neuro Flashcards
what are the 2 types of stroke
ischaemic- blocked artery - more common
haemorrhagagic- artery the breaks
Haemorrhagic can be further divided into Intracerberal haemorrhage- stays within the cerebrum and a SAH- occurs between the PIA mater and the Arachnoid mater
if symptoms resolved in 24 hours what I sit called
TIA
2 ways an ischeamic stroke can happen
endothelial cell damage
and embolism
describe endothelial cell damage
irritants damage endothelium, now a site of atherosclerosis- plaque forms.
describe embolism
when a blood clot breaks from one location and travels and becomes lodged in a vessel with a small diameter
what does lacunar stroke
damage to the middle cerebral artery and affects legs
what can shock lead to?
reduction in blood throughout the body
risk factors for stroke?
smoking
dm
heart disease
alcohol
is there recovery with embolic stroke?
no
is there recovery from a haemorrhage stroke or embolic?
haemorrhagic
What do we use to estimate the risk factor of strokes?
CHA2DS2-VASc ) Congestive heart failure - HTN - Age >75 (2 points) - DM - Stroke prior, TIA (2 points) - Vascular disease - Age 65-74 - Female
Stroke tests:
) HTN
- ECG - AF
- Echo
- Carotid doppler US - for stenosis
- MRI/CT
how do we prevent strokes:
- Stop smoking
- Control BP
- Move around/exercise
- Hyperlipidaemia
What is TIA?
An ischaemic (usually embolic) neurological event with symptoms lasting <24hours MAY LEAD TO STROKE
Cause of TIA?
Atherothromboembolism from carotid
- Cardioembolism
- Hyperviscosity
- Vasculitis
Tests for TIA
FBC, ESR, U&ES, glucose, lipids
- CXR
- ECG
- Carotid doppler +/- angiography
- CT/diffusion weighted MRI
- Echocardiogram
treatment for TIA?
) Control CV risk factors
- Antiplatelet drugs (aspirin, then clopidogrel)
- Anticoagulation indications (if cardiac source of emboli)
- Carotid endarterectomy is >70% stenosis
what is ABCD2 risk score
risk of stroke following suspected tia
- Age >60
- BP high
- Clinical features (unilateral weakness 2, speech 1)
- Dyration of symptoms (>1hr 2, <1hr 1)
- DM
what makes up the ABCD2 Score?
- Age >60
- BP high
- Clinical features (unilateral weakness 2, speech 1)
- Dyration of symptoms (>1hr 2, <1hr 1)
- DM
what is a subarachnoid haemorrhage?
Spontaneous bleeding into the subarachnoid space, often catastrophic
symptoms of SAH
- Sudden onset excruciating headache (thunderclap)
- neck pain as a result of irritation to meninges
- Vomiting
- Collapse
- Seizures
- Coma
- Possible preceding sentinel headache
signs of SAH
Neck stiffness
- Kernig’s sign (leg extension)
- Retinal, subhyaloidand vitreous bleeds
- Focal neurology at presentation may suggest site of aneurysm
cause if SAH
) Berry aneurysm rupture
- trauma
- Arteriovenous malformations - get tangled up
- Encephalitis, vasculitis, tumour, idiopathic
Risk factors for SAH?
) Previous aneyrysmal SAH
- Smoking
- Alcohol misuse
- High BP
- Bleeding disorders
- SBE
- Family history