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year 5 neurology > stroke > Flashcards

stroke Flashcards

1
Q

which branch of the MCA stroke will give wernickes aphasia?

A

the inferior MCA- patients will be fluent in their speech but will lose comprehension

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2
Q

which branch of the MCA will give Brocas aphasia?

A

the superior MCA- patients will understand what is being said to them but they will be unable to speak fluently- they will have Broca Broca speech

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3
Q

what is the ROSIER calculation?

A

a tool used to Rule Out Stroke In the Emergency Room

- if > 0 then stroke is likely

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4
Q

what is hoovers sign?

A
  • separates organic from non organic causes of paresis of the legs.

if the cause of leg weakness is organic then you should feel the opposite heel dig into the couch when the patient attempt to lift their paralysed leg

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5
Q

what is the jendrasik manoeuvre?

A

used to illicit reflex responses when previously unsuccessful as it raises the threshold for anterior horn cells, bringing them closer to threshold so that a response can be elicited

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6
Q

what is a crescendo TIA?

A

2 TIA in the space of a week- increased risk of stroke

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7
Q

what is the window for thrombolysis after stroke?

A

4.5 hr from onset of symptoms.

intravenous alteplase is usually given as a bolus and subsequently continued as an infusion for one hour.

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8
Q

what is the long term management of stroke?

A

aspirin 300mg for 2 weeks, and then switched to clopidogrel long-term. This is due to the risk of haemorrhagic transformation.

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9
Q

how is bells palsy different from a stoke?

A

it spares the muscles of the forehead and muscles of mastication

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10
Q

how is bells palsy managed?

A

50mg OM for 10 days, followed by a taper.

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11
Q

which arteries may be affected in an anterior circulation stroke?

A

Anterior cerebral artery (ACA)

Middle cerebral artery (MCA)

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12
Q

which arteries do a posterior stroke affect?

A 
Posterior cerebral artery (PCA)
Basilar artery
Superior cerebellar artery
Anterior inferior cerebellar artery
Posterior inferior cerebellar artery
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13
Q

what is locked in syndrome and stroke in which region can cause it?

A

patient is fully aware but cannot move or speak- only move eyes vertically

caused by a stroke in the basilar artery

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14
Q

what are driving rules after a stroke?

A

the patient cannot drive for a month after a stroke or TIA

multiple TIAs mean no driving for 3 months

if driving heavy goods vehicle then no driving for a year

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15
Q

which risk stratification tool is used to determine the risk of stroke in someone with a TIA?

A

ABCD2

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16
Q

when is imaging done for a TIA?

A

CT after patient has been seen in a TIA clinic within 24hrs of onset of sxs

17
Q

what is the risk of stroke after a TIA?

A

10% in the next week

18
Q

what is the acute management of TIA

A

Antiplatelet: initially aspirin 300mg the first-line, immediate management until the patient is reviewed in TIA clinic

Do not offer aspirin in these circumstances
- Bleeding disorder/ taking an anticoagulant: needs immediate admission and assessment

  • taking low-dose aspirin regularly: continue the current dose and arrange a specialist review
  • Aspirin is contraindicated: needs specialist advice
19
Q

what is secondary prevention of a TIA?

A

Clopidogrel 75 mg daily is first-line once the patient has been reviewed in TIA clinic and a diagnosis of TIA is confirmed

  • Offer aspirin 75mg daily with MR dipyridamole if clopidogrel is contraindicated
  • Offer MR dipyridamole if both clopidogrel and aspirin are contraindicated

Offer aspirin 75mg daily if both clopidogrel and MR dipyridamole are contraindicated

High-dose statin: all patients should be started on a high dose statin, such as atorvastatin 20-80mg
Manage hypertension, diabetes, smoking and other cardiovascular risk factors

20
Q

what is the manifestation of an ACA stroke?

A

Contralateral hemiparesis and sensory loss with lower limbs > upper limbs

21
Q

what is the manifestation of an MCA stroke?

A

Contralateral hemiparesis and sensory loss with upper limbs > lower limbs

Homonymous hemianopia

Aphasia: if affecting the ‘dominant’ hemisphere (the left in 95% of right-handed people)

hemineglect syndrome: if affecting the ‘non-dominant’ hemisphere

22
Q

what is the manifestation of a PCA stroke?

A
  • Contralateral homonymous hemianopia with macular sparing

- Visual agnosia (difficulty interpreting Images

23
Q

what would be the manifestation of a vertibrobasilar artery stroke?

A

Cerebellar signs
Reduced consciousness
Quadriplegia or hemiplegia

24
Q

what are the indications to treat a stroke with thrombectomy?

A
  • must score > 5 on NIH Stroke Scale/Score (NIHSS)
  • and pre-stroke functional status < 3 on the modified Rankin scale
  • Confirmation of stroke requires CTA or MR angiogram prior to thrombectomy
25
Q

what is the time limit for doing a thrombectomy for a stroke?

A

within 24hrs

26
Q

what is the time limit for doing a thrombolysis with a stroke?

A

within 4.5 hrs of symptom onset

27
Q

what is a TACI?

A

total anterior cerebral artery infarct- involves the ACA and MCA

symptoms include

  • contralateral hemiplegia/paresis
  • contralateral homonymous hemianopia
  • higher cerebral dysfunction- aphasia or neglect
28
Q

what is a PACI?

A
  • partial anterior circulation infarct
  • affects the anterior OR middle cerebral artery

either contralateral hemiplegia and homonymous hemianopia or higher cerebral dysfunction

29
Q

what is a LACI?

A

lacunar stroke affecting the small deep perforating arteries- supplying the internal capsule or thalamus

sxs: pure motor, pure sensory, sensory motor, or ataxic hemiparesis

there are no visual changes or higher dysfunctions

30
Q

which additional blood tests should those under 55 with stroke have?

A

Young’ stroke blood tests include thrombophilia and autoimmune screening - performed in those under 55 with no obvious cause of a stroke

his can include tests such as antinuclear antibodies (ANA), antiphospholipid antibodies (APL), Anticardiolipin antibodies (ACL), Lupus anticoagulant (LA), coagulation factors, erythrocyte sedimentation rate (ESR), homocysteine and syphilis serology.

31
Q

what is the management of TIA patient on an anticoagulant?

A
  • CT scan in case they had a brain bleed

year 5 neurology (14 decks)

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