Neuro Flashcards
There are different types of stroke, including haemorrhagic and ischaemic. A rarer type is cerebral venous thrombosis; which patient groups is this more commonly seen in?
Prothrombotic tendencey e.g. pregnancy, infection, intracranial hypertension, inherited thrombophilia, dehydration or malignancy.
Give 4 female-specific risk factors for stroke.
Current OCP use
Migraine with aura
Immediate post-partum period
Pre-eclampsia
Which area of the brain is affected in a LACUNAR stroke?
Perforating artery around the internal capsule, basal ganglia and thalamus.
Which artery is affected in lateral medullary syndrome, and what is the eponymous name for this syndrome?
PICA
Wallenberg’s
Which artery is affected in lateral pontine syndrome?
AICA
Give the 3 possible presentations of a lacunar stroke. They have a strong association with hypertension.
Isolated hemiparesis
Hemisensory loss
Hemiparesis + ataxia
Features of Lateral Medullary Syndrome:
Ipsilateral: Facial PAIN and temp loss
Contralateral: limb/torso PAIN and temp loss
+ ataxia and nystagmus
Features of lateral pontine syndrome:
Ipsilateral: Facial paralysis and deafness
Contralateral: limb/torso pain and temp loss as in PICA
What does Weber’s syndrome refer to?
Branches of the PCA that supply the midbrain are affected.
Ipsilateral CNIII palsy
Contralateral weakness of upper and lower extremity
A person has had a stroke. They have had a CT and confirmed a lesion on the right hand side. They have left sided hemiparesis and sensory loss, affecting their lower limb > upper limb. Which artery is the most responsible?
Right ACA
A person has had a stroke. They have had a CT and confirmed a lesion on the left hand side. They have right sided hemiparesis and sensory loss, affecting their upper limb > lower limb. Which artery is the most responsible, and what other symptoms are likely to be present?
Right MCA
Contralateral homonymous hemianopia
Aphasia
What symptoms would you expect to find in someone who has had a right PCA stroke?
Left sided homonymous hemianopia with macular sparing.
Visual agnosia
Where is the lesion if a patient has had a stroke and presents with visual agnosia?
PCA
Where is the lesion if the patient presents with sudden total loss of vision?
Retinal / ophthalmic artery
A patient presents with ‘locked in’ syndrome. Where is the lesion?
Basilar artery
How would a patient with a TACS present?
Contralateral:
Hemiplegia
Homonymous hemianopia
Sensory deficit
+ aphasia / visuospatial disturbance
How may a person who has had a posterior circulation stroke present?
Classicaly difficult to diagnose. Often acute vestibular syndrome symptoms e.g. continuous vertigo or dizziness with nystagmus, n&v, gait disturbance etc.
CN impairment
First line medication for an acute ischaemic stroke once haemorrhagic stroke has been excluded via CT.
300 mg aspirin
If cholesterol levels are >3.5 mmol then patients should be commenced on a statin. In the context of an acute ischaemic stroke, why might physicians delay this treatment until at least 48 hours after the event?
Risk of transforming into haemorrhagic stroke.
Give 2 standard criteria for thrombolysis in acute ischaemic stroke, and which drugs are used?
Alteplase / tenecteplase
<4.5 hours until administration
Haemorrhagic stroke excluded on CT
First and second choice of secondary prevention after ischaemic stroke?
Clopidogrel
Aspirin + MR dipyridamole
When should carotid endarterectomy be considered?
> 50% stenosis
If patient suffered a stroke / TIA in the carotid territory and is not severely disabled. Should be done within 7 days.
Absolute contraindications to thrombolysis:
Previous ICH
Seizure at onset of stroke
Intracranial neoplasm
SAH
Stroke or TBI in last 3 months
LP in 7 days prior
Active bleeding, or haemorrhage in last 3 weeks, varices
Uncontrolled hypertension
What score is most commonly used to measure disability / outcomes after stroke?
Barthel Index
10 tasks, scored according to amount of time or assistance the patient requires for each task.
Discuss blood pressure management post stroke.
BP should only be lowered post stroke if there is a hypertensive emergency e.g. hypertensive encephalopathy, nephropathy, MI, aortic dissection, PET.
This is because lowering BP too much can potentially compromise collateral blood flow to affected area and hasten time to complete and irreversible tissue infarction.
If blood pressure management is required post stroke, which 3 agents are recommended due to possibility for rapid and safe titration?
Labetalol
Nicardipine
Clevedipine
Patients with hyperglycaemia post stroke have increased mortality. Why?
Increased tissue acidosis from anaerobic metabolism, free radical generation and increased BBB permeability.
Describe the ROSIER score and when it is used.
Screening tool for possible stroke.
New acute onset of any of these = +1 point:
Asym facial weakness
Asym arm weakness
Asym leg weakness
Speech disturbance
Visual field defect
-1 point:
Loss of conscious / syncope
Seizure activity
TIA management in a patient who presents within 24 hours of onset with LOW bleeding risk:
DAPT:
300mg clopidogrel + 300mg aspirin
Continuation:
75 mg aspirin 21 days
75 mg clopidogrel continuous
+ PPI
Not suitable for DAPT? just clopidogrel then
What lipid modification treatment should be offered at diagnosis of stroke or TIA?
STATIN high intensity e.g. 20-80 mg daily
