Stroke Flashcards
How does a middle cerebral a stroke usually present? (5)
Arm more affected than leg Contralat paresis face and arm / leg Contralat sensory loss Aphasia (dominant hemisphere) Contralateral neglect syndrome (non-dominant hemisphere)
Clinical picture of lacunar infarctions? (4)
Dense motor hemiplegia (pure motor) Hemihypoesthesia (pure sensory) Dysarthria clumsy hand syndrome Homolateral ataxia with crossed paresis ('ataxic hemiparesis) No cortical signs
Carotid TIA presentation (5)
Transient ipsilateral monocular blindness
Contralateral body weak or clumsy
Contralateral body sensory loss or paraesthesia
Aphasia (dominant hemisphere)
Contralat homonymous visual field defects
Vertebro-basilar area ischaemia (post circulation) presentation (4)
Bilateral weak or clumsy (may be unilat or shifting)
Bilat shifting or crossed sensory loss or paraesthesiae
Bilat binocular visual defects
2 or more: vertigo, diplopia, dysphasia, dysarthria, ataxia
(Worse prognosis)
What area of brain does cerebral haemorrhages most frequently occur?
Internal capsule
How does a subarachnoid bleed present? (2)
Sudden onset severe headache
Neck stiff
How does an intracerebral haemorrhage present? (3)
Sudden onset severe headache
Focal neurological deficit
Depression LOC
8 risk factors for stroke
Hypertension most NB Heart lesions or cardiac disease: Afib!, CAD DM Alcoholism Oral contraceptive pill (oestrogen) HIV Hypenlipidaemia (→CAD) Smoking
Define stroke (4)
- Acute onset (minutes to hours) of
- focal neurological deficit (eg hemiparesis)
- of the CNS (above foramen magnum / excluding spinal cord) from vascular origin
- duration more than 24 hours
Name 4 diagnostic criteria for transient ischaemic attacks
- Focal non - convulsive neurological deficit from ischaemic origin
- sudden onset (embolic phenomenon) reaching max intensity almost Immediately
- lasts 5-20 minutes usually ( < 24 h by definition)
- repeated attacks usually clinically stereotyped
Name 3 criteria of total anterior circulation stroke (tacs)
All 3!
- unilateral weakness andor sensory deficit of the face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
Name 3 criteria of partial anterior circulation stroke (PACS)
Two of the following:
- unilateral weakness andor sensory deficit of the face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
How will ACA stroke present
Leg > arm
How will MCA stroke present
Arm > leg
How will lacunar stroke present
(Internal capsule),
Arm = leg
Name 4 criteria lacunar syndrome (lacs)
One of the following:
- pure sensory stroke
- pure motor stroke
- sensori-motor stroke
- ataxic hemiparesis
Name 5 criteria posterior circulation syndrome (pocs)
One of following:
- cranial nerve palsy and contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder eg gaze palsy
- cerebellar dysfunction eg ataxia, nystagmus, vertigo
- isolated homonymous hemi anopia or cortical blindness
Management stroke?
BRAIN ATTACK
- blood pressure
- respiration
- airway
- imaging
- normoglycemia
- anti-platelets, anti-lipids
- thrombolysis with TPA for ischaemic stroke
- temperature
- assess swallow, nutrition, hydration
- Consult rehab team
- keep vigilant for complications: neuro deterioration ( haemorrhagic transformation), aspiration pneumonia, seizures, UTI, pressure injuries, DVT / PE
How manage blood pressure in stroke (4)
- Permissive hypertension first 2-5 days
- then continue on chronic anti- ht treatment
- only treat if SBP > 220, DBP >120, map > 130
- target sbp reduction by 20% in first 24 hours
- candidates for thrombolysis: SBP >180 and DBP > 110
- If parenteral agents used, labetalol or nicardipine preferred because of ease of titration and limited effect on cerebral blood vessels. Don’t give sublingual nifedipine or nitroglycerin, can cause precipitous drop in bp → decreased cerebral perfusion + damage to penumbra.
What type of Ct do for stroke
- Acute stroke <4,5 hours ago: non-contrast Ct head
- late presenting strokes (4,5 - 9 hours, wake up stroke, stroke of unknown time onset ): Ct perfusion scan
Name 5 criteria for lyric for stroke
- Presentation <4,5 hours
- proven not haemorrhagic stroke by scan
- bp < 185/110
- 18-80 years old
- NIHS score < 23
Post stroke best medical therapy to prevent recurrence? (7)
Aabbccd
- aspirin (anti-platelet)
- anticoagulant
- blood pressure: ace-i/ arb even if normal
- blood pressure! Goal <140 /90
- cholesterol (statin)
- carotid endarterectomy for selected patients
- diabetes control: keep bp <130/85. Put on SGLP2 (prevent vascular complications)