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BDS3 BAMS Diseases of Human Systems > Neurology - Stroke > Flashcards

Neurology - Stroke Flashcards

1
Q

What is a stroke defined as

A

acute focal neurological deficit resulting form cerebrovascular disease and lasting more than 24h or causing earlier death

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2
Q

What is a store

A

it is the death of brain tissue from hypoxia due to no local cerebral blood flow

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3
Q

What can result in no local cerebral blood flow

A

infarction of tissue

hemorrhage into the brain tissue

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4
Q

What is it called if there is temporary ischemia

A

transient ischemic attack

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5
Q

What are the 4 big symptoms

A

facial drooping
arm weakness
speech difficulty
time

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6
Q

What is a transient ischemic attack

A

localized loss of brain function due to an ischemic event not a hemorrhage

full recovery within 24 hours but most recover in 30 minutes

results in higher risk of proper stroke

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7
Q

What are risk factors for stroke

A 
HYPERTENSION
SMOKING
alcohol
ISCHAEMIC HEART DISEASE
atrial fibrillation
diabetes mellitus
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8
Q

How is hypertension such a big risk?

A

if the diastolic is >110mg then there is a 15x risk compared to diastolic <80mmHg
even borderline hypertension has a risk

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9
Q

What are the different types of stroke

A

ischemic stroke
intracranial bleed
embolic stroke

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10
Q

What causes an inter cranial bleed usually

A

aneurysm rupture

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11
Q

What can cause an embolic stroke

A

embolism coming from left side of the heart

atheroma of cerebral vessels

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12
Q

What can cause embolism from the LHS of the heart

A

atrial fibrillation
heart valve disease
recent MI

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13
Q

What can cause an atheroma of a cerebral vessels

A

carotid bifurcation
internal carotid artery
vertebral artery

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14
Q

What are less common causes of stroke

A

venous thrombosis
borderline infarction
vasculitis

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15
Q

What can cause venous thrombosis

A

oral contraceptive use
polycythemia
thrombophillia

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16
Q

How do we prevent stroke

A 
reduce risk factors
anti platelet action
anticoagulants
carotid endarterectomy 
preventative neurosurgery
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17
Q

What risk factors can we reduce

A

smoking
diabetes
control hypertension

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18
Q

How is anti platelet action used for stroke prevention

A

used for secondary prevention only
aspirin
dipyridamole
clopidogrel

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19
Q

Why are anticoagulants used for prevention

A

embolic risk - usually those with AF, LV thrombus

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20
Q

What are the common anticoagulants usually given for prevention

A

warfarin, apixaban

21
Q

What are the preventative neurosurgery

A

aneurysm clips

AV malformation correction

22
Q

What do we need to figure out in investigation of stroke

A

need to differentiate cause - is it infarct, bleed or subarachnoid hemorrhage

23
Q

What is used for investigation of stroke

A

CT scan
MRI
DSA

assess risk factors

24
Q

What are advantages and disadvantages of CT scan

A

rapid, easy access

poor for ischemic stroke

25
Q

What are advantages and disadvantages of MRI scan

A

difficult to obtain quickly
better at visualizing early changes of damage
MRA is the best investigation for visualizing the brain circulation

26
Q

What is DSA used

A

if MRA not available

27
Q

How do we assess risk factors in investigations

A 
carotid ultrasound
cardiac ultrasound (LV thrombus)
ECG (arythmias)
blood pressure
diabetes screen
thrombophilia screen (young px)
28
Q

What is the effect of a stroke

A

loss of functional brain tissue
gradual or rapid loss of function
inflammation in tissues around the infart/bleed

29
Q

Why i sheer loss of functional brain tissue

A

due to immediate nerve cell death

nerve cell ischemia in penumbra around infarction will result in death if not protected

30
Q

What are complications of stroke

A 
motor function loss
dysphonia
swallowing
sensory loss
cognitive impairment
31
Q

How does motor function loss present

A

can be cranial nerve or somatic (opposite side!)

autonomic is effected in brain stem lesions

32
Q

What are complications of the loss of swallowing in complications

A

aspiration of food and saliva

pneumonia and death

33
Q

How may sensory loss present

A

cranial nerve or somatic may be effected (opposite side)

body perception may be different - neglect or phantom limbs

34
Q

How will the cognitive impairment present

A

appreciation - special sensation
processing
memory impairment
emotional lability and depression

35
Q

How does the processing present

A

understanding of information

speech and language - dysphasia, dyslexia, dysgraphia, dyscalculia

36
Q

What is the management of stroke in the acute phase

A

limit damage

reduce future risk

37
Q

What is the management of stroke in the chronic phase

A

rehabilitation

reduce future risk

38
Q

How do we limit damage in acute phase treatment

A

penumbra region 0 survivable ischaemia
improve blood flow/oxygenation
normoglycemia

39
Q

How do we try to save the penumbra region in acute phase treatment

A

using calcium channel blockers (nimodipine)

40
Q

How do we improve blood flow/oxygenation

A

thrombolysis possible within 3 hours (alteplase)

maintain perfusion pressure to brain tissue

41
Q

When can we remove the hematoma

A

in sub arachnoid hemorrhage only

42
Q

How do we prevent future risk

A

aspirin 300mg daily

anticoagulation if indicated (delay 2 weeksO

43
Q

When are anticoagulants indicated

A

atrial fibrillation

LV thrombus

44
Q

What is chronic phase treatment

A

nursing and rehabilitation - immobility support, speech and language therapy, occupational therapy

45
Q

How do we give immobility support

A

prevention of bed sores

physiotherapy to prevent contractures

46
Q

Why do we give speech and language therapy

A

communications

swallowing and eating

47
Q

What are dental aspects of stroke

A 
impaired mobility and dexterity
communication difficulties
risk of cardiac emergency 
loss of protective reflexes 
loss of sensory information
stroke pain
48
Q

What is the relevance of sensory information

A

difficulty in adaption to new oral environment

49
Q

What is the risk fo cardiac emergencies

A

MI, further stroke

BDS3 BAMS Diseases of Human Systems (11 decks)

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