Neuro Flashcards
What is a stroke (cerebrovascular accident)?
When the blood supply to part of the brain is cut off
What can cause a stroke?
Small vessel occlusion/ thrombosis in situ
Cardiac emboli, CNS bleeds e.g. aneurysm rupture
Subarachnoid haemorrhage
What are the modifiable risk factors for strokes?
High BP, smoking, diabetes, heart disease, peripheral vascular disease
What medical conditions act as risk factors for strokes?
Hypertension, carotid artery stenosis, vasculitis, hyper viscosity
What is the ischaemic pathology of a stroke?
Sustained occlusion of a cerebral artery leads to ischaemic necrosis of the territory of the brain supplied by the affected artery
What is the haemorrhagic pathology of a stroke?
Hypertension due to ruptured Charcot-Bouchard aneurysms
Haematoma forms which destroys the brain structure and causes a sudden rise in intracranial pressure
Which manifestations of a stroke point to a haemorrhagic cause?
Meningism, severe headache, coma
Which manifestations of a stroke point to an ischaemic cause?
Carotid bruit, AF, past TIA, IHD
How do cerebral infarcts present?
Visuo-spatial deficit, dysphasia, spasticity (UMN)
Contralateral sensory loss or hemiplegia
How do brainstem infarcts present?
Quadriplegia, disturbances of gaze and vision, locked-in syndrome (aware but can’t respond)
How do lacunar infarcts present?
5 syndromes: Ataxic hemiparesis, pure motor, pure sensory, sensorimotor, dysarthria
How are strokes diagnosed?
FAST, CT/ MRI for haematoma, ECG: AF, CXR: LV hypertrophy
How are strokes managed?
Ischaemia - thrombolysis with IV Altepase
Aspirin for 2 weeks, then clopidogerol
Haemorrhagic - control BP (beta blocker)
Surgery - Clot evacuation
How can strokes be primarily prevented?
Control risk factors - hypertension, diabetes mellitus, cardiac disease, quit smoking. Use lifelong anticoagulant in AF and prosthetic heart valves
How can strokes be secondarily prevented?
Lower BP and cholesterol
Anti-platelet agents after stroke
Anticoagulation after stroke from AF
What is a transient ischaemic attack?
An ischaemic (usually embolic) neurological event with symptoms lasting <24h (often much shorter)
What are the causes of TIAs?
Atherothromboembolism from the carotid, cardioembolism, hyper viscosity, vasculitis
Explain the ABCD2 score for strokes
Age: 60+ BP: 140/90mmHg + Clinical features: unilateral weakness (2 points), speech disturbance without weakness Duration: 60+ = 2 points, 10-50 = 1 Diabetes
What indicates a high risk of stroke?
ABCD2 score 4+
AF, more than one TIA in one week
What is amaurosis fugax?
Occurs when the retinal artery is occluded, causing unilateral progressive vision loss ‘like a curtain descending’
What is a differential diagnosis for a TIA?
Focal epilepsy
How are TIAs investigated?
FBC, CXR, ECG, Carotid Doppler with angiography r CT
How are TIAs managed?
Control CV risk factors; high BP (beta blocker), diabetes, smoking
Antiplatelet drugs - aspirin (immediate)/clopidogrel
Statins - simvastatin
What is a carotid endarterectomy?
Surgery to remove a build-up of plaque in the carotid artery