Stroke Flashcards
What is a cardioembolic stroke?
An embolism which travels from the heart to block a blood vessel higher up
What is the biggest risk factor for stroke?
Transient Ischaemic Attack (TIA)
Name 5 risk factors for stroke, excluding TIA
- Hypertension
- Smoking
- Diabetes
- Obesity
- Lifestyle (diet, alcohol and drug use)
Name 4 uncontrollable risk factors for stroke
- Family history
- Increased age
- Being male
- African / Asian / Hispanic background
Name 2 types of stroke
- Atherosclerosis
2. Embolism
What does ICH stand for?
Intra-cerebral haemorrhage
Name 5 risk factors for ICH
- Prolonged HTN
- Amyloid Angiopathy
- Age
- Head trauma
- Structural abnormalities e.g Cavernoma
Describe how antithrombotic drugs may be viewed ask a risk factor with regards to ICH
These drugs will not typically cause a bleed but will make a bleed much worse when it occurs
Describe the slogan used for how to act if a person is having a suspected stroke
F - Face drooping on one side
A - Arms unable to raise on one side
S - Speech is slurred
T - Time to call 999
Describe 2 important questions when determining if a person is having a stroke
Does it look like a stroke?
Describe 2 important questions when determining if a person is having a stroke
Does it look like a stroke?
Onset and course
General and focal symptoms (negative symptoms)
Is the patient at risk of a stroke?
Name 5 conditions which may mimic a stroke
- Migraine
- Epilepsy
- Structural brain lesions (tumour, abscess etc)
- Psychological disorders
- Demyelination
Name 5 reasons an urgent CT is needed in case of suspected stroke
- Depressed levels of concoction
- Papilloedema, neck stiffness or fever
- Severe headache at onset
- Thrombolysis being considered
- Unexplained progressive symptoms
Describe the relationship of blood flow and neuronal function from the core area
- At core there is irreversible damage occuring which expends out to the surrounding tissue
- In the part around the core there is reversible damage occuring but will turn to irreversible if left for too long
- Rate at which brain damage occurs varies from person to person
What is the ischaemic penumbra?
Area of the brain where blood supply has decreased but the part of the brain has not yet died
What is thrombectomy>
Fine wire put into the brain and the clot is physically removed using stent remover
What is the most common treatment for a stroke, given no contra-indications?
Thrombolysis
Name 4 types of stroke in the Oxford classification
- TACS
- PACS
- LACS
- POCS
Describe collateral circulation in the brain
- Carotid artery supplies anterior of the brain
- Vertebral artery supplies posterior of the brain
- Circle of Willis connects the two so if one becomes occluded, there is still some supply to the part it supplies
Describe TACS
- Total anterior circulation infarct
- Higher cortical dysfunction
- Hemiparesis
- Homonymous hemianopia
Describe LACS
- Lacunar infarct
- Motor or sensory stroke affecting face, arms and legs
- Does not cause cortical dysfunction
Describe PACS
- Partial anterior circulation stroke
- Includes 1 or 2 symptoms of TACS but not all 3
Describe POCS
- Posterior circulation stroke syndrome
- Cranial nerve palsies
- Bilateral motor / sensory loss
- Cerebellar dysfunction
Describe the survival of patients suffering from LACS, TACS, PACS and POCS
LACS - 2% death
TACS - 39% death
PACS - 4% death
POCS - 7% death
Describe the relationship between oral hygeine and cardiovascular disease
- Poor oral hygeine is associated with higher levels of risk of cardiovascular disease
- Periodontitis has 25% increase of CHD
Name an example of surgery to treat CHD
Carotid endarterectomy
Name 4 complications of CEA
- Death / Stroke / MI
- Hyperperfusion syndrome
- Nerve injury
- Parotitis
Name 3 facial symptoms of a stroke
- Oropharyngeal anaesthesia
- Facial pain or tingling
- Flattening nasolabial fold
Describe peri-procedural dental management of patients taking antithrombotic medications
- Medications remain in the system for up to 7 days after stopping
- Continue aspirin when undergoing dental procedures
- Given minimal bleeding risks, undergo dental procedures should continue warfarin
Name 4 cardiac conditions at risk of developing infective endocarditis
- Acquired valvular heart disease with stenosis
- Valve replacement
- Structural congenital heart disease
- Previous IE
Describe antibiotic prophylaxis against IE for dental procedures in a person with cardiac conditions
- Do not routinely offer prophylaxis (consider in higher risk patients)
- Do not offer chlorhexidine mouthwash prophylaxis
- Informed consent very important
