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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What are key features of a stroke? (5)

A 
sudden onset 
focal symptoms 
loss of brain function 
last >24hrs 
neurological problems due to vascular disease
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2
Q

1/3 of all stroke presentations are stroke mimics. True/false?

A

True

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3
Q

What are 5 main stroke mimics?

A 
seizure (mostly)
sepsis 
toxic/metabolic 
Space-occupying lesions 
presyncope
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4
Q

The Rosier Score helps determine if patient is having a stroke. With Score >0 = stroke is likely and score 0 = stroke is unlikely. What scores you -1 and what scores you +1?

A

-1: loss of consciousness or syncope
+1: asymmetric facial weakness, asymmetric arm weakness, asymmetric leg weakness, speech disturbance, visual field defect

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5
Q

What is the 3 types of stroke in order to most common to least? (85%, 10%, 5%)

A

Infarct
Haemorrhage
Subarachnoid haemorrhage

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6
Q

What are 3 types of haemorrhagic strokes?

A 
structural abnormality (e.g. arterio-venous malformation) 
hypertensive
amyloid angiopathy (protein deposition that makes brain more likely to bleed)
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7
Q

What are 3 common types of infarcts in order of most common to least?

A

artheroembolic arteries
cardioembolic
small vessel (due to damage over time)

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8
Q

What is the most common cause of cardioembolic infarct?

A

atrial fibrillation

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9
Q

What are the investigations for stroke?

A

CT first

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10
Q

Infarcts appear white/dark on CT and haemorrhages appear white/dark.

A

infarct - dark

haemorrhage - white

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11
Q

Which appears sooner on CT scan - infarct/haemorrhage?

A

haemorrhage

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12
Q

What is a hyperacute sign of stroke visible on CT?

A

artery occlusion - static blood will show up as bright white

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13
Q

What type of infarcts are difficult to pick up on CT and so MRI is used?

A

posterior circulation infarct (lots of bony interference)

tiny infarct

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14
Q

The key sequence used in MRI for showing infarcts is Diffusion Weighted Imaging and is then compared to ADC map. How long are MRIs sensitive to infarcts for after the infarct has occurred?

A

10 days

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15
Q

Why is it difficult to differentiate an infarct and haemorrhage on CT when scan is done 1 week or more after the stroke?

A

Because CT is not sensitive for blood after 1 week so area will appear dark

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16
Q

What are 7 steps to the acute management of stroke?

A 
thrombolysis/thrombectomy,
imaging,
swallow assessment,
nutrition and hydration, 
antiplatelets,
stroke unit care,
DVT prevention
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17
Q

What is the substance in thrombolysis that causes clot breakdown?

A

Recombinant tissue plasminogen activator

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18
Q

How long do you have to thrombolyse patient from onset of stroke for it to be beneficial?

A

4.5hrs

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19
Q

What are some factors to consider when deciding whether to thrombolyse or not?

A 
age (older more likely to bleed) 
time since onset
previous intracerebral haemorrhage or infarct
atrophic changes 
BP (hypertensive) 
diabetes
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20
Q

What is the risk of bleeding with thrombolysis?

A

5%

21
Q

What are the overall recanalisation rates of IV tPA?

A

40-50%

22
Q

What scoring system is used for assessing severity of stroke?

A

NIHSS

23
Q

What dose of aspirin after stroke?

A

300mg

24
Q

What must you do before giving aspirin to stroke patient?

A

CT to check its not a haemorrhage

25
Q

How long do you wait after thrombolysis to give aspirin?

A

24hrs

26
Q

In case of mild stroke (NIHSS <3) what treatment do you give and for how long after the stroke?

A

clopidogrel and aspirin

for 3 weeks

27
Q

What is used in stroke patient to prevent DVT & what patients is this contraindicated in?

A

intermittent pneumatic compression

contraindicated in peripheral arterial disease, leg ulcers

28
Q

If symptoms last less than ___hrs, it is a TIA and if they last more than ___hrs it is a stroke.

A

24hrs

29
Q

A TIA is a benign process and does not cause ischaemic damage to the brain. True/false?

A

False

It causes long term ischaemic damage & increases your risk of having a minor stroke

30
Q

What are the investigations for TIA?

A

carotid imaging to look for carotid artery stenosis,
ECG,
blood tests

31
Q

What is the treatment for TIA?

A

medication: antiplatelets (aspirin) & statins

consider carotid endartectomy

32
Q

If systolic blood pressure is >150mmHg in patients with primary intracerebral haemorrhage or >185mmHg in patients for thrombolysis what is treatment?

A

Medication for 7 days to lower systolic BP to 140mmHg

often IV GTN

33
Q

15% of ICH is associated with anticoagulation. What is mortality rate from ICH?

A

30-50%

34
Q

What is the treatment for anticoagulant reversal for warfarin, direct thrombin and factor Xa inihibitors?

A

warfarin: vitamin K/prothrombin complex
direct thrombin +
factor Xa inhibitors: prothrombin complex

35
Q

What are types of embolism in stroke?

A 
Cardiac embolism (Atrial fibrillation, ventricular aneurysm, endocarditis) 
Paradoxical embolism 
Atherosclerotic embolism 
Fat embolism 
Air embolism
36
Q

What are 2 types of thrombosis?

A

Perforator thrombosis: lacunar infarct

Acute plaque rupture with overlying thrombosis

37
Q

What are 3 causes of ischaemic stroke?

A

Embolism, thrombosis & arterial dissection

38
Q

Difference between Wernickes area and Broca’s area and aphasia

A

wernickes area responsible for formulating what were going to say and Broca’s area executes the plan by activating the vocal apparatus in motor cortex,
so wernicke’s aphasia
So wernicke is the writer of the play in the back and broca is the expressive actor on stage

39
Q

Where is Broca’s area exactly?

A

left frontal lobe

40
Q

Where is Wernicke’s area exactly?

A

Left temporal lobe

41
Q

Broca’s aphasia?

A

Expressive aphasia - difficulty in getting words out and forming the words, able to comprehend speech of others when its simple grammatically

42
Q

Wernicke’s aphasia?

A

No difficulty producing speech, sentences normal grammatically but sentences are incoherent, struggle to understand other people or written word - is essentially language comprehension area

43
Q

What is the most common location for a ruptured berry aneurysm causing subarachnoid haemorrhage?

A

anterior communicating artery and anterior cerebral junction

44
Q

What can be detected in CSF from lumbar puncture after subarachnoid haemorrhage?

A

xanthochromia - bilirubin pigments

45
Q

What arteries are most commonly involved in lucanar infarcts?

A

lenticulostriate arteries (branches of the middle cerebral arteries) that feed the basal ganglia

46
Q

Gerstmann came from AFAR?

A

Agraphia, Finger agnosia, Acalculia and Right-left confusion - a lesion of dominant inferior parietal lobe supplied by middle cerebral artery

47
Q

Subdural haematoma presents how on CT

A

crescent-shaped haemorrhage, crosses suture lines - can present with headache and gradual dementia

48
Q

Epidural haematoma presents how on CT

A

bi-convex haemorrhage, doesn’t cross suture lines - can present with lucidity and then loss of consciousness, CN palsies and hemiparesis - much more acute

49
Q

PICA - posterior inferior cerebellar artery syndrome presentation?

A

sensory deficits of trunk and extremities on opposite side of infarction, sensory deficits of face and CN on ipsilateral side. Loss of pain and temp on contralateral side of body and ipsilateral side of face. also dysphagia, swallowing problem, ataxia
Lesion of lateral part of medulla

Neurology (34 decks)

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