Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen med - neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke

A

A stroke (also known as cerebrovascular accident, CVA) represents a sudden interruption in the vascular supply of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Two main types of strokes

A

Ischaemic

Haemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Subtypes of ischaemic stroke

A

Thrombotic

Embolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an important risk factor for embolic stroke

A

AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

General risk factors for ischaemic stroke

A 
age
hypertension
smoking
hyperlipidaemia
diabetes mellitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

General risk factors for haemorrhagic stroke

A 
age
hypertension
arteriovenous malformation
anticoagulation therapy
Alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Features of cerebral hemisphere infarcts

A

contralateral hemiplegia: initially flaccid then spastic
contralateral sensory loss
homonymous hemianopia
dysphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of brainstem infarction

A

may result in more severe symptoms including quadriplegia and lock-in-syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of lacunar infarcts

A

small infarcts around the basal ganglia, internal capsule, thalamus and pons
this may result in pure motor, pure sensory, mixed motor and sensory signs or ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which criteria are assessed in the Oxford stroke classification

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arteries affected by total anterior circulation infarcts(TACI)

A

Middle and anterior cerebral arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Criteria for TACI

A
  1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g. dysphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Arteries affected in partial anterior circulation infarcts(PACI)

A

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Criteria for PACI

A

2 of the Oxford criteria are present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Arteries affected by lacunar infarcts

A

involves perforating arteries around the internal capsule, thalamus and basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do lacunar infarcts present

A

presents with 1 of the following:

  1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
  2. pure sensory stroke.
  3. ataxic hemiparesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Arteries affected by posterior circulation infarcts(POCI)

A

involves vertebrobasilar arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Presentation of POCI

A

presents with 1 of the following:

  1. cerebellar or brainstem syndromes
  2. loss of consciousness
  3. isolated homonymous hemianopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What features are patients with haemorrhagic strokes more likely to have

A

decrease in the level of consciousness

Headache

Nausea and vomiting

Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Blood pressure management in strokes

A

Blood pressure should not be lowered in the acute phase unless there are complications e.g. Hypertensive encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Criteria for thrombolysis in acute ischaemic stroke

A

it is administered within 4.5 hours of onset of stroke symptoms

haemorrhage has been definitively excluded

22
Q

Absolute contraindications to thrombolysis

A

Previous intracranial haemorrhage

Seizure at onset of stroke

LP in preceding 7 days

GI haemorrhage preceding 3 weeks

Active bleeding

Uncontrolled HTN

23
Q

when should thrombectomy and IV thrombolysis be offered

A

As soon as possible and within 6 hours of symptom onset, together with intravenous thrombolysis (if within 4.5 hours), to people who have:

acute ischaemic stroke and
confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)

24
Q

Criteria for just offering thrombectomy

A

as soon as possible to people who were last known to be well between 6 hours and 24 hours previously (including wake-up strokes):

confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA and

if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

25
Q

Recommended patient clinical status for thrombectomy

A

A pre-stroke functional status of less than 3 on the modified Rankin scale and a score of more than 5 on the National Institutes of Health Stroke Scale (NIHSS)

26
Q

Anticoagulation in secondary prevention of stroke

A

Clopidogrel

27
Q

Alternatives for anticoagulation in secondary prevention of stroke

A

Aspirin plus MR dipyridamole is now recommended after an ischaemic stroke only if clopidogrel is contraindicated or not tolerated

28
Q

When should carotid artery endarterectomy be considered for stroke management

A

recommend if patient has suffered stroke or TIA in the carotid territory and are not severely disabled
should only be considered if carotid stenosis > 70% according ECST** criteria or > 50% according to NASCET*** criteria

29
Q

Why is mortality raised in patients with poor glycemic control post-stroke

A

This is likely due to increased tissue acidosis from anaerobic metabolism, free radical generation, and increased blood brain barrier permeability post injury

30
Q

What can mimic stroke-related neurological deficits

A

Hypoglycaemia

31
Q

Why should anti-hypertensive therapy only be initiated in certain co-morbidities in stroke management

A

This is because lowering blood pressure too much can potentially compromise collateral blood flow to the affected region, and possibly hasten the time to complete and irreversible tissue infarction

32
Q

Recommended anti-hypertensive therapy in stroke management if appropriate

A

intravenous labetalol, nicardipine and clevidipine as first-line agents, due to the possibility for rapid and safe titration to control blood pressure

33
Q

Why should BP be reduced in thrombolytic therapy candidates

A

Elevated BP can affect thrombolytic eligibility and delay treatment

Recommended 185/110mmHg

34
Q

NICE advice regarding SALT assessment following stroke

A

This should preferably within 24 hours of admission and not greater than 72 hours after

Prior to assessment is undertaken, a patient should remain nil by mouth to prevent complications

35
Q

Management of feeding post stroke in patients deemed unsafe for oral intake

A

NG within 24 hrs unless thrombolytic therapy

Nasal bridle tube/gastrostomy if NG not tolerated

36
Q

Index used to measure disability

A

Barthel index

This index should be used to assess the functional status of a patient post stroke, and to monitor their improvement with ongoing rehabilitation to regain independence after the event

37
Q

Recommended tool for assessment of stroke

A

ROSIER score

38
Q

1st line ix for suspected stroke

A

Non-contrast CT head

39
Q

Recommended anticoagulation for AF following a stroke

A

Warfarin or direct thrombin or factor Xa inhibitor

In the absence of haemorrhage, anticoagulation therapy should be commenced after 2 weeks

40
Q

Anterior cerebral artery lesion effects

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

41
Q

Middle cerebral artery lesion effects

A

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia
Aphasia

42
Q

Posterior cerebral artery lesion effects

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

43
Q

What is weber’s syndrome(branches of the posterior cerebral artery that supply the midbrain)

A

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

44
Q

Posterior inferior cerebellar artery lesion effects

aka lateral medullary syndrome, Wallenberg syndrome

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

45
Q

Anterior inferior cerebellar artery(lateral pontine syndrome) lesion effects

A

Symptoms are similar to Wallenberg’s ,but:

Ipsilateral: facial paralysis and deafness

46
Q

Retinal artery/ophthalmic artery lesion effects

A

Amaurosis fugax

47
Q

Basilar artery lesion effects

A

‘Locked-in’ syndrome

48
Q

What are lacunar strokes associated with

A

HTN

49
Q

When should oxygen be given in acute stroke

A

If less than 95%

50
Q

General advice for secondary prevention of stroke

A 
Physical activity 
Smoking cessation 
Balanced diet 
Alcohol intake limited to 14 units/week
Advise against routine dietary supplementation
51
Q

Medications used in secondary prevention of stroke

A

Clopidogrel
Statins - Aim to reduce non-HDL cholesterol by >40%
Anti-hypertensives

52
Q

How long is anticoagulation deferred for in patients with a stroke

A

Treatment is deferred until at least 14 days from onset in people with disabling ischaemic stroke. In the interim aspirin 300 mg daily will be used

Gen med - neuro (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions