Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 CBLs > Medicine: Cerebrovascular disease > Flashcards

Medicine: Cerebrovascular disease Flashcards

1
Q

New definition of TIA

A

* even short periods of ischaemia can lead to permanent changes → therefore a new ‘tissue-based’ definition rather than a ‘time-based’

‘Tissue-based’ definition: a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

New definition of stroke

A

Sudden onset of a focal neurological deficit, lasting more than 24 hours (or leading to death) due to either infarction (85%) or haemorrhage (15%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s ROSIER score?

Describe it

A

ROSIER it’s a variant of FACE used by medical professionals

  • Total Score > 0 (1-6) = Acute Stroke is likely
  • Total Score 0, -1 or -2 = Stroke unlikely (Discuss with Stroke Team)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

First-line investigation for a suspected stroke

A

A non-contrast CT head scan is the first-line radiological investigation for suspected stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anatomy of circle of Willis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What’ total anterior circulation stroke

A

Total Anterior Circulation Stroke (TACS)

•Hemiparesis +/- hemisensory loss

AND

•Homonymous hemianopia

AND

•Cortical dysfunction (dysphasia /perceptual problem)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What’s that?

A

Total Anterior Circulation Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What’s that?

A

Clot in left middle cerebral artery (MCA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What’s partial circulation stroke?

A
  • 2 of the 3 below:
  • Hemiparesis +/- hemisensory loss
  • Homonymous hemianopia
  • Cortical dysfunction (dysphasia / perceptual problem)
  • OR
  • Cortical dysfunction alone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What’s that?

A

Partial anterior circulation stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What’s a lacunar stroke? (criteria)

A

LACUNAR STROKE (LACS)

• Hemiparesis

OR

• Hemisensory loss

OR

• Hemisensorymotor loss

OR

•Ataxic hemiparesis

* No cortical dysfunction or hemianopia *

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s that?

A

Lacunar stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Signs and symptoms of Posterior Circulation Stroke

A

Posterior Circulation Stroke (POCS)

  • Brainstem nuclei or cerebellar signs & symptoms
  • Occipital signs

Presentation:

•Diplopia, vertigo, ataxia, bilateral limb problems, hemianopia, cortical blindness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What’s that?

A

Posterior circulation stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Acute Mx of stroke

A
  • CT Brain
  • Bloods
  • ECG
  • CXR
  • Aspirin 300mg ASAP (PO/PR/NG) – if no bleed on scan
  • Stroke Unit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mx of a stroke at stroke unit

A
  • Careful monitoring and correction of physiological parameters
  • Hypoxia / Glucose / Blood pressure / Pyrexia
  • Early SALT input
  • Early feeding
  • Physiotherapy and rehab
  • Psychology input
17
Q

What’s the Modified Rankin Scale?

A

Commonly used measure of disability / dependence in people who have suffered a stroke or other causes of neurological disability

0 - No symptoms

1 - No significant disability. Able to carry out all usual activities, despite some symptoms

2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.

3 - Moderate disability. Requires some help, but able to walk unassisted.

4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted

5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent

6 - Dead

18
Q

Power grading in neurological examination

A
19
Q

Secondary prevention of stroke

A
  • Clopidogrel 75mg od, after 2 weeks of Aspirin 300mg od
  • Cholesterol control (target < 4.0) - Statin
  • BP Control (target < 130/80)
  • Screen for and treat diabetes
  • Smoking cessation
  • Screen for and treat carotid stenosis
  • Screen for and manage AF (anticoagulation)
  • Echocardiogram
20
Q

What’s the driving restriction post-stroke?

A

Driving restrictions (DVLA): Car – 1 month off driving if good functional recovery

21
Q
A
22
Q

What’s the ischaemic core?

A

ISCHAEMIC CORE (irreversible damage) :

Area of brain tissue local to the blood vessel occlusion, whose blood supply is entirely supplied by this vessel, dies.

23
Q

What’s Ischaemic Penumbra?

A

ISCHAEMIC PENUMBRA (SALVAGEABLE TISSUE):

  • Surrounding the ischaemic core is an area with some collateral blood supply (blood flow is reduced)
  • Without intervention much of this will also die
  • Over subsequent hours this area either becomes viable again, or forms part of the ischaemic core.
24
Q

Role/considerations in the hyperacute treatment of stroke

A
  • Earlier treatment = better outcomes
  • Ischaemic penumbra is likely to be larger
  • As the penumbra disappears, stroke therapy such as thrombolysis becomes ineffective
  • Most patients no longer have a penumbra beyond 4.5 hours
  • Ischaemic core becomes more friable
  • Risk of bleeding is higher & usually outweighs benefits of thrombolysis
25
Q

Management of stroke with thrombolysis

  • drug used
  • timeframe
  • what must be done before treatment
  • possible complications
  • when to repeat CT
A
  • IV Alteplase
  • Bolus – 10% of total dose (0.9mg/kg)
  • Infusion over 1 hour (remainder of drug)
  • Given within 4.5 hours of symptom onset
  • Urgent CT brain to exclude bleed prior to treatment
  • Complications include bleeding & angio-oedema
  • Repeat CT Brain at 24 hours
26
Q

What’s thrombectomy?

  • timeframe
  • complications
A

Thrombectomy = Mechanical Clot Retrieval

• offered up to 6 hours post symptom onset

  • Can be as 1st line but usually as 2nd line treatment after failed thrombolysis
  • Risk of serious complications: Intracranial haemorrhage / access site complications / vessel perforation / distal emboli
27
Q

Thrombectomy procedure - describe

A

Procedure:

  • Under sedation (Local or General anaesthesia)
  • Initially, patient undergoes conventional cerebral angiography: demonstrates presence & location of arterial occlusion
  • Delivery catheter inserted (usually through femoral artery) & advanced using X-ray guidance to occluded vessel
  • Clot retrieval device attached to a guidewire is introduced through the delivery catheter to the occlusion site
28
Q

Ix in deteriorating stroke patient

A
  • ABCDE
  • Blood glucose
  • GCS and Neurological examination
  • Bloods - Consider aspiration / infection
  • Urgent CT Brain
29
Q

What’s the scan present?

A

Intracerebral haemorrhage with surrounding oedema and midline shift

30
Q

What’s the scan present?

A

Malignant MCA Syndrome

31
Q

ABCD2 scoring system

A
  • Age > 60 = 1
  • BP > 140/90 = 1
  • Clinical – speech disturbance (1), unilateral weakness (2)
  • Duration – 10 mins to 59 mins (1), 1hr + (2)
  • Diabetes = 1

1-3 = 2-day risk of 1%, 7 day risk of 1.2%

4-5 = 2-day risk of 4%, 7 day risk of 6%

>5 = 2-day risk of 8%, 7 day risk of 12%

32
Q

Why seizures and transient LOC are not usually indicative of a stroke?

A
  • stroke does not cause seizures ACUTELY → however possible to cause seizures later on due to fibrosis of the dead tissue etc
  • stroke does not cause transient LOC/syncope → if stroke causes LOC it would be more long-term like
33
Q

What do we with high BP in acute ischaemic stroke?

A
  • do not lower BP → sometimes high BP needed to maintain perfusion
  • lower BP → if thrombolysis is indicated
34
Q

What to do with high BP in acute haemorrhagic stroke?

A

lower BP gradually

35
Q

Stroke differentials

A
  • post- seizure Todd Paresis → is a focal weakness in a part or all of the body after a seizure. This weakness typically affects appendages and is localized to either the left or right side of the body. It usually subsides completely within 48 hours
  • Bell’s Palsy
  • migraine
36
Q

How to differentiate between stroke vs Bell’s Palsy

A
  • Bell’s Palsy is LMN → therefore both, forehead + face affected
  • Stroke is UMN → forehead sparing
37
Q

How to differentiate between haemorrhagic and ischaemic stroke on CT scan?

A

Y4 CBLs (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions