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4th Year > Stroke > Flashcards

Stroke Flashcards

1
Q

what is the window for reversal in thrombolysis and thrombectomy

A

thrombolysis 4.5hrs

thrombectomy 6 hrs

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2
Q

how is a scan diagnosed

A

acute onset
focal neuropathy
imaging to rule out other presentations

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3
Q

what is an intracranial bleed

A

NOT A STROKE
extradural/subdural/subarachnoid
causes neurosigns due to compreesion

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4
Q

what is an intracerebral bleed

A

haemorrhagic stroke

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5
Q

when is neurosurgery used in haemorrhagic strokes

A

to relieve compression- will not relieve disability

will only do when risk to life (coning, obstructive hydrocephalus)

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6
Q

causes of haemorrhagic stroke

A

blood- anticoagulants/platelets, excessive bleeding
vessel- HTPN, atherosclerosis, vasculitis, aneurysms, AVM, amyloid angiopathies
extravascular- bleeding into a tumour

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7
Q

what type of stroke does atherosclerosis cause

A

ischaemic (high cholesterol/diabetes causes formation of atheromas)

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8
Q

what type of stroke does arteriosclerosis cause

A

haemorrhagic stroke

thickening of lumen (middle layer) due to HPTN (calcification)

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9
Q

name stroke mimics

A

migraine, post seizure focal deficits, hypoglycaemia, acute presentation of SOL, bells palsy

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10
Q

which carotid supplies anterior circulation

A

internal

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11
Q

which artery supplies posterior circulation

A

vertebral

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12
Q

what does the circle of willis provide

A

collateral blood supply when blockage occurs - if acute blockage occurs before circle of willis will not be able to compensate

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13
Q

what is the cortex if the brain

A

outermost part
grey matter
has communicating vessels

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14
Q

what is the cerebral medulla

A

the inner part of brain
white matter (axons)
has non communicating vessels (if occluded no collateral)- perforating arteries (are end arteries)

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15
Q

what is causes when a cerebral artery is blocked

A

large artery occlusion- grey and white natter will die

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16
Q

what happens when a perforating artery is blocked

A

deep infarct, small artery occlusion

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17
Q

what does the internal carotid divide into

A

anterior and middle cerebral

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18
Q

what is the basilar artery

A

formed from vertebral arteries

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19
Q

what does the basilar artery divide into

A

posterior cerebral

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20
Q

what is a embolus

A

a thrombus that occludes an artery distal to where it was formed

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21
Q

what is a thrombus

A

blocks artery where it was formed

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22
Q

is an embolus or thrombus more likely to cause a stroke

A

embolus

thrombus forms slowly, large vessels have collaterals

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23
Q

are large vessel infarcts usually embolic or thromobic

A

embolic (needs acute occlusion due to collateral vessels)

24
Q

do embolic strokes usually affect cortex or medulla

A

cortex

25
Q

what should you think when there is multiple infarcts in multiple locations

A

source- e.g. heart

26
Q

what are the cortical signs of a stroke

A

dominant hemisphere: (usually left, controls communication)
- dysphagia (expressive understand cant express, receptive fluent but cant understand- usually mixed)
-agnosia (cant recognise objects)
right hemisphere
-hemispatial neglect
-personality changes
-sensory inattention

27
Q

what can cause a pure motor stroke

A

large vessels embolic cortical OR small vessel thrombotic deep infarct

28
Q

what causes a wedge shaped infarct

A

embolic large vessel occlusion

29
Q

what causes just a hand/leg motor stroke

A

thrombotic small vessels deep infarct in internal capsule

30
Q

what is a TACS

A

total anterior circulation stroke

31
Q

what are the features of a TACS

A

hemiparesis
hemisensory loss
hemianopia
higher cerebral dysfunction (cortical signs)

32
Q

what causes a TACS

A

embolus (large vessel)

could also be a large lobar bleed

33
Q

what is a PACS

A

partial anterior circulation stroke

34
Q

what are the features of a PACS

A

can be isolated in cortex (Cortical signs)
or can have any 2 features of TACS (usually cortical + hemi symp)
need to have cortical as this shows is an embolic large vessel block

