Neurology 3 (Stroke) Flashcards
The common carotid arteries bifurcate into which vessels?
Internal and External carotid arteries
Which arteries fuse to form the basilar artery?
The vertebral arteries
Which carotid artery supplies the face?
External carotid artery
Name the two paired arteries that supply the brain…
internal carotid arteries and the vertebral arteries
The internal carotid arteries supply which part of the brain?
Anterior
The vertebral arteries supply which part of the brain?
Posterior
What is the purpose of the circle of willis?
Acts to provide collateral blood flow between the anterior and posterior circulations of the brain, protecting against ischemia in the event of vessel disease or damage in one or more areas.
Name the three cerebral arteries
Posterior
Middle
Anterior
What is the key difference between an ischemic stroke and a TIA?
In an ischaemic stroke, symtoms >24 hrs
Transient Ischaemic Attack (TIA) – transient; less than 24 hrs
What are the three different types of ischemic stroke?
Lacunar
Thrombotic
Embolic
What is a Hemorrhagic stroke?
Caused when a blood vessel leaks/ruptures and bleeds into the brain.
What is the number one risk factor for stroke?
Hypertension
Define: Lacunar Stroke
Blood flow to one of the small arteries deep within the brain becomes blocked.
Lacunar infarctsare small infarcts (2–20 mm in diameter)
Define: Thrombotic Stroke
when a blood clot (thrombus), forms due to a ruptured atherosclerotic plaque and blocks blood flow through the artery in which it formed.
Name some (6) of the risk factors for Thrombotic Stroke
hyperlipidemia, hypertension, smoking, obesity, diabetes, and family history.
Define: Embolic Stroke
Clot reaching and occluding an artery in the brain from a distant site, which therefore causes an embolic stroke
What are the two types of hemorrhagic stroke?
Intracerebral Hemorrhage (ICH)
Subarachnoid hemorrhage (SAH)
Define: Subarachnoid hemorrhage (SAH)
Bleeding into the subarachnoid space due to a ruptured blood vessel.
What are the two major causes of bleeding in a Subarachnoid hemorrhage (SAH)
Arterial rupture due to berry aneurysms or AVMs within theCircle of Willis.
Define: Intracerebral Hemorrhage (ICH)
Rupture of the small vessels supplying the deep areas of the brain which results in bleeding within the brain tissue itself.
What is the acronym used in the UK as a mnemonic to help detect and enhance responsiveness to the needs of a person having astroke?
BE FAST
Balance
Eyes (blurred vision)
Face (drooping)
Arm or leg weakness
Speech difficulty
Time to call 999
According to NICE, in people presenting with sudden onset of neurological symptoms, what the first thing that should be excluded as a cause?
Hypoglycemia
Neck stiffness is commonly associated with which type of stroke?
Haemorrhagic Stroke
What imaging is used to differentiate between ischemic stroke and hemorrhagic stroke
Head CT
What is the name of the scoring system used to assess the severity of a stroke in a acute setting?
TheNational Institute of Heath Stroke Scale/Score(NIHSS)
What is the highest score on the NIHSS, indicating a severe stroke?
42 points
On the NIHSS, what score would indicate a minor stroke?
1-4
What is the most commonly used thrombolytic drug?
Alteplase; tissue plasminogen activator (tPA)
In the event of an ischemic stroke, in what time frame is thrombolysis most effective?
Only effective up to 4.5 hours of symptom onset.
In the event of an ischemic stroke, how much aspirin is the patient given?
300mg
In the event of an ischemic stroke, how long is aspirin until the dose is lowered?
2 weeks (or until discharge from hospital)
In the event of an hemorrhagic stroke, what is the acute treatment?
Reverse anti-coagulation (if entirely possible).
Two weeks after an ischemic stroke, what factor is the choice of secondary prevention medicine dependent on?
Treatment dependent on whether the patient has Arial Fibrillation/Flutter.
In secondary prevention of an ischemic stroke (2 weeks later), if the patient is NOT in AF, what medication will they be started on?
Anti-platelet - Clopidogrel
What is the MOA of Clopidogrel?
Irreversibly binds adenosine diphosphate (ADP) receptors on platelets, preventing platelets from releasing granules to recruit others and therefore inhibiting platelet aggregation.
In secondary prevention of an ischemic stroke (2 weeks later), if the patient is DOES HAVE AF, what medication should be considered to start them on?
Anti-coagulation medications
In secondary prevention of an ischemic stroke (2 weeks later), if the patient is NOT in AF but Clopidogrel in contraindicated, what medication is used?
Dipyridamole +/- Aspirin
What is the most common side effect of Dipyridamole? Why?
Headache, due to causing vasodilation
What is the MOA of Dipyridamole?
Antiplatelet that increases cAMP which inhibits platelet aggregation
In secondary prevention of an ischemic stroke (2 weeks later), if the patient DOES HAVE AF, what is the preferred anticoagulant medication?
NOACs are now the most preferred anticoagulant of choice, specifically Rivaroxaban
In secondary prevention of an ischemic stroke (2 weeks later), if the patient DOES HAVE AF, in what (3) circumstances is Warfarin used?
Valvular HD, Severe Renal Impairment or Interacting Drugs
What secondary prevention strategies can be used after a Haemorrhagic Stroke?
Stop anti-coagulants (where possible)
Stop Smoking
Control BP
On examination of a patient with suspected Bell’s palsy, what (5) key features are seen?
(1) Unilateral facial weakness involving upper AND lower parts of the face
(2) Eyebrow droops
(3) Eye cannot close
(4) Unable to puff cheeks
(5) Cannot purse lips
If patients with Bell’s palsy present within 72 hours of symptom onset, what medication is reccomended?
50mg of Prednisone for 10 days.
What is the main differentiating factor between Bell’s palsy and stroke?
In a stroke, the forehead is spared and the extremities are often affected, rather than just the face.
What other (5) secondary prevention strategies should be considered post stroke?
(1) Anti-hypertensives
(2) Type 2 Diabetes
(3) Cholesterol lowering
(4) Smoking cessation
(5) Stop OCP or HRT
When considering anti-coagulation in secondary prevention of an ischemic stroke (2 weeks later) in a patient with AF, what is the name used of the two scoring systems used to asses benefits vs risk?
Chad vasc
HAS-BLED
What does the HAS-BLED score estimate?
Estimates the 1-year risk for majorbleedingin patients with atrial fibrillation.
What does the Chad Vasc score estimate?
Estimates the risk of stroke in patients with atrial fibrillation
What medication is recommended for first line for TIA?
Dipyradamole +/- Aspirin
