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Y4 Cardiology > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke definition: _____ onset with focal neurological signs due to disrupted _____, with symptoms lasting longer than ____ hours

A

Stroke definition: ACUTE onset with focal neurological signs due to disrupted BLOOD SUPPLY, with symptoms lasting longer than 24 hours

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2
Q

TIA definition: symptoms last less than ____ hours, ischaemia without infarction

A

TIA definition: symptoms last less than 24 hours, ischaemia without infarction

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3
Q

What is a crescendo TIA?

A

2 or more TIAs within 1 wk

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4
Q

Give 5 differentials for a stroke

A
  • Metabolic eg hypoglycemia
  • SOL
  • Intoxication
  • Wernicke’s encephalopathy
  • Bell’s palsy
  • Demyelination
  • Herpes encephalitis
  • Post ictal eg Todd’s paresis
  • Traumatic head injury
  • Hemiplegic migraine
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5
Q

“The ability of the brain to remodel itself, allowing other areas of the brain to take over the function of the lost cells” is the definition of what

A

Neuroplasticity

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6
Q

What are the 2 types of strokes? What percentage of strokes to each represent?

A

85% ischemic

15% haemorrhagic

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7
Q

What is the classification system for ischaemic stroke? Name each type of stroke within the classification system

A

TOAST

  • Large vessel
  • Small vessel
  • Cardioembolic
  • Other
  • Cryptogenic
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8
Q

Large vessel ischaemic strokes are due to ______. Do they effect cortex or deep brain? Would they cause an anterior or posterior circulation stroke?

A

Large vessel strokes due to atherosclerosis, effect cortex (therefore cause cortical signs), cause anterior circulation strokes

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9
Q

Small vessel ischaemic strokes are also called what? Do they effect cortex or deep brain? What type of vessels are involved?

A

Small vessel strokes = lacunar strokes. Effect deep brain (therefore no cortical signs), effect perforator arteries (small branches of large vessels, don’t communicate with each other)

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10
Q

Name 3 causes of cardioembolic strokes

A

AF, endocarditis, mechanical heart valve

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11
Q

What is a paradoxical embolism?

A

Right to left shunt through septal defect or patent foramen ovale
(Associated with anterior circulation strokes)

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12
Q

What is a watershed infarct?

A

Due to hypoperfusion eg sudden drop in BP in sepsis

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13
Q

What type of stroke can be due to neck trauma, fibromuscular dysplasia or occur spontaneously?

A

Carotid artery dissection

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14
Q

Does antiphospholipid syndrome and thrombophilia cause arterial or venous clots?

A 
APS = arterial and venous
Thrombophilia = venous
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15
Q

Vasospasm strokes occur as a result of what?

A

Post SAH (after 4-10 days)

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16
Q

Haemorrhagic strokes can be divided into 2 types, name them

A

SAH and intracerebral haemorrhage

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17
Q

What type of stroke are the following things risk factors for?-AF

  • Blood thinners
  • ADPKD
  • Cavernous malformation
  • Bleeding disorder
  • Metabolic syndrome
A
  • AF = ischaemic
  • Blood thinners = haemorrhagic
  • ADPKD = haemorrhagic
  • Cavernous malformation = haemorrhagic
  • Bleeding disorder = haemorrhagic
  • Metabolic syndrome = ischaemic
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18
Q

What are the criteria for TACS total anterior circulation stroke?

A

Homonymous hemianopia + motor + higher cortical deficit

(Motor = 2/3 of arm/face/leg)
Higher cortical deficit could be: dysphagia, dysphasia, dyscalculia, dyspraxia, personality change, hemispatial neglect, new cognitive impairment, agnosia etc)
(these are large vessel strokes)

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19
Q

What are the criteria for PACS partial anterior circulation stroke?

A

2/3 of: homonymous hemianopia OR motor OR higher cortical deficit
OR isolated higher cortical deficit

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20
Q

What are the criteria for LACS lacunar syndrome?

A

Purely motor OR purely sensory OR purely sensorimotor or ataxic hemiparesis
(No cortical signs)
(Often face/hand)

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21
Q

What type of stroke has the worst prognosis?

A

TACS

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22
Q

A stroke that causes a pure hemiparesis is difficult to distinguish the cause because ….

A

Could be small vessel internal capsule (MCA branches) or large vessel primary motor cortex
(If just leg/arm = cortical, if face / hand = lacunar)

23
Q

A stroke effect the pons would be the result of TACS or PACS or LACS or PACS …?

A

LACS

Pons supplied by pontine arteries (branches of basilar artery)

24
Q

What is the criteria for POCS?

