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Neurology > Neurology: Clinical - Stroke > Flashcards

Neurology: Clinical - Stroke Flashcards

1
Q

What is ischaemia?

A

Lack of blood flow

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2
Q

What is hypoxia?

A

Lack of oxygen

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3
Q

What is the WHO definition of a stroke?

A

Focal neurological deficit due to disruption of blood supply

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4
Q

What is the overall cause of stroke?

A

Interruption of supply of oxygen and nutrients, causing damage to brain tissue

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5
Q

What is the interruption of oxygen caused by changes in?

A 
Vessel wall
Blood flow (including BP)
Blood constituents
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6
Q

What could be a change in a vessel wall that would cause a stroke?

A

Atheroma or vasculitis

Outside pressure e.g. strangulation, spinal cord compression or compression of veins

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7
Q

What could be a change in blood flow or pressure that would cause a stroke?

A

Decreased blood flow, increased blood pressure due to bursting of vessels

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8
Q

What could be a change in blood constituents that would cause a stroke?

A

Thrombosis of arteries (rarely veins)

Bleeding due to anticoagulation, reduced platelets and clotting factors

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9
Q

What are the 3 main causes of localised interrupted blood supply?

A

Atheroma and thrombosis
Thromboembolism
Ruptured aneurysm

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10
Q

What does atheroma and thrombosis ultimately cause?

A

Ischaemia

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11
Q

If there was internal carotid artery thrombosis where would you typically get ischaemia?

A

Middle cerebral artery territory

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12
Q

What kind of symptoms do you get with reversible ischaemia and how long do they last?

A

Transient symptoms

<24hrs

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13
Q

What kind of symptoms do you get with irreversible ischaemia and how long do they last?

A

Infarct (longstanding symptoms)

>24hrs

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14
Q

What happens to neurons if infarction?

A

Damage to neurons is permanent (cannot regenerate)

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15
Q

What does a regional cerebral infarct typically look like on a brain?

A 
Wedge shaped (arterial territory)
Yellow colouration
Tissue disintegration
Congested vessels
Swelling of surrounding brain tissue
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16
Q

What does an infarcted area of brain look like histologically?

A

Loss of neurons

Foamy macrophages - repair process leading to gliosis

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17
Q

What is gliosis?

A

CNS equivalent of fibrosis

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18
Q

What does thromboembolism lead to?

A

Ischaemia

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19
Q

How can aneurysms form in the cerebral arteries?

A

Weakening of the wall + hypertension

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20
Q

What does a ruptured cerebral artery cause?

A

Haemorrhage and distal ischaemia as there is decreased blood glow distally

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21
Q

Where are the 2 most common sites of ruptured vessels causing haemorrhagic stroke?

A

Basal ganglia - microaneurysms

Circle of Willis - berry aneurysms

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22
Q

What causes generalised interrupted blood supply or hypoxia in the brain?

A
  1. Low O2 in blood (hypoxia)
  2. Inadequate supply of blood
  3. Rare - inability to use O2 (cyanide)
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23
Q

When are example of low O2 in the blood causing generalised interrupted blood supply or hypoxia?

A

CO2 poisoning
Near drowning
Respiratory arrest

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24
Q

When are example of inadequate supply of blood causing generalised interrupted blood supply or hypoxia?

A

Cardiac arrest
Hypotension
Brain swelling (trauma)

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25
Q

What are Watershed infarcts?

A

Zones of infarction at interface of artery perfusion territories

26
Q

What does pure hypotension with oxygenated blood lead to?

A

Watershed infarcts

27
Q

How does a cardiac arrest leading to interrupted blood supply and/or hypoxia?

A

No circulation to brain and no oxygen in brain

28
Q

75yr old woman with known coronary artery disease. Suffers bout of pneumonia. Then suffers cardiac arrest and dies. What types of infarct would this patient have and due to what?

A

Watershed infarcts = hypotension
Laminar cortical necrosis (infarction) = cardiac arrest causes no circulation and no oxygen
Regional infarcts = related to poor flow through cerebral vessels narrowed by atheroma

29
Q

What time of infarction does cardiac arrest cause?

A

Cortical infarction

30
Q

What is more common: ischaemic or haemorrhagic stroke?

A

Ischaemic

31
Q

What is the ischaemic penumbra?

A

The area surrounding an ischaemic event

32
Q

What is the most important modifiable risk factor for stroke?

A

Hypertension

33
Q

What is stroke risk related to?

