
- Admission to specialist stroke units
- Medication (aspirin 300mg daily for 2 weeks then
75mg daily) - Speech and Language Assessment (SALT)
- Nutrition (screen for malnutrition)
- Blood Pressure
- Blood Glucose Level
Issues with CT Brain in Acute Stroke Management
Acute infarcts not visible in the acute phase
Long-Term Management of Strokes (4)
- Physiotherapy
- Occupational Therapists
- Carotid Endarterectomy
- Modification of Risk Factors
Non-Modifiable Risk Factors of Strokes (4)
- Age
- Sex
- Race
- Family History
What is a Thrombectomy with the use of a stent retriever?
A stent retriever is a cylindrical device that consists of a self-expanding stent mounted on a wire and deployed within a catheter
Symptoms of Stroke based on Blood Vessel: Anterior Cerebral Artery
- Leg»_space; arms (Legs affected more)
- Urinary incontinence
Symptoms of Stroke based on Blood Vessel: Middle Cerebral Artery
- Face, speech
- Arms» legs (arms, hand affected more than legs)
Symptoms of Stroke based on Blood Vessel: Posterior Cerebral Artery
Problem in vision
Symptoms of Stroke based on Blood Vessel: Pons
Locked in syndrome
Symptoms of Stroke based on Blood Vessel: Vertebrobasilar Arteries
- Syncope
- Ataxia
Middle Cerebral Artery Damage: If Dominant Hemisphere is Affected
- Speech and Contralateral
- Weakness
- Gerstmann Syndrome
Middle Cerebral Artery Damage: If Non-Dominant Hemisphere is Affected
- Hemineglect Syndrome
- Speech Preserved
What happens in Broca’s Aphasia?
- Meaningful but broken speech
- Frustrated patient
What happens in Wernicke’s Aphasia?
- Fluent speech but meaningless
- Patient not frustrated
What is Hemineglect Syndrome?
Neglects one half of everything including himself
What is Gerstmann Syndrome?
A rare neurological disorder that results from damage to a specific area of the brain known as the left parietal lobe in the region of the angular gyrus
What are the Symptoms of Gerstmann Syndrome? (4)
- Impairment in performing calculations (acalculia)
- Discriminating their own fingers (finger agnosia)
- Writing by hands (agraphia)
- Impairment of distinguishing left from right (left-
right disorientation)
How do long do TIA symptoms last?
The effects last a few minutes to a few hours and fully resolve within 24 hours
What does FAST stand for in Strokes?
Facial drooping
Arms
Speech
Time
TIA Scoring (8 Factors that contribute to scoring)
- Age >60years = 1 point
- BP >140 / >90 = 1 point
- Any weakness = 2 points
- No weakness but speech disturbance = 1 point
- 60mins+ = 2 points
- 10-59mins = 1 point
- <10mins = 0 points
- Diabetic = 1 point
What is the score of a Low-Risk TIA?
1-3 (or over a week since symptoms)
How to treat a Low-Risk TIA? (3)
- Aspirin 300mg daily
- Specialist assessment within a week
- Address risk factors immediately
What is the score of a High-Risk TIA?
Score 4+
How to treat a High-Risk TIA? (6)
- Aspirin 300mg daily
- Specialist assessment within 24hrs
- Neuroimaging
- Carotid Imaging
- ECG
- ECHO
What is done in a workup for TIAs? (7)
- ECG
- ECHO
- Carotid Doppler
- Diffuse Weighted MRI
- CBC
- Blood Glucose
- Lipids
