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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Is a headache a symptom of an ischaemic stroke?

A

no, only focal neurology. Haemorrhagic strokes e.g. SAH can present with a headache

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2
Q

What is the window for thrombolysis in stroke?

A

<4.5 hr

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3
Q

Which investigations should be carried out in stroke?

A

CT, ECG, CXR, blood sugar!!!, swallow assessment!!, routine bloods, Hba1C and lipids long-term

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4
Q

How would a dense MCA sign appear on CT?

A

central white lesion

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5
Q

What are the four types of ischaemic stroke?

A
  1. embolic
  2. plaque
  3. hypoperfusion/hypovolaemic
  4. venous sinus thrombosis
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6
Q

A 24 y/o with no co-morbidities presents with stroke symptoms. She takes the combined oral contraceptive pill. Which type of ischaemic stroke are you worried about?

A

venous sinus thrombosis

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7
Q

Which classification is used to divide stroke?

A

oxford classification

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8
Q

Name three contraindications for thrombolysis

A

recent thrombolysis, warfarin/DOAC, very high BP, haemorrhagic stroke

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9
Q

What is the management of stroke?

A

thrombolysis +

  • aspirin and clopidogrel
  • PPI
  • Statin
  • ACEi
  • consider anticoag
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10
Q

Why is omeprazole not used as PPI treatment in stroke? Which PPI is used instead?

A

lanzoprazole. omeprazole interacts with clopidogrel

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11
Q

which is the scoring system for TIAs?

A

ABCDD- age, BP, clinical features of TIA, duration of syx, diabetes

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12
Q

Why would you conduct a carotid doppler in stroke?

A

to look for stenosis

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13
Q

Name three key considerations that ensue after someone has had a stroke

A
  1. Swallow/nutrition
  2. Driving status
  3. R/L handed (Rehab)
  4. Depression/low mood
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14
Q

Name five risk factors for stroke

A

infective endocarditis, diabetes, alcohol, smoking, M>F, HTN, coagulopathy, obesity, stroke, syndromes

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15
Q

What is CADASIL?

A

inherited form of cerebrovascular disease, risk fx for stroke

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16
Q

Which classification is used for stroke

A

Bamford/oxford stroke classification

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17
Q

What are the components of the Bamford stroke classification

A

Total anterior circulation stroke TACS
Partial anterior circulation stroke PACS
lacunar syndrome LACS
posterior circulation syndrome POCS

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18
Q

Which arteries are affected in TACS

A

middle and anterior cerebral arteries

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19
Q

Which arteries are affected in PACS

A

part of anterior circulation?

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20
Q

Name two parts of the brain that are affected in POCS?

A

cerebellum and brainstem

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21
Q

What are the criteria for TACS?

A

All of the following three are required:

  1. Unilateral weakness +- sensory deficit of the face, arm, and leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction- dysphasia, visuospatial disorder
22
Q

What are the criteria for PACS?

A

Two of the following:

  1. Unilateral weakness +- sensory deficit of the face, arm, and leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction- dysphasia, visuospatial disorder

(same criteria for TACS)

23
Q

What are the criteria for POCS

A

One of the following:

  1. Cranial nerve palsy and a contralateral motor/sensory deficit
  2. Bilateral motor/sensory deficit
  3. Conjugate eye movement disorder (e.g. horizontal gaze palsy)
  4. Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
  5. Isolated homonymous hemianopia
24
Q

Which vessels are affected in lacunar stroke?

A

subcortical small vessels

25
Q

What are the criteria for lacunar stroke?

A

One of the following:

  1. Pure sensory stroke
  2. Pure motor stroke
  3. Sensory-motor stroke
  4. Ataxic hemiparesis
26
Q

Patient has contralateral homonymous hemianopia. Which artery is affected?

A

middle cerebral artery

27
Q

Name two causes of a positive romberg’s sign?