35
Q

what causes a PACS

A

large vessel embolus

36
Q

what is a POCS

A

posterior circulation stroke

37
Q

what are the features of a POCS

A 
brain stem- syncope
occipital lobe- visual disturbance, hemianopia (isolated) 
pariatal lobe- sensory 
cerebellum- ataxia, diplopia 
low MN facial weakness
38
Q

what causes a POCS

A

embolic/thrombotic in vertebral basilar artery

if isolated hemianopia then embolic

39
Q

what is a LACS

A

lacunar stroke

40
Q

what are the features of a LACS

A 
pure physical (ataxic hemiparesis if occurs in internal capsule, if anywhere else may go unnoticed) 
pure sensory
41
Q

what causes a LACS

A

small deep vessels thrombosis

42
Q

do you get cortical signs in a LACS

A

no

43
Q

what usually causes large vessel stokes

A

atheroembolic

44
Q

what can cause a stroke in infants

A

dissection (only painful stroke)

hypoperfusion - causes watershed infarcts between two artery territories)

45
Q

what is a venous infarct

A

blockage in IJV causes brain swelling and haemorrhage due to back pressure (Tx anticoagulation)

46
Q

what is a paradoxical embolism

A

when hole in heart means DVT goes to brain (Tx thrombolysis, anticoagulation and 2ndary prevention)

47
Q

what is a TIA

A

true TIAs only last few minutes
if hours then stroke with neuroplasticity
need urgent Ix and Tx as most recovery to gain and high risk of recurrence

48
Q

what are the IX for stroke

A 
blood- general, lipids, glucose 
ECG- AF
carotid doppler 
-ambulatory monitoring -PAF 
ECHO- AF, mitral/aortic valve disease
CT best for acute haemorrhage (all Pts get CT), doesnt always show infarct but diagnosis is clinical anyway - use CT to find contraindication to thrombolysis 
if cant tell after 1-2 weeks if ischaemic/haemorrhagic do MRI 
if TIAS do MRI if possible
49
Q

what are the indications for a carotid endartectomy

A

stenosis >70% in stroke causes artery/ >50% in young males NOT DONE IN ASYMPTOMATIC ARTERY EVEN IN >80% AS RISK OF STROKE
needs to be within 14 days of TIA/stroke

50
Q

what is the treatment for venous clots

A

anticoagulation

51
Q

what is the treatment for arterial clots

A

antiplatelets

52
Q

what strokes can hyperacute treatments be used for

A

ischaemic

53
Q

what are the hyperacute treatments and when can they be used

A

thrombolysis- within 4.5 hrs (risk of haemorrhagic transformation after), aim to reduce disability (cant reverse stroke)
thrombectomy- 6 hrs, only for large vessel proximal occlusions (ICA), need CT angiogram

54
Q

what is the secondary prevention following strokes

A

antiplatelet-75 mg clopidogrel (aspirin if CI, dual if high risk)
anticoagulants- TIAs start day 1, large infarcts 1-14 days later to prevent haemorrhage, use aspirin 300mg in interim
statins (only for atherosclosis: 20-80mg
antiHPTNsives (HPTN biggest RF for stroke, very important to control in acute setting for haemorrhagic strokes)
diabetic/ lifestyle management
MDT rehab

55
Q

Tx pathway for stroke and TIA

A

300mg aspirin when suspected, continue for 2 weeks (offer PPI
CT for stroke
for TIA only CT if considering other diagnosis, consider MRI. Do carotid doppler for TIA. Carotid endarectomy for TIA and non disabling stroke with stenosis >50/70%

ischaemic stroke:
thrombolysis with alteplase within 4.5 hours
thombectomy with thrombolysis, if within time frame, within 6 hours

venous sinus thrombosis:
anticoag: heparin and then warfarin

haemorrhagic stroke:
Bp control if hypertensive

4th Year (7 decks)

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