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Z Year3 Neuro Conditions > Stroke > Flashcards

Stroke Flashcards

1
Q

How common is stroke?

A

11% of all deaths in England

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2
Q

What are different types of stroke and their prevelances?

A
  1. Ischaemic: 87%
  2. Haemorrhagic: 10%
  3. Subarachnoid haemorrhage: 3%
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3
Q

What is ischaemic stroke?

A
  1. syndrome not disease

2. reduction in cerebral blood flow due to arterial occlusion or stenosis

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4
Q

What is a haemorrhagic stroke?

A

spontaneous intracerebral haemorrhage

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5
Q

What are RF for ischaemic stroke?

A
  1. Older age
  2. FHx of stroke
  3. Hx of ischaemic stroke
  4. Hypertension
  5. Smoking
  6. DM
  7. AF
  8. Sickle cell
  9. Dyslipidaemia
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6
Q

What are RF for haemorrhgaic stroke?

A
  1. Hypertension
  2. Older age
  3. Male sex
  4. Asian
  5. Heavy alcohol use
  6. Fhx
  7. Haemophilia
  8. Anticoagulation
  9. Etc
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7
Q

What are common causes for haemorrhagic stroke?

A
  1. Long standing hypertension
  2. Cerebral amyloid Angiopathy
  3. Sympathomimetic drugs of misuse e.g. cocaine and amphetamine
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8
Q

Where in the brain are infarct of stroke commonly?

A

Cerebral infarcts: 50%
Brainstem infarct: 25%
Lacunar infarcts:25%

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9
Q

What are common signs and symptoms of an ischaemic stroke?

A
  1. Unilateral weakness or paralysis in face, arm or leg
  2. Dysphasia
  3. Ataxia
  4. Visual disturbance
  5. Headache
  6. Numbness
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10
Q

What are common signs and symptoms of haemorrhagic stroke?

A
  1. Unilateral weakness or paralysis in face, arm or leg
  2. Dysphasia
  3. Dysarthria
  4. Visual disturbance
  5. Headache
  6. Photophobia
  7. Ataxia
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11
Q

What are possible DDx for stroke?

A
  1. Intracerebral haemorrhage
  2. TIA
  3. Hypertensive encephalopathy
  4. Hypoglycaemia
  5. Complicated migraine
  6. Seizure
  7. Wernicke’s encephalopathy
  8. Brain tumour
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12
Q

What is the first line investigation for stroke?

A

immediate non-contrast head CT

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13
Q

What would a non-contrast CT head show in ischaemic stroke?

A
  1. hypoattenuation (darkness) of brain parenchyma
  2. loss of grey matter-white matter differentiations and sulcal effacement
  3. hyperattentuaton (brightness) in an artery indicates clot within vessel lumen
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14
Q

What would non contrast CT head show in haemorrhagic stroke?

A

hyperattenuation (brightness), suggesting acute blood, often with surrounding hypoattenuation (darkness) due to oedema

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15
Q

What bloods would you do for stroke and why?

A
  1. Serum glucose
  2. Serum electrolytes
  3. Serum U and E
  4. Cardiac enzyme
  5. FBC
  6. ECG
  7. PT and PTT with INR
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16
Q

Why are you checking clotting factors?

A

to see if coagulopathy

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17
Q

What is the management of ischaemic stroke?

A
  1. ABCDE
  2. Admit everyone within 4hr presentation
  3. IV alteplase: 0.9mg/kg within 4.5 hrs of onset and intracranial haemorrhage excluded
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18
Q

What else is added to the treatment of ischaemic stroke?

A
  1. Mechanical thrombectomy performed in some within 6-24hrs of symptoms onset
  2. Antiplatelet agent ASAP e.g. aspirin 300mg
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19
Q

What is the treatment of ischaemic stoke after 4.5hr?

A
  1. Supportive care + monitoring + antiplatelet agent + VT prophylaxis + high-intensity statin
  2. Consider mechanical thrombectomy
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20
Q

What is the 1st line treatment for haemorhagic stoke?

A

1st line: supportive care and monitoring + neurosurgery assessment

  • rapid BP control
  • urgent reversal anticoag
  • Vt prophylaxis
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21
Q

What are complications of ischaemic stroke?

A
  1. DVT
  2. Haemorrhagic transformation of ischaemic stroke
  3. Alteplase-related orolingual oedema
  4. Depression
  5. Aspiration pneumonia
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22
Q

What are the complications of a hameorrhgaic stroke?

A
  1. Infection
  2. DVT
  3. seizures
  4. Delirium
  5. Aspiration pneumonia
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23
Q

What acronym is used for assement of stroke?

A
  • ROSIER in A and E

- FAST in community

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24
Q

What is the mortality of stroke?

A

haemorrhagic High mortality 35%-40% than ischaemic stroke

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25
Q

What does the anterior cerebral artery (ACA) supply?

A
  1. Medial and superior parts of frontal lobe

2. Anterior parietal lobe

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26
Q

What are the associated signs in a ACA stroke?

A
  1. Contralateral hemiparesis to more lower limbs > upper limbs/face
  2. Behavioural changes
27
Q

What does the middle cerebral artery (MCA) supply?

A

Lateral parts of frontal, temporal and parietal lobes

28
Q

What are the associated signs in a MCA stroke?

A
  1. Contralateral hemiparesis: upper limbs/face > lower limbs
  2. Contralateral hemisensory loss
  3. Apraxia
  4. Aphasia
  5. Quadranotopias
29
Q

What is Broca’s area responsible for?

A

Responsible for speech production

30
Q

What does a stroke in Brocca’s area result in?

A

expressive aphasia

B for ‘buccal’ or ‘bouche’ (your mouth is where speech is produced)

31
Q

What is Wernicke’s area responsible for?

A

Responsible for speech comprehension

32
Q

What does a stroke in Wernicke’s area result in?

A

receptive aphasia

W for “What do you mean?”

33
Q

What would a lesion at parietal upper optic radiation mean?

A

contralateral homonoygous inferior quadranopia

34
Q

What would a lesion at temporal lower optic radiation

A

Contralateral homonymous superior quadranopia

35
Q

What does the posterior cerebral artery (PCA) supply?

A
  1. Occipital lobe

2. Inferior part of temporal lobe

36
Q

What are the associated signs in a PCA stroke?

A
  1. Contralateral homonymous hemianopia

2. Visual agnosia (difficulty recognising familiar objects/faces)

37
Q

What would a lesion at the occipital visual cortex lead to?

A

contralateral homonymous hemianopia (macular sparing)

38
Q

What would a lesion at the optic tract lead to?

A

contralateral homonymous hemianopia

39
Q

What would a lesion at the optic chiasm lead to?

A

bitemporal hemianopia

40
Q

What would lesion of optic nerve result in?

A

ipsilateral monocular visual loss

41
Q

What would a posterior circulation stroke lead to?

A
  1. damage in the brainstem

2. (don’t confuse with posterior cerebral artery with contralateral signs)

42
Q

What signs does a cerebllar lesion give?

A

ipsilateral signs

DANISH

43
Q

What are the signs of a cerebllar stroke?

A
  1. Dysdiadochokinesia
  2. Ataxia (gait and posture)
  3. Nystagmus
  4. Intention tremor
  5. Slurred, staccato speech
  6. Hypotonia/Heel-shin test
    + Decreased consciousness
44
Q

What is the rosier score?

A

RISK OF STROKE IN EMERGENCY ROOM

45
Q

Why do you measure serum glucose?

A

hypoglycaemia may minimic stroke

46
Q

Why do you measure serum U+Es?

A

exclue hyponatremaia

47
Q

Why do you measure cardiac enzymes?

A

eg. troponin → exclude concomitant myocardial infarction

48
Q

Why do you measure FBC?

A

Check for anaemia or thrombocytopenia prior to possible initiation of thrombolysis or anticoagulant

49
Q

Does a normal CT rule out ischaemic stroke?

A

no

50
Q

What is the management plan for an iachamic stroke less than 4.5 hours from symptoms onset?

A
  1. Thrombolysis - IV alteplase
    (Recombinant tissue plasminogen activator, r-tPA)
  2. Then give aspirin (300 mg, oral)
  3. Note: Endovascular interventions can be beneficial in large vessel occlusions
51
Q

What is the management plan for an ischamic stroke more than 4.5 hours from symptoms onset or thrombolysis contraindictaed?

A

Aspirin (300 mg, oral)

52
Q

What are contraindications for thrombolysis?

A
  1. Symptom onset > 4.5 hours
  2. CT reveals acute trauma or haemorrhage
  3. Symptoms suggestive of subarachnoid haemorrhage
  4. High INR, APPT, PT
53
Q

What is done at stroke unit?

A
  1. Swallowing assessment -aspiration pneumonia, choking
  2. VTE prophylaxis
  3. GCS monitoring
  4. Early mobilization and rehabilitation
  5. MDT approach
54
Q

What further investigations may be done for iachameic stroke?

A
  • find cause
    1. CT angiogram
    2. Carotid doppler
55
Q

What can CT angiogram show?

A

performed in all patients with acute ischaemic stroke and suspicion of a large vessel occlusion who would be candidates for endovascular thrombectomy

56
Q

When is a carotid doppler used?

A
  • Checks for carotid artery stenosis

- If >70% occlusion, carotid endarterectomy recommended

57
Q

What is the surgical option after ischaemic stroke?

A

carotid endarterectomy

58
Q

What is the secondary prevention for ischaemic stroke?

A

antiplatelets

59
Q

What antiplatelets are given for AF patients?

A

Warfarin prophylaxis

60
Q

What antiplatelets are given for non-AF patients?

A
  1. Continue 75mg aspirin for 2 weeks

2. Then switch to lifelong 75 mg clopidogrel

61
Q

What lifestyle changes are reccomended for stroke patient?

A
  1. Avoid heavy drinking
  2. Glucose control
  3. Maintenance of healthy BMI
  4. Aerobic activity
  5. Reduce salt intake
62
Q

How is haemorrhgaic stroke managed?

A
  1. ICU or surgery
  2. Important NOT to administer thrombolysis or aspirin in suspected haemorrhagic strokes
  3. Review anticoagulant medications
63
Q

Why do you need to review anticoagulant medication for haemorrhgic stroke?

A
  1. Anticoagulants and antithrombotic drugs can make bleeding worse
  2. Discontinued or reverse
  3. Contact GP to change medications

Z Year3 Neuro Conditions (34 decks)

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