A

vestibular- merniere’s, brainstem lesion, viral labyrinthisis

Proprioceptive loss- peripheral neuropathy, dorsal column (B12 deficiency)

28
Q

Define stroke

A

rapid onset, focal neurological deficit due to a vascular lesion lasting >24hr

29
Q

State two types of ischaemic stroke

A

atheroma and embolus

30
Q

State three causes of haemorrhagic stroke

A 
trauma
aneurysm rupture
anticoagulation
thrombolysis
increased BP
31
Q

State four risk factors for stroke

A 
HTN
AF, valvular disease
Peripheral vascular disease
PMH
Smoking
DM
FH
32
Q

State four cardiac causes of stroke

A 
AF
Prosthetic valves
Cardiac surgery
Acute MI
Valve vegetations
33
Q

What is a differential for stroke?

A
  1. head injury +- haemorrhages
  2. space occupying lesion
  3. infecious: encephalitis, abscess
  4. Drugs: opiate overdose
  5. Hypo/hyperglycaemia
  6. Migraine
34
Q

What is the medical management of stroke?

A

Alteplase <4.5 hr

Aspirin 300mg once haemorrhagic stroke excluded +- PPI

35
Q

If patient is aspirin sensitive, which drug can be administered in stroke?

A

clopidogrel

36
Q

Primary prevention strategies for stroke?

A

Control risk factors: HTN, hyperlipidaemia, smoking, DM, cardiac disease

Consider life-long anticoag in AF (CHADVASC2)

Carotid endarterectomy if symptomatic and 70% stenosis

Exercise!

37
Q

Which is an important aspect of history in stroke?

A

DRIVING!! R/V law on driving following stroke

38
Q

Secondary prevention for stroke?

A
  1. Risk factor control
  2. Aspirin initially, switch to clopidogrel after 3 weeks
  3. Carotid endarterectomy
  4. Statins
39
Q

Which scoring system predicts stroke following TIA?

A

ABCD2 score

40
Q

Difference between TIA and stroke?

A

blockage is temporary and blood flow is restored spontaneously

41
Q

Pt has left hemiplegia and facial drop, language is intact, neglect of left side. What is the cause of stroke?

A

Right middle cerebral artery

42
Q

What is a lacunar stroke?

A

occlusion of the small arteries of the brain, affecting mostly white matter, not penetrating cortex

43
Q

Why should you not give food or drink to stroke patient?

A

need to assess swallow reflex, otherwise there will be a high aspiration risk

44
Q

When are CT scans with contrast helpful?

A

to identify aneurysms, and tumours

45
Q

What are the contraindications for tPa?

A

haemorrhage, coagulopathy, high BP, recent surgery, significant hypoglycaemia

46
Q

Name two roles of imaging in acute stroke?

A
  1. ID haemorrhagic or ischaemic stroke 2. ID ischaemic penumbra and therefore areas of reperfusion 3. ID site of thombus (requires angiography)
47
Q

What are the five mechanisms of cellular death following stroke?

A
  1. Excitoxicity 2. Apoptosis 3. Oxidative stress 4. Inflammation 5. Peri-infarct depolarisation
48
Q

Patient with no cortical signs or hemianopia has had stroke, left side hypoasethesia in face, arm, and leg. No movement in left arm and leg against gravity. Classify this stroke and which vessels are affected?

A

lacunar syndrome, small vessels

49
Q

Which investigations other than blood tests should be performed in acute stroke?

A

BP, ECG, brain imaging- CT or MRI, vascular imaging- CT angiogram

50
Q

What is the first line long-term management for TIA or ischaemic stroke?

A

clopidogrel, atrovastatin after 48 hr

51
Q

Patient presents with acute ischaemic stroke within 4 hours. CT shows ischaemic lesion in R hemisphere wit no evidence of haemorrhage. What is the next step?

A

thombolysis AND throbectomy (2019 guidelines) within 4.5 hours. Thrombectomy decision based on rankin score<3 and NIHSS >5.

Neurology (13 decks)

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