Neuro Flashcards
STROKE
What is a stroke?
- Stroke represents a sudden interruption in the vascular supply of the brain leading to neurological deficit with associated infarction of CNS tissue.
STROKE
What are the two main causes of stroke and how do they cause a stroke?
- Ischaemic (85%)
- Haemorrhagic (15%)
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What are the causes of ischaemic strokes?
- Cardiac (atherosclerosis, AF, infective endocarditis)
- Vascular (aortic or vertebral dissection)
- Haem (sickle cell, polycythaemia)
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What are the causes of haemorrhagic stroke?
Intracerebral haemorrhage
- Trauma, AVM
- Cerebral amyloid angiopathy
- Small vessel disease due to chronic HTN
SAH (trauma, berry aneurysm, AVM)
Anticoagulants, tumours + substance abuse (secondary causes)
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Give an example of how chronic HTN can cause a stroke.
- Charcot-Bouchard aneurysms most often in the basal ganglia
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What are the risk factors for strokes?
- HTN = biggest
- CV = hypercholesterolaemia, smoking, AF, IHD, DM
- Previous TIA, carotid artery stenosis
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What vessels can be affected in TACS?
What criteria must be met for a TACS?
- ACA, MCA, carotid
All three Hs – - Hemiplegia (unilateral ± sensory deficit of face, arm leg)
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disturbance)
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What vessels can be affected in PACS?
What criteria must be met for a PACS?
- ACA, MCA, carotid (same vessels as TACS)
- 2/3 of the criteria for TACS
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What vessels can be affected in POCS?
What criteria must be met for a POCS?
- PCA, vertebrobasilar artery or branches
One of the following – - Cerebellar dysfunction
- Conjugate eye movement disorder (e.g., gaze palsy)
- Bilateral motor/sensory deficit
- Cranial nerve palsy with contralateral motor/sensory deficit
- Isolated homonymous hemianopia + cortical blindness
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What vessels can be affected in LACS and what does that mean?
What areas can be affected in LACS?
What criteria must be met for a LACS?
- Perforating arteries so no higher cortical dysfunction or visual field abnormality, subcortical stroke
- Thalamus, basal ganglia, internal capsule
One of following – - Pure sensory stroke (thalamus)
- Pure motor stroke (posterior limb of internal capsule)
- Sensori-motor stroke
- Ataxic hemiparesis
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How would a brainstem/basilar artery infarct present?
- Locked in syndrome – complete paralysis BUT eye movement + awareness preserved
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How would lateral medullary/Wallenberg’s syndrome present?
What vessel is implicated?
- Ipsi: ataxia, nystagmus, dysphagia, facial numbness + CN palsy
- Contra: limb sensory loss
- Posterior inferior cerebellar artery
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How would lateral pontine syndrome present?
What vessel is implicated?
- Similar to Wallenberg’s but ipsilateral facial paralysis + deafness
- Anterior inferior cerebellar artery
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What is Weber’s syndrome
Ipsilateral CN3 palsy + contralateral hemiparesis
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What is a transient ischaemia attack (TIA)?
- Transient neurological dysfunction secondary to cerebral ischaemia without infarction, usually self-resolving
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What risk assessment tool can be used to calculate a person’s risk of having a stroke within the next 48h?
ABCD2
- Age >60 (1)
- BP >140/90mmHg (1)
- Clinical features (unilateral weakness = 2, speech disturbance = 1)
- Diabetes (1)
- Duration (≥60m = 2, 10–59m = 1)
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What do the scores from ABCD2 mean?
- ≥4 = specialist assessment within 24h (give aspirin 300mg OD)
- ≤3 = specialist assessment within 1 week, ?brain imaging
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What investigation is crucial for the management of stroke and why?
- Non-contrast CT head to exclude haemorrhagic before treatment given.
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How would an ischaemic stroke appear on CT head?
- Hypodensity in region affected with hyperdense vessel
- Loss of grey-white matter differentiation + sulcal effacement (loss of sulci definition) in cortical infarction
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How would a haemorrhagic stroke appear on CT head?
- Acute = hyperdense
- Subacte = isodense
- Chronic = hypodense
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What is the gold standard imaging for stroke if nothing can be seen on CT head?
- Diffusion-weighted MRI head as shows changes within minutes + higher sensitivity for infarcts
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What bloods may be taken in suspected stroke?
- FBC, ESR + clotting screen (vasculitis, clotting disorders)
- U+Es, LFTs, Ca2+ (electrolytes)
- Blood glucose (hypo)
- TFTs, lipid profile
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What other investigations may you do in stroke?
- ECG 72h tape to look for paroxysmal AF
- ECHO to check for endocarditis or CHD
- CTA/MRA or carotid doppler USS to look for dissection or carotid stenosis
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What are some potential complications following a stroke?
- Raised ICP
- Aspiration pneumonia due to dysphagia, pressure sores
- Cognitive impairment
- Long-term disability
- VTE due to immobility