Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS3 BAMS > Neurology - Stroke > Flashcards

Neurology - Stroke Flashcards

1
Q

What is a stroke?

A
  • An acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24 hours or causing earlier death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens during a stroke? (3)

A
  • Death of brain tissue from hypoxia
  • No local cerebral blood flow: - infarction of tissue - haemorrhage into the brain tissue
  • Temporary ischaemia = TIA (transient ischaemic attack)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

There are 2 types of stroke. What are these?

A
  • Ischaemic and haemorrhagic stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a transient ischaemic attack?

A
  • This happens when there is a rapid loss of function but then a rapid recovery of function so that then thee patient within 24 hours has recovered all of the neurological issues which were lost
  • TIA’s represent issues in the blood vessels and are suggestive that the patient has a higher risk of a proper stroke at some point in the future
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the acronym to help people to remeber what to look for when considering a stroke?

A

FAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does FAST stand for?

A
  • Facial drooping
  • Arm weakness
  • Speech difficulty
  • Time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is a TIA thought to occur?

A
  • It is thought that these happen because of platelet emboli from the vessels in the neck
  • These platelets block the blood flow to the brain tissue causing ischaemia but are then rapidly removed by the circulation and the blood flow is restored before any permanent damage has occurred
  • Localised loss of brain function - ischaemic event not haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long does it take for full recovery from a TIA?

A
  • FULL recovery within 24 hours

- Most recover in 30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

TIA’s indicate a higher risk of a ‘proper’ stroke over 5 years. What is the % chance of having a stroke 1 year after a TIA?

A

12%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

TIA’s indicate a higher risk of a ‘proper’ stroke over 5 years. What is the % chance of having a stroke 5 year after a TIA?

A

29%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the % risk of an MI if a person has had a TIA?

A

2.4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors increase the risk of a stroke? (6)

A
  • Hypertension
  • Smoking
  • Alcohol
  • Inchaemic heart disease
  • Atrial fibrillation
  • Diabetes mellitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hypertension is a risk factor for a stroke. If diastolic >110mm Hg then how many more times likely is the patient to have a stroke than if they has diastolic <80mm Hg?

A
  • 15x higher risk

- Even borderline hypertension has a risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What % of all deaths are from a stroke?

A

12%

- It is the commonest cause of adult disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the lifetime risk of a person having a stroke?

A

1 in 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Does age affect the likelihood of having a stroke?

A
  • Increasing incidence with age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who is more likely to be at risk of stroke; males or females?

A

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What % of strokes are from infarction?

A

85%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What % of strokes are from haemorrhage?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What % of strokes are from subarachnoid haemorrhage?

A

5%

21
Q

What % of strokes are from venous thrombosis?

A

<1%

22
Q

What is the cause of an ishaemic stroke?

A
  • Uncertain
  • Most of the time it is due to narrowing of the vessels, plaques forming and ischaemia in the same way as would happen in a cardiac event
23
Q

One cause of a stroke is an intracranial bleed, how does this occur?

A
  • Aneurysm rupture
24
Q

One cause of a stroke could be an embolic stroke. How does this occur? (3)

A

Embolism from left side of heart:

  • Atrial fibrillation
  • Heart valve disease
  • Recent MI
25
Q

One cause of a stroke could be an atheroma of cerebral vessels. Where does this occur? (3)

A
  • Carotid bifurcation
  • Internal carotid artery
  • Vertebral artery
26
Q

What are other less common causes of a stroke? (3)

A

Venous thrombosis:

  • Oral contraceptive use
  • Polycythaemia
  • Thrombophilia

‘Borderzome’ infarction:

  • Severe hypotension
  • Cardiac arrest

Vasculitis - these may narrow the blood vessels into the brain and cause limitation of oxygen delivery and thereofre stroke

27
Q

How can we prevent a stroke? (3)

A

Reduce risk factors:

  • Smoking
  • Diabetes control
  • Control Hypertension

Antiplatelet action (secondary prevention only)

  • Aspirin
  • Dipyrisamole
  • Clopidogrel

Anticoagulants - embolic risk - AF, LV thrombus
- Warfarin, Apixaban

28
Q

What kinds of surgery are there to prevent a stroke? (2)

A

Carotid endarterectomy:

  • Severe stenosis
  • Previous TIA’s
  • <85 years of age

But 7.5% mortality from surgery

Preventative neurosurgery:
- Aneurysm clips, AV malformation correction

29
Q

Why do we need to investigate the cause of a stroke?

A

Need to differentiate:

  • Infarct
  • Bleed
  • Subarachnoid haemorrhage
  • Early information is needed to assess treatment options
30
Q

What kinds of imagine might we use to investiage a stroke? (3)

A
  • CT scan
  • MRI scan
  • Digital Subtraction Angiopathy
31
Q

What is a positive and a negative for using CT scans to investigate a stroke?