A

Blood pressure level

34
Q

A blockage of the ACA would result in a stroke of which part of the brain?

A

Medial part of whichever hemisphere is affected

35
Q

What are the symptoms of ACA occlusion?

A

Contralateral:

Paralysis of foot and leg, sensory loss over foot and leg and impairment of gait and stance

36
Q

What are the symptoms of MCA occlusion?

A 
Contralateral:
Paralysis of face/arm/leg
Sensory loss face/arm/leg
Homonymous hemianopia
Gaze paralysis to the opposite side
Aphasia if stroke on dominant (left) side
37
Q

Sum up the main 3 features of an MCA occlusion

A

Hemiplagia
Homonoymous hemianopia
Dysphagia

38
Q

Which part of the brain is responsible for recognising fans and where is it?

A

Fusiform gyrus

Broadman area 37 - occipitotemporal

39
Q

What is prosopagnosia?

A

Failure to recognise faces

40
Q

What is there is an occlusion in the right hemisphere, what could be some of the symptoms?

A

Left hemiplegia
Homonymous hemianopia
Agnosia: visual, sensory etc.

41
Q

Which types of stroke cause damage to the basal ganglia?

A

Lacunar strokes

42
Q

What are the signs of a lacunar stroke?

A 
Pure motor stroke
Pure sensory stroke
Dysarthria - clumsy hand syndrome
Ataxic hemiparesis
(NO cortical signs)
43
Q

What signs are lacking in a lacunar stroke?

A

Cortical signs

44
Q

What structures are affected in a posterior circulation occlusion?

A

Brain stem, cerebellum, thalamus, occipital and medial temporal lobes

45
Q

What are symptoms of brainstem dysfunction?

A

Coma, vertigo, nausea, vomiting, cranial nerve palsies, ataxia
Hemiparesis, hemisensory loss
Crossed sensori-motor deficits
Visual field deficits

46
Q

What should acute ischaemic stroke therapies aim to do?

A

Restore blood supply
Prevent extension of ischaemic damage
Protect vulnerable brain tissue

47
Q

What are the treatments for stroke?

A

Thrombectomy
IV TPA (Tissue plasminogen activator)
Aspirin
Stroke unit care

48
Q

What are the different classifications of stroke (Bamford classification)?

A

Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar stroke (LACS)
Posterior circulation stroke (POCS)

49
Q

What is the name of the system of classifying strokes?

A

Bamford Stroke Classification

50
Q

Which is the worst type of stroke in the Bamford classification?

A

TACS

51
Q

What do you need to be classified as having a TACS (Bamford classification)?

A

All 3 of the following:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (e.g. dysphasia, visuospatial disorder)

52
Q

What do you need to be classified as having a PACS (Bamford classification)?

A

Any 2 of the following:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (e.g. dysphasia, visuospatial disorder)

53
Q

What do you need to be classified as having a LACS (Bamford classification)?

A 
One of the following:
Pure motor stroke
Pure sensory stroke
Sensori-motor stroke
Ataxic hemiparesis
54
Q

What do you need to be classified as having a POCS (Bamford classification)?

A

One of the following:
Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. gaze palsy)
Cerebellar disorder (e.g. ataxia, nystagmus, vertigo)
Isolated homonymous hemianopia or cortical blindness

55
Q

How soon do you have to administer TPA as treatment for stroke?

A

<4.5hours from symptom onset

56
Q

What is the criteria for TPA use?

A

<4.5hours from symptom onset
Disabling neurological deficit
Symptoms present >60 mins
Consent obtained

57
Q

What is the exclusion criteria for IV TPA?

A

Anything that increases risk of haemorrhage

58
Q

What is effective treatment in symptomatic internal carotid artery stenosis?

A

Carotid endarterectomy

59
Q

What are the main causes of an ischaemic stroke?

A 
Large artery atherosclerosis
Cardioembolic (AF)
Small artery occlusion
Undetermined
Rare care - arterial dissection/venous sinus thrombosis
60
Q

What are the investigations for stroke?

A 
Blood tests - FBC, glucose, lipids, ESR
CT/MRI head scan
ECG - ?AF, LVH
Echocardiogram - (valves, congenital)
Carotid doppler ultrasound - ?stenosis
Cerebral angiogram/venogram - ?vasculitis
Hyper-coagulable blood screen
61
Q

What is secondary prevention treatment for stroke?

A 
Anti-hypertensives
Anti-platelets
Lipid lowering agents
Warfarin (AF)
Carotid endarterectomy

Neurology (9 decks)

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