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Neurology > stroke > Flashcards

stroke Flashcards

1
Q

define TIA time scale?

A

<24hrs

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2
Q

most TIA are less than how long?

A

<1hr

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3
Q

define stroke?

A

Vascular compromise causes neuro deficit >24hrs.

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4
Q

Vascular compromise in the brain can be broadly split into what two categories.

how common are each at causing strokes?
-%

A

ischaemia 85%

haemorrhage 15%

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5
Q

why is Brain so susceptible to ischaemic damage?

A

can only do aerobic respiration

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6
Q

stroke pt can not take oral meds, what common symptom is the cause of this?

what tube can you use instead to deliver meds?

A

Dysphagia

NG tube

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7
Q

how can brain haemorrhage lead to a secondary stroke?

A

Haemorrhage, pool of blood hits on other blood vessels –> pool of blood has breakdown products –> these hit on vessels causing vasospasm –> secondary stroke

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8
Q

define ischaemic penumbra?

A

brain tissue will progress to infarction because of stroke but is still salvageable if perfused.

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9
Q

how long will ischaemic penumbra tissue last?

A

few hours

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10
Q

Broca’s and Wernicke’s is supplied by what artery?

A

MCA - middle cerebral artery

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11
Q

which protein that causes dementia can cause cerebellar bleeding.

how does it do this?

A

Amyloid

amyloid protein stiffens brain so bleeds more easily

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12
Q

which endocrine blood abnormality can mimic stroke symptoms?

A

Hypoglycaemia

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13
Q

why might a Toxicology screen be useful in pt with suspected stroke?

A

because intoxicants can mimic stroke symptoms

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14
Q

Smoking & HTN can cause what structures of brain to bleed?

A

basal ganglia

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15
Q

how will a superficial MCA stroke differ from a deeper MCA stroke in terms of symptoms?

A

superficial MCA stroke - symptoms more focal, .e. just arms, or just face, or just tongue effected.

deeper MCA stroke - arms, face & tongue all effect, not focal.

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16
Q

Vascular causes of stroke in the brain can be broadly split into what two categories.

how common are each at causing strokes?
-%

A

ischaemia 85%

haemorrhage 15%

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17
Q

blood clot risk factors for stroke?

blood clots that cause stroke can be split into two categories?
10

A 
o	HTN  
o	Old Age
o	Atherosclerotic plaques (high LDL) 
o	Diabetes 
o	Smoking 
o	Atrial fibrillation - creates emboli 
o	Aortic dissection
o	Sickle cell disease 
o	Polycythaemia 
o	Hypercoagulability

thrombotic or embolic

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18
Q

Haemorrhage risk factors for stroke?

-8

A 
o	HTN 
o	Age
o	Trauma 
o	AV malformation 
o	HTN 
o	Anticoagulation therapy 
o	Berry aneurysm 
o	Cerebra amyloid
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19
Q

which ethnicity is at risk of HTN and thus stroke?

A

afro-carribean

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20
Q

why is ↑Age a risk factor for stroke?

A

with age:

walls become weaker = haemorrhage.
Walls become stiffer = HTN

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21
Q

how does HTN cause haemorrhage stroke?

-step by step

A

high pressure RBC bang on artery walls, –> walls swell out to make aneurysm –> high BP will make aneurysm burst –> bleeding.

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22
Q

how does HTN cause ischaemic stroke?
-step by step

based on this pathophysiology what kind of stroke is this?

A

small arterioles cannot take the pressure > thicken their walls to compensate > small lumen > eventually infarct –> called a lacunar stroke

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23
Q

define AV malformation?

how can this cause haemorrhage stroke?

A

direct connection between arteries and veins

high pressure arteries push blood into low pressure veins (no dampening capillaries), so they bleed.

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24
Q

how can hyperglycaemia cause ischaemic stroke?

-step by step

A

high glucose causes oxidative stress –> walls damaged, LDL will fill in the gap in the wall
–> atherosclerotic plaque.

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25
Q

if pt is having stroke why do you never give pt water with glucose in it.

A

because high glucose during a stroke will exacerbate stroke

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26
Q

what effect does polycythaemia have on blood clotting rate?

A

increases your rate of blood clotting

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27
Q

pt has Brainstem infarct.

what are the differentiating features?
-2

A

quadriplegia + lock-in syndrome

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28
Q

which endocrine meds are a risk factor for stroke?
-2

why?

A

HRT or pill

oestrogen increases coagulability

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29
Q

how does hypovolaemia impact on an acute stroke?

A

worsen ischaemic penumbra

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30
Q

how does hypervolemia impact on an acute stroke?

