stroke Flashcards
which branch of the MCA stroke will give wernickes aphasia?
the inferior MCA- patients will be fluent in their speech but will lose comprehension
which branch of the MCA will give Brocas aphasia?
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
what is the ROSIER calculation?
a tool used to Rule Out Stroke In the Emergency Room
- if > 0 then stroke is likely
what is hoovers sign?
- 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
what is the jendrasik manoeuvre?
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
what is a crescendo TIA?
2 TIA in the space of a week- increased risk of stroke
what is the window for thrombolysis after stroke?
4.5 hr from onset of symptoms.
intravenous alteplase is usually given as a bolus and subsequently continued as an infusion for one hour.
what is the long term management of stroke?
aspirin 300mg for 2 weeks, and then switched to clopidogrel long-term. This is due to the risk of haemorrhagic transformation.
how is bells palsy different from a stoke?
it spares the muscles of the forehead and muscles of mastication
how is bells palsy managed?
50mg OM for 10 days, followed by a taper.
which arteries may be affected in an anterior circulation stroke?
Anterior cerebral artery (ACA)
Middle cerebral artery (MCA)
which arteries do a posterior stroke affect?
Posterior cerebral artery (PCA) Basilar artery Superior cerebellar artery Anterior inferior cerebellar artery Posterior inferior cerebellar artery
what is locked in syndrome and stroke in which region can cause it?
patient is fully aware but cannot move or speak- only move eyes vertically
caused by a stroke in the basilar artery
what are driving rules after a stroke?
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
which risk stratification tool is used to determine the risk of stroke in someone with a TIA?
ABCD2
when is imaging done for a TIA?
CT after patient has been seen in a TIA clinic within 24hrs of onset of sxs
what is the risk of stroke after a TIA?
10% in the next week
what is the acute management of TIA
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
what is secondary prevention of a TIA?
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
what is the manifestation of an ACA stroke?
Contralateral hemiparesis and sensory loss with lower limbs > upper limbs
what is the manifestation of an MCA stroke?
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
what is the manifestation of a PCA stroke?
- Contralateral homonymous hemianopia with macular sparing
- Visual agnosia (difficulty interpreting Images
what would be the manifestation of a vertibrobasilar artery stroke?
Cerebellar signs
Reduced consciousness
Quadriplegia or hemiplegia
what are the indications to treat a stroke with thrombectomy?
- 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
what is the time limit for doing a thrombectomy for a stroke?
within 24hrs
what is the time limit for doing a thrombolysis with a stroke?
within 4.5 hrs of symptom onset
what is a TACI?
total anterior cerebral artery infarct- involves the ACA and MCA
symptoms include
- contralateral hemiplegia/paresis
- contralateral homonymous hemianopia
- higher cerebral dysfunction- aphasia or neglect
what is a PACI?
- partial anterior circulation infarct
- affects the anterior OR middle cerebral artery
either contralateral hemiplegia and homonymous hemianopia or higher cerebral dysfunction
what is a LACI?
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
which additional blood tests should those under 55 with stroke have?
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.
what is the management of TIA patient on an anticoagulant?
- CT scan in case they had a brain bleed
