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MEH > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the difference between an ischemic and hemorrhagic stroke?

A

Ischemic: A clock blocks the blood flow to an area of the brain

Hemorrhagic: Bleeding occurs inside or around the brain tissue

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2
Q

What is the difference between ichaemia and infarction?

A

Ischaemia is a condition in which there is insufficient blood flow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia, and may in turn lead to the death of brain tissue or cerebral infarction.

Ischaemia may be reversible whereas infarction is irreversible.

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3
Q

What is TIA?

A

A brief episode of neurological dysfunction caused by focal brain and/or retinal ischaemia, with clinical symptoms typically lasting < 1 hour, and without evidence of acute infarction.

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4
Q

Describe the 4 ages of an infract.

A
  • Hyperacute (1st 6 hours)
  • Acute (up to 7 days)
  • Subacute (up to 4 months)
  • Chronic (after 4 months)
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5
Q

How do you treat a hyper acute infarct?

A

Intravenous thrombolysis with Alteplase

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6
Q

Why do we CT patients with suspected stroke?

A
  • Available 24/7
  • Fast
  • Not limited by contraindications, intolerances and the need for life support/monitoring equipment
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7
Q

How can intracranial haemorrhages be classified?

A
  • Primary (small vessel) haemorrhage

- Secondary haemorrhage

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8
Q

Give some causative examples of primary haemorrhages.

A
  • Hypertension

- §Cerebral amyloid angiopathy (CAA)

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9
Q

Give some causative examples of secondary haemorrhages.

A
  • Tumour
  • Vascular
  • Coagulopathy, warfarin, aspirin
  • Cocaine, alcohol
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10
Q

Describe the neurosurgery management of an intracranial haemorrhage.

A
  • Clot reduction
  • Decompression craniotomy
  • Intraventricular shunting
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11
Q

Describe the medical management of an intracranial haemorrhage.

A 
Supportive
Blood pressure
Mass effect
Seizures
Secondary prevention
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12
Q

Where is a typical hypertensive bleed located?

A

Basal ganglia

2/3rds Putamen 1/4 Thalamus

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13
Q

Name the location of a Cerebral Amyloid Angiopathy (CAA) intracranial haemorrhage.

A

Corticomedullary junction

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14
Q

What features in the clinical history would mean you suspect a patient is suffering from a Intratumoral Haemorrhage?

A
  • Stuttering onset
  • Oedema
  • Irregular nature of clot
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15
Q

Name some complications of intracranial haemorrhage.

A
  • Effacement of the ventricles
  • Displacement of the ventricles
  • Midline shift
  • Twisted ventricle
  • Hydrocephalus
  • Cerebral herniation
    (Subfalcine, uncal, tenting, coning)
  • Raised intracranial pressure
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16
Q

How do you calculate Cerebral Perfusion Pressure (CPP).

A

CPP= Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP)

17
Q

What is the source of the bleed in an extradural haematoma?

A

Meningeal vessels

18
Q

What is the source of the bleed in a subdural haematoma?

A

Bridging veins

19
Q

Describe some lifestyle modifications that patients can make to reduce their risk of a stroke.

A
  • Smoking cessation
  • Weight management
  • Alcohol avoid heavy intake
  • Dietary modifications: Low fat, low salt, low sugar, high fibre
  • Aerobic exercise
20
Q

Describe the stroke rehab criteria.

A
  • Medically stable
  • Needing no more than 24% oxygen
  • NG feeding established with no risk of refeeding
  • Stroke consultant review twice a week
  • Do not need to await echo etc before transfer unless urgent.
  • Transfer around day 7 (flexible)
21
Q

Describe some good prognostic factors following a stroke.

A
  • Absence of coma
  • Early motor recovery
  • Continence
22
Q

Describe some poor prognostic factors following a stroke.

A
  • Severe communication deficit
  • Old age
  • Incontinence
  • Neglect
  • No leg movement at 2 weeks
  • Severe upper limb weakness at 4 weeks
23
Q

Name some problems patients experience during stroke rehab.

A
  • Aphasia
  • Dysarthria
  • Impaired swallowing
  • Hydration and malnutrition
  • Balance and walking
  • Fatigue
  • Continence
  • Spasticity and contractures
  • Sensation
  • Mouth care
  • Anxiety and depression
  • Neuropathic pain
24
Q

Name some stroke secondary prevention techniques.

A
  • Antithrombotic therapy (antiplatelet versus anticoagulation)
  • BP control(average BP<130/80)
  • Lipid control (t. chol<4, LDL chol<2)
    Glycaemic control (HbA1c <7)
  • Carotid endarterectomy (symptomatic ICA >50% lumen reduction NASCET)
  • Lifestyle changes (smoking cessation, weight loss, optimisation of sleep, exercise)
25
Q

Describe the 3 groups of stroke mimics.

A

Group 1 – readily identifiable on brain imaging

Group 2 – syndromically distinguishable from the stroke syndrome on clinical grounds after general medical assessment

Group 3 – exclusion of stroke syndrome requires specialist stroke assessment including brain imaging

26
Q

Name some common stroke mimics.

A

Migraine with aura – hall mark is cortical spreading depression

(Focal) seizures

Functional syndrome

Apparent neurological deficits

MEH (6 decks)

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