A
  • Rapid, easy access

- Poor for ischaemic stroke (but very good for showing a haemorrhagic stroke

32
Q

What is a positive and a negative for using MRI scans to investigate a stroke?

A
  • Difficult to obtain quickly

- Better at visualising early changes of damage

33
Q

What is the best investigation for visualising the brain circulation?

A
  • MRA (MR angiopathy)
34
Q

IF an MRA is not available what kind of imaging would we use to investiaget a stroke?

A
  • Digital subtraction angiopathy

- This can be used for looking at blood flow in the brain

35
Q

What can we see in an MR angiopathy?

A
  • Can see both the blood vessels and their location in 3 dimensions
36
Q

What can we see in a subtraction angiography?

A
  • The brain tissue has been removed and we can only see the changes of the blood vessels
37
Q

When investigating a stroke we want to assess risk factors. How would we do this? (6)

A
  • carotid ultrasound (looking for evidence of atherosclerosis in the carotid artery)
  • Cardiac ultrasound (Left ventricle thrombosis)
  • ECG (arrythmias)
  • Blood pressure (is the pressure in the vessels too high?)
  • Diabetes screen
  • Thrombophilia screen (young patients)
38
Q

What are the possible effects a stroke can have? (3)

A

Loss of functional brain tissue

  • Immediate nerve cell death
  • Nerve ischaemia in penumbra around infarction (will die of not protected)

Gradual or rapid loss of function - stroke may ‘evolve’ over minutes or hours

Inflammation in tissue surrounding infarct/bleed
- Recovery of some function with time

39
Q

Give examples of motor function loss complications of a stroke? (4)

A
  • Cranial nerve or somatic (opposite side)
  • Autonomic in brainstem lesions
  • Dysphonia
  • Swallowing (aspiration of food and saliva -> pneumaonia and death)
40
Q

What is dynphonia?

A
  • Having an abnormal voice
41
Q

Give examples of sensory loss complications of a stroke? (3)

A
  • Cranial nerve or somatic (opposite side)
  • Body perception:
  • Neglect
  • Phantom limbs
  • The patient might have an arm that they no longer feel belongs to them - they know it is there and they know it is there arm but they feel it is no longer part of their body
  • As a result they neglect it and it can result in significant damage
  • Similarly the opposite where the patient feels that they have an extra limb can be found
42
Q

What are cognitive impairment complications of a stroke? (4)

A
  • Appreciation - special sensation

Processing:

  • Understanding of information
  • Speech and language (dysphasia, dyslexia, dysgraphia & dyscalculia)
  • Memory impairment
  • Emotional lability and depression
43
Q

What is dyscalculia?

A
  • This is a specific persistent difficulty in understanding numbers which can lead to a diverse range of difficulties with mathematics
44
Q

How would we manage a stroke in the acute phase? (2)

A
  • Limit damage

- Reduce further risk

45
Q

How would we manage stroke in the chronic phase? (2)

A
  • Rehabilitation

- Reduce further risk

46
Q

Give examples of acute phase treatment to reduce damage? (5)

A

Penumbra region - survivable ischaemia
- Calcium channel blockers (Nimodipine)

Improve blood flow/oxygenation:

  • Thrombolysis possible within 3hrs (alteplase)
  • Maintain perfusion pressure to brain tissue

Normoglycaemia - hyper/hypo harmful
- One thing that is very important is the brain glucose level - the brain is solely dependent on glucose for its energy stores and therefore if this is not available the patient will have more of an exaggerated damage from the stroke

Remove haematoma:
- Subarachnoid haemorrhage only

Prevent further risk:
- Aspirin 300mg daily
- Anticoagulation if indicated (delay 2 weeks)
Particularly if patient has a history of:
- Atrial fibrillation
- Left ventricular thrombus

47
Q

Give examples of nursing anf rehabilitation chronic phase treatment? (3)

A

Immobility support:

  • Prevention of bed sores
  • Physiotherapy to prevent contractures

Speech and languahe therapy:

  • Communications
  • Swallowing and eating

Occupational therapy

48
Q

What are the dental aspects of a stroke? (6)

A

Impaired mobility & dexterity:

  • Attendance
  • Oral hygiene

Communication difficulties:

  • Dysphonia, dysarthia
  • Cognitive difficulties

Risk of cardiac emergencies

  • MI
  • Further stroke

Loss of protective reflexes:

  • Aspiration
  • Managing saliva (alticholinergic drugs help?)

Loss of sensory information:
- Difficulty in adaption to new oral environment e.g. new dentures

‘Stroke pain’

  • CNS generated pain perception
  • The damage to the brain can change the way in which the brain processes the environment and sometimes the pain is reported by the patient that is essentially generated within the damaged CNS and not due to any peripheral stimulation

BDS3 BAMS (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions