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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the difference between stroke and epilepsy in type of symptoms?

A
  1. Stroke - negative symptoms

2. Epilepsy - positive symptoms

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2
Q

What is a stroke?

A

Sudden interruption in the vascular supply of the brain resulting in focal neurological deficits lasting over 24 hours.

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3
Q

What are the causes of an ischaemic stroke?

A
  1. Atherothromboembolism from internal carotid
  2. Cerebral microangiopathy
  3. Carotid artery dissection (younger)
  4. Thrombophilia
  5. Venous sinus thrombosis
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4
Q

What are the three different types of stroke?

A
  1. Ischaemic (85%) - block in blood flow
  2. Intraparenchymal haemorrhagic (15%) - burst small blood vessel, reduction in blood flow
  3. Venous stroke (1%)
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5
Q

What are the causes of an intraparenchymal haemorrhagic stroke?

A
  1. HTN

2. Coagulopathy

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6
Q

What is the difference between intraparenchymal haemorrhagic stroke and a subarachnoid haemorrhage?

A
  1. SAH is intracerebral

2. SAH involves berry aneurysm of large vessel, IHS involves a burst small blood vessel

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7
Q

How does a venous stroke present?

A
  1. Raised ICP

2. Focal neurology and seizures

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8
Q

Why are the optic tracts less affected in strokes than other cortical functions?

A

They are in white matter, so only a large stroke would affect them.

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9
Q

What is the underlying pathophysiology of a haemorrhagic stroke?

A
  1. Hyaline arteriosclerosis and microaneurysm formation

2. Cerebral amyloid angiopathy of the small leptomeningeal vessels

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10
Q

What are the risk factors for developing a stroke?

A

HTN (leading cause), age, smoking, alcohol, diabetes, IHD, AF, PVD, COCP, hyperlipidaemia, coagulopathies.

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11
Q

What are the differentials for a stroke?

A

Head injury, hypoglycaemia, tumour, migraine, encephalopathy, encephalitis, MS, syncope.

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12
Q

What are the signs seen in a stroke from a cerebral infarct?

A
  1. Contralateral sensory loss - hemiplegia
  2. Hemiparesis - initially flaccid
  3. Pyramidal weakness - upper limb extensor weakness, lower limb flexor weakness
  4. Spasticity
  5. Hyperreflexia
  6. Dysphasia
  7. Homonymous hemianopia
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13
Q

What are the signs seen in a stroke from a brainstem infarct?

A
  1. Varied - including quadriplegia

2. Vision disturbances

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14
Q

What are the signs seen in a stroke from a lacunar infarct?

A
  1. Pure motor, ataxic, pure sensory, or mixed sensorimotor hemiparesis
  2. Dysarthria/clumsy hand
  3. Cognition/consciousness intact except in thalamic strokes
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15
Q

What are the signs seen in a haemorrhagic stroke?

A

Meningism, headache, coma within hours.

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16
Q

Why are Broca and Wernicke areas on the left in most peoples brains?

A

Because most people are left brain dominant

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17
Q

What are the non-dominant Broca and Wernicke areas responsible for?

A
  1. Broca - tone of speech

2. Wernicke - understanding non-verbal language

18
Q

What is the effect of a unilateral temporal lobe infarction on hearing?

A
  1. No contralateral deafness as auditory fibres cross over

2. Patients cannot locate where sounds are coming from

19
Q

What is the criteria for a partial vs a total anterior stroke?

A

All 3 = total, any 2 = partial:

  1. Unilateral weakness (+/- sensory deficit)
  2. Homonymous hemianopia
  3. Dysphasia
20
Q

What is this a presentation of?

Contralateral hemiparesis and sensory loss - LEGS.

A

Anterior cerebral artery stroke

21
Q

What is this a presentation of?
Contralateral hemiparesis and sensory loss - ARMS.
Contralateral homonymous hemianopia
Aphasia

A

Middle cerebral artery stroke

22
Q

What is this a presentation of?

Contralateral homonymous hemianopia and macular sparing. Visual agnosia and cerebellar signs.

A

Posterior cerebral artery stroke

23
Q

What is this a presentation of?
Ipsilateral CN III palsy
Contralateral weakness of upper and lower limb.

A

Weber’s stroke (branches of PCA that supply the midbrain)

24
Q

What is this a presentation of?
Ipsilateral facial pain and temperature loss
Contralateral limb pain and temperature loss

A

Lateral medullary syndrome

Posterior inferior cerebellar artery stroke

25
Q

What is this a presentation of?
Ipsilateral facial paralysis and deafness
Contralateral limb pain and temperature loss
Acute bilateral deafness and vertigo

A

Lateral pontine syndrome

Anterior inferior cerebellar stroke

26
Q

What is the important differential to exclude in acute bilateral deafness and vertigo?

A

Anterior inferior cerebellar stroke

27
Q

What examination should you perform on a suspected stroke patient?

A
  1. Look for xanthoma, stigmata of endocarditis, marfanoid appearance.
  2. Full neurological examination
28
Q

What bloods should you order for a suspected stroke patient?

A
  1. FBC, ESR (vasculitis), U&Es + LFTs (metabolic cause of neurological impairment), clotting, glucose, lipids.
  2. Young stroke - lupus screen, HIV, ANA, dsDNA, ESR
  3. Consider - factor V Leiden, JAK2
29
Q

What imaging should be performed on a suspected stroke patient?

A
  1. 24hr/7d ECG - look for AF
  2. CXR - signs of LVH from HTN and cancer
  3. Echo heart for emboli
  4. Doppler USS carotids - source of emboli, potential carotid endarterectomy if stenosis >70%
  5. CTA/MRI for posterior circulation stroke
30
Q

What is the immediate management in resus for a suspected stroke patient?

A
  1. Protect airway
  2. Maintain homeostasis - BG, BP, sats
  3. Assess safe swallow, NBM if necessary
  4. Non-contrast CT within 1 hour
  5. Admit to stroke unit
31
Q

What is the management of a suspected stroke patient once a haemorrhagic stroke has been ruled out on CT?

A
  1. Give aspirin 300mg if >4.5 hours from onset
  2. Thrombolysis with alteplase within 4.5 hours of onset of symptoms, re-do CT 24 hours later.
  3. If >4.5 hours then only aspirin loading dose.
  4. Start aspirin 300mg for 2 weeks - wait 24 hours after thrombolysis
  5. Thrombectomy if proximal large artery occlusion
  6. SALT, OT, PT input
32
Q

What are the main contraindications for thrombolysis?

A

Major trauma/haemorrhage, surgery in past 2 weeks, LP in past week, ischaemic stroke in past 3 months, seizures at presentation, BP>185, INR>1.7

33
Q

How effective is thrombolysis and what is the risk of complication?

A
  1. Helps 1 in 8 recover

2. 1 in 18 risk of bleed in the brain which can cause death

34
Q

What is the management for a haemorrhagic stroke identified on CT?

A
  1. Reverse anticoagulation
  2. Lower BP to 140mmHg systolic
  3. Neurosurgery referral
  4. Hyperdense on CT brain
35
Q

What is the primary prevention for stroke?

A
  1. Control HTN, DM, and lipids
  2. Quit smoking
  3. Anticoagulate in cardiac causes of stroke
36
Q

What is the secondary prevention for ischaemic stroke?

A
  1. Aspirin 300mg for 2 weeks then switch to long term clopidogrel monotherapy.
  2. If clopidogrel not tolerated, aspirin and dipyridamole
37
Q

What is the secondary prevention for ischaemic stroke in underlying AF?

A
  1. DOAC for non-valvular AF

2. Warfarin for valvular AF/significant CKD/metallic valves

38
Q

What are the target results for antihypertensives and statins in the secondary prevention of a stroke?

A
  1. Antihypertensives - 130/80 BP

2. Statins - cholesterol <4, LDL <2

39
Q

What advice do the DVLA give for driving after a stroke?

A

Not for 1 month, no need to inform DVLA

40
Q

What is the prognosis of a stroke?

A

Less than 40% achieve full recovery.

41
Q

How does a haemorrhagic vs ischaemic stroke show up on CT?

A
  1. Haemorrhagic - white/’hyperdense’ area

2. Ischaemic - dark area

Neurology (51 decks)

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