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B3 CTB > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stoke?

A

The sudden onset of neurological symptoms due to haemorrhage from or occlusion of vessels in the cerebral circulation.

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2
Q

What was the FAST campaign?

A

To increasd public awareness.

Face – Has their face fallen on one side? Can they smile?

Arms – Can they raise both their arms and keep them up there?

Speech – Is their speech slurred?

Time to call 999.

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3
Q

What are the two main types of stroke?

A
  • Ischaemic – generally resulting from reduced blood supply to an area. Often caused by vessel occlusion due to a thrombus or embolus.
  • Haemorrhagic - resulting from a bleed into the area.

Can lead to ischaemia and tissue damage. Often due to an aneurysm/vessel rupture.

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4
Q

List some risk factors for haemorrhagic stroke?

A
  • High blood pressure.
  • Presence of aneurysms.
  • Head trauma.
  • Blood thinners.
  • Long term NSAIDs.
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5
Q

What does a ‘thunderclap’ headache indicate?

A

Sub-arachnoid haemorrhage

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6
Q

List some risk factors for ischaemic stroke.

A
  • Hypercholesterolaemia.
  • History of cardiovascular disorders (arrhythmias, heart disease).

Atrial fibrillation predisposes patients to clot formation due to erratic flow and pooling of blood in the atria.

  • Age.
  • Poor diet.
  • Obesity.
  • Inactivity.
  • Diabetes.
  • Smoking.
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7
Q

Symptoms of stroke vary depending on site. List five common symptoms.

A
  • Weakness/ paralysis on contralateral side.
  • Vertigo/ dizziness.
  • Headache.
  • Visual loss/ blurred vision
  • Faintness and confusion.
  • Speech problems.
  • Difficulty swallowing.
  • Cognitive problems.
  • Memory problems.
  • Consciousness alterations.
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8
Q

What is usually used to classify stroke (according to regional vasculature).

A

Oxford Stroke Classification.

Anterior, posterior, small vessels.

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9
Q

What are anterior and posterior circulation?

A
  • Anterior circulation is anything supplied by the Carotid arteries (Anterior and Middle Cerebral arteries) and the anterior communicating artery.
  • Posterior circulation is