-3

A

more cerebral oedema, hyponatraemia and cardiac failure

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31
Q

differentiating feature of ACA stroke?

A

Leg problems

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32
Q

differentiating features of posterior communicating artery stroke (on the left side)?
3

A

o L sided ptosis
o Double vision
o Pupil dilated

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33
Q

differentiating features of MCA stroke?

-3

A

Arm, face problems
Broca gone
Wernicke gone

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34
Q

how will Broca and Wernicke aphasia sound?

A

Broca gone - like Yoda no fluid speech

Wernicke gone - no meaningful speech

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35
Q

differentiating feature of PCA stroke?

what does PCA stand for?

A

Vision loss

posterior cerebral artery

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36
Q

Left occipital lobe ischaemic.

how does this effect vision?

A

right visual field of both eyes lost

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37
Q

acronym to remember presentation of a cerebellum stroke

A

DANISH

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38
Q

Right occipital lobe ischaemic.

how does this effect vision?

A

left visual field of both eyes lost

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39
Q

what does DANISH stand for?

A

o Dysdiadochokinesia
o Ataxia
o Nystagmus
o Intention tremor – point to finger, point to nose. Past pointing.

o Speech – slurred/staccato
o Hypotonia

40
Q

red herring to intention tremor?

basically things that might look like intention tremor but are not

A

diplopia + motor weakness

41
Q

how can you test intention tremor?

A

ask to point to finger and point to nose and check for:

shaking
past pointing

42
Q

define dysdiadochokinesia.

how can you test for this?

A

inability to perform rapid alternating muscle movements

mr bean clap

43
Q

define nystagmus?

A

involuntary rhythmic eye movements

44
Q

someone has DANISH presentation.

where is there stroke?

A

cerebellum

45
Q

general stroke symptoms?

-7

A 
motor weakness
speech problems (dysphasia)
face "melts"
swallowing problems
visual field defects 
balance problems
initial stroke hypertonic. Weeks later hypotonic.
46
Q

most common type of visual field defect in stroke?

A

homonymous hemianopia

47
Q

someone has stroke and loses balance

where is there stroke?

A

cerebellum

48
Q

TIA symptoms resolve within how long?

A

24 hours

49
Q

1st line imaging?

A

Non-contrast CT head

50
Q

to assess internal carotid arteries, what Ix do you use?

A

Doppler US

51
Q

to assess vertebral artery, what Ix do you use?

A

CT angiogram

52
Q

Non-contrast CT head is contraindicated.

what is the alternative?

A

MRI head

53
Q

main thing you are looking for in ECG, think of cause?

A

Atrial fib

54
Q

what do you look for in bloods?

-6

A

Hba1c
hypoglycaemia

lipids
clotting screen (INR),

hyponatremia ,
CRP

55
Q

on CT sometimes CSF and blood clot can look the same colour.

so what unit do you use to distinguish between the two?

what value would indicate a clot?

A

Hounsfield unit

Hounsfield unit 70 = clot

56
Q

which imaging can let you identify if it is ischaemic or haemorrhagic stroke?

A

CT

57
Q

pt is having a stroke.

in acute Mx what needs to be stabilised?
-3

A

fluids, glucose, BP

58
Q

pt is having a stroke from a blood clot.

what drug do you give acutely?

  • name
  • dose
  • how long

should this drug not stop the clot, what intervention do you take now 2nd line?

  • name of therapy
  • name of drug in this therapy
A

Aspirin 300mg for 2 weeks

Thrombolysis - alteplase

59
Q

pt is having a stroke from a blood clot.

when should you lower BP?

A

only If there is emergency HTN

60
Q

pt is having a stroke from a blood clot.

why do you usually not lower BP?

A

because if BP is too lowered you inhibit collateral perfusion.

61
Q

if pt having thrombolytic therapy how low must be BP be?

why?

A

BP must be <185/110

↑↑↑BP effects thrombolysis.

62
Q

pt is having a stroke from a blood clot.

what drug do you give acutely?

  • name
  • dose
  • how long

should this drug not stop the clot, what intervention do you take now 2nd line?

  • name of therapy
  • name of drug in this therapy
A

Aspirin 300mg for 2 weeks

Thrombolysis - alteplase

63
Q

pt had a stroke from a blood clot, now resolved and acute Mx is done.

what drug is given to prevent future clots and strokes?

  • drug name
  • strength
  • frequency
  • how long

2nd line drug is above is CI?

  • drug name
  • strength
  • frequency

3rd line drug is above is CI?

