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NI1 > Mechanisms & Management of Stroke > Flashcards

Mechanisms & Management of Stroke Flashcards

1
Q

What is a stroke?

A
  • Sudden, focal neurological syndrome due to cerebrovascular disease
  • Causes neuronal cell death & brain damage
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2
Q

What are the three classifications of stroke?

A

Haemorrhagic:
- Bleeding into the brain from a vessel rupture

Ischaemic (80%):
- Occlusion of blood supply to a region of the brain

Transient Ischaemic Attack (TIA):
- Focal/global disturbance of cerebal function lasting < 24 hrs

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3
Q

What percentage of oxygen does the brain consume at rest?

A

25%

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4
Q

What blood vessels supply oxygen to the proximal part of the brain?

A

Internal carotid arteries & vertebrobasilar system (combine to form Circle of Willis)

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5
Q

What blood vessels supply oxygen to the distal part of the brain?

A
  • Middle cerebral artery (MCA)
  • Anterior cerebral artery (ACA)
  • Posterior cerebral artery (PCA)
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6
Q

What are the two types of haemorrhagic stroke?

A
  • Intracerebral: Bleeding in brain tissue

- Subarachnoid: Bleed between two layers of dura (arachnoid and pia mater)

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7
Q

What are the two types of ischaemic stroke?

A
  • Large vessel disease: Internal carotid, vertibrobasilar system
  • Small vessel disease: MCA, ACA, PCA
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8
Q

What are the causes of ischaemic stroke?

A
  • Embolism (DVT, PE)
  • Hypoperfusion
  • Hyperviscosity or hypercoagulability
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9
Q

What is the main cause of intracerebral haemorrhage?

A
  • Spontaneous haemorrhage into brain

- Mostly due to hypertension

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10
Q

Where is an intracerebral haemorrhage commonly located?

A
  • Deep within brain, either in basal ganglia or cerebrellum/pons
  • Can lead to displacement of midline structures
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11
Q

How is the volume of haemorrhage related to mortality?

A
  • Prognosis depends on size & location

- Volume > 60mL has > 90% mortality

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12
Q

How is the type of stroke determined?

A
  • Imaging with CT or MRI

- No major distinguishing clinical features for haemorrhagic & ischaemic

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13
Q

What are the risk factors for haemorrhagic stroke?

A
  • Hypertension
  • Vascular malformations (aneurysms, AVMs)
  • Bleeding disorders (haemophilia, leukemia)
  • Anticoagulant meds
  • Tumours
  • Illicit drugs (cocaine, amphetamines)
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14
Q

What does ischaemic stroke cause?

A
  • An area of infarction (cell death)

- Symptoms depend on vascular territory involved

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15
Q

Which type of stroke has better mortality rates?

A

Ischaemic

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16
Q

What are the risk factors for ischaemic stroke in large vessels?

A

Artherosclerosis

  • Age
  • Hypertension
  • Physical activity
  • High cholesterol
  • Smoking
  • Diabetes
  • Obesity
  • Family history
Carotid artery disease
Pregnancy
Haematological malignancy
Thrombophilic disorders
Vasculitis
17
Q

What are the risk factors for ischaemic stroke in small vessels & cardiac embolism?

A

Lacunar (small vessels)
- Hypertension

Cardiac embolism

  • Atrial fibrilation
  • Cardiomyopathy
  • Endocarditis
18
Q

What do the clinical manifestations of stroke depend on?

A

Blood vessel and area of brain affected

19
Q

Where are the centres for motor control and sensation located?

A
  • Motor control: Pre-central sulcus

- Sensation: Post-central sulcus

20
Q

What are the roles of the temporal, parietal and frontal lobes?

A
  • Temporal: Memory, emotions, hearing, speech
  • Parietal: Spatial awareness/orientation, arithmetic, visual memory
  • Frontal: Executive level thinking, motor planning, continence, speech
21
Q

What are the roles of the cerebellum & brainstem?

A
  • Cerebellum: Coordination

- Brainstem: Basic homeostatic mechanisms & reflexes (respiration, HR, sleep)

22
Q

Where is the most common area of stroke?

A

MCA - supplies two thirds of the brain

23
Q

What are the roles of the dominant and non-dominant hemispheres?

A
  • Dominant (usually L): Speech & cognition

- Non-dominant: Processing non-verbal stimuli

24
Q

What are the typical clinical symptoms of an MCA stroke?

A
  • Contralateral strength & sensory loss
  • Neglect
  • Hemianopia (blindness in one field of vision)
  • Dysphasia (language impairment)
  • Apraxia (difficulty performing actions)
25
Q

What are the typical clinical symptoms of an ACA stroke?

A
  • Isolated contralateral leg strength loss
  • Aphasia
  • Urinary incontinence
26
Q

What are the typical clinical symptoms of an PCA stroke?

A

Hemianopia

27
Q

What are the typical clinical symptoms of basilar, lacunar and posterior cerebellar artery strokes?

A
  • Basillar: Coma, 40% mortality, bilateral motor weakness
  • Lacunar: Pure motor weakness/sensory loss
  • Posterior cerebellar artery: Coordination loss
28
Q

What does the acute phase medical treatment for a stroke consist of?

A
  • Revascularisation therapy: Thrombolysis, intra-arterial TPA/clot retrieval
  • Aspirin
  • Supportive care
  • Stroke unit admission (highly effective)
29
Q

What does supportive care involve?

A
  • Maintain hydration
  • Early speech assessment to prevent aspiration pneumonia
  • Treat fever aggressively
  • Treat hyperglycaemia
30
Q

What does the subacute phase medical treatment & secondary prevention for a stroke consist of?

A
  • Blood pressure management (ACE inhibitors)
  • Antiplatelet agents (aspirin)
  • Cholesterol lowering
  • Carotid endarterectomy
  • Anticoagulation
31
Q

What are the benefits of rehabilitation following a stroke?

A
  • Essential for recovery

- Early mobilisation shown to improve outcomes

32
Q

What are some of the sensory and motor impairments following stroke?

A
  • Sensory: Loss of tactile sensation/kinaesthesia

- Motor: Loss of strength/dexterity, spasticity, contracture

33
Q

What are some of the physio management strategies for stroke?

A
  • Strength training
  • Sensory retraining
  • Activity training
  • Management of contracture & spasticity
  • Prevention of secondary complications (CV fitness, pain, swelling, shoulder subluxation)

NI1 (10 decks)

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