A

Brainstem infarct or isolated homonymous hemianopia

Brainstem disturbance: vertigo, dysarthria, ataxia

25
Q

Carotid bruit and a past TIA both point to [haemorrhagic or ischaemic] stroke

A

Pointers towards ischaemic stroke: carotid bruit, AF, past TIA, IHD

26
Q

Low GCS, papilledema, progressive symptoms point to [haemorrhagic or ischaemic] stroke?

A

Pointers towards haemorrhagic stroke: low GCS, signs of raised ICP, meningism, progressive symptoms, known RF eg anticoagulant, bleeding disorder

27
Q

How do you differentiate ischaemic v haemorrhagic strokes?

A

The only way to definitely differentiate is by imaging

28
Q

What is the name of the assessment tool use for determining stroke likeliness in the assessment room?

A

ROSIER

29
Q

1st line investigation for stroke?

Gold standard investigation for stroke?

A

1st line non-contrast enhanced CT

Gold standard diffusion weighted MRI

30
Q

The NICE guidelines say ever stroke patient should get a CT within 24 hours, but what are the criteria for urgent CT?

A
  • If thrombolysis considered
  • If suspicion haemorrhagic stroke
  • Signs of meningism
  • GCS <13
  • Severe HA
31
Q

What additional investigation would you perform for anterior circulation strokes?

A

Carotid doppler

32
Q

What additional investigation would you perform if you suspect endocarditis or patent foramen ovale?

A

Echo

33
Q

What are the 3 aims of stroke management?

A
  • Regain reversible losses
  • Maximise residual function
  • Prevent further stroke
34
Q

Blood pressure should not be lowered in the acute management of a stroke, why is this?

A

Since will reduce cerebral perfusion

35
Q

What drug should you give stat when you suspect a stroke? What dose? Continue for how long? What exception?

A

Once haemorrhagic stroke excluded give 300mg aspirin stat (continue for 2 wk then switch to antithrombotic either antiplatelet or anticoagulant depending on if cardioembolic)

36
Q

What are the criteria for thrombolysis i.e. who is suitable?

A

If onset <4.5hr ago ischaemic stroke

37
Q

What are the risks of thrombolysis?

A

Bleeding - so CT after 24hr to identify bleeds

38
Q

What drug is thrombolysis for stroke?

A

Alteplase tissue plasminogen activator tPA

39
Q

What are the contraindications for thrombolysis?

A
  • Major infarct on CT
  • Haemorrhage on CT
  • Non disabling deficit
  • Recent trauma / surgery
  • On anticoagulant
  • INR >1.7
  • BP >220/130
  • Aneurysm
  • AVM
  • Cirrhosis/varices/portal HTN
  • Seizures at presentation
40
Q

Is thrombectomy done as an alternative or an adjunct to thrombolysis? How many hours after onset should it be performed in?

A

Adjunct

Within 6hr of onset

41
Q

How do you reverse warfarin?

A

Vitamin K + prothrombin complex concentrate

42
Q

Every stroke patient should be admitted to a specialist stroke unit - T or F

A

True (in NICE guidelines)

43
Q

Patients with a TIA should be seen within __ hours by a stroke specialist

A

24 hours (NICE guidelines)

44
Q

What is the management of a TIA?

A

300mg aspirin stat (continue daily) + secondary prevention

45
Q

What are the criteria for carotid endarterectomy?

A

If >70% stenosis in ipsilateral artery +
<14d since stroke/TIA +
Symptomatic

46
Q

What is the secondary prevention for a cardioembolic ischaemic stroke?

A

Anticoagulant + statin + antihypertensive

Statin atorvastatin 80mg

47
Q

What is the secondary prevention for a non-cardioembolic ischaemic stroke?

A

Antiplatelet + statin + antihypertensive

Antiplatelet clopidogrel 75mg

48
Q

What is the secondary prevention for a haemorrhagic stroke?

A

Antihypertensive

49
Q

Receptive aphasia is cause by a lesion where?

A

Wernicke’s area in left parietal lobe

50
Q

Expressive aphasia is caused by a lesion where?

A

Broca’s area in left frontal lobe

51
Q

Gerstmann syndrome is caused by a lesion where?

A

Angular gyrus - junction of pareital/temporal lobe

52
Q

Expressive aphasia in the absence of other symptoms would be what type of stroke?

A

PACS

53
Q

Contralateral hemiparesis + hemisensory loss (mainly face + hand) + contralateral VFD would be cause by occlusion of what vessel?

A

MCA superior division

Y4 Cardiology (9 decks)

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