A

Clopidogrel 75mg daily lifelong

Aspirin 75mg daily

Dipyridamole

64
Q

pt had a stroke from a blood clot, now resolved and acute Mx is done.

one of pt’s risk factors is high LDL.

what drug do you give to address this?

  • class
  • strength range
A

Statin 20-80mg

65
Q

pt had a stroke from a blood clot, now resolved and acute Mx is done.

one of pt’s risk factors is atrial fib.

what 2 drugs do you give to address this?
-name

A

Apixaban + warfarin

66
Q

main SE of alteplase?

A

haemorrhage

67
Q

when is alteplase contraindicated?

-3

A

active brain haemorrhage
any history of brain haemorrhage
uncontrolled HTN

68
Q

what group is clopidogrel in?

A

Antiplatelet drugs

69
Q

side effects of clopidogrel?

-3

A
  • Dyspepsia
  • Bleeding
  • Diarrhoea
70
Q

moa of clopidogrel?

A

inhibition of ADP-dependent activation of
the GPIIb/IIIa receptor thus stopping platelet
aggregation

71
Q

aspirin group?

A

Antiplatelet drugs

72
Q

medical name for aspirin?

A

acetylsalicylic acid

73
Q

moa of aspirin?

-step by step

A

Irreversible cyclooxygenase enzyme inhibition –> stops prostaglandins and thromboxanes synthesis –> ↓synthesis & ↓ platelet aggregation.

74
Q

aspirin SE?

- 4

A

GI bleeding, ulcer, HTN, Reye’s syndrome

75
Q

Dipyridamole group?

A

antiplatelet medicine

76
Q

pt having haemorrhagic stroke.

where do you admit pt to?
- and why?

who do you refer to?

A

Admit to neurocritical care - because ICP needs monitoring

refer to neurosurgeon ASAP

77
Q

pt having haemorrhagic stroke.

cause is a berry aneurysm bleed.

how do you treat?

A

– interventional radiologist goes in from femoral artery and clips it

78
Q

pt having haemorrhagic stroke.

general goal of surgery if indicated?

A

decompression

79
Q

pt having haemorrhagic stroke.

ICP is raised.

what three Mx step do you do initially?

A 
raise head (30°)  
intubate with hyperventilation 
IV hypertonic Saline
80
Q

pt having haemorrhagic stroke.

will most pts have surgery or conservative (i.e. drug) Mx?

A

conservative

81
Q

pt having haemorrhagic stroke.

what is general conservative Mx in terms of drugs?

A

stop warfarin, aspirin, clopidogrel

82
Q

pt had a stroke.

DVLA rules on driving?

when can you start driving again and on what condition?

A

1 month no driving

After 1 month if doctor is happy with progress you can drive.

83
Q

pt had a TIA.

DVLA rules on driving?

when can you start driving again and on what condition?

A

1 month no driving

After 1 month if doctor is happy with progress you can drive.

84
Q

pt had multiple TIAs in short period.

DVLA rules on driving?

A

No driving for 3 months

85
Q

pt had a stroke or TIA and drives a heavy good vehicle.

DVLA rules on driving?

when can you start driving again and on what conditions?

A

1 year no driving

After 1 year can drive again if no significant neuro symptoms and no significant RF

86
Q

why is High Ca2+ a problem in the brain?

A

High Ca2+ is toxic to neurons –> High Ca2+ makes free radicals & ROS = neurons die

87
Q

how can brain ischemia cause High Ca2+ in the brain?

A

no O2 to make ATP pump work which normally takes Ca2+ out of neuron –> so Ca2+ builds in neuron

88
Q

what happens to BBB in stroke?

why?

what risk does this propose?
step by step

A

BBB leaky

Ischaemia + inflammation from stroke will make the tight BBB leaky

Protein + water in blood will leak from blood vessels into brain tissue –> causing oedema –> oedema can push brain so herniation

89
Q

Hypoglycaemia symptoms that can mimic stroke?

-4

A

weakness
numbness
trouble speaking
vision problems

90
Q

which area is the inner ear?

A

wernicke

91
Q

which area is the inner voice?

A

broca

92
Q

how does broca aphasia sound?

A

like yoda; not fluent, speech halting

93
Q

is wernicke speech fluent or not?

A

it is fluent

94
Q

is broca’s speech sensible/appropriate to the question?

A

yes

95
Q

is wernicke’s speech sensible/appropriate to the question?

A

no

96
Q

people wernicke’s aphasia can not do what?

A

understand speech

97
Q

people with broca’s aphasia can not do what?

A

express speech fluently

Neurology (40 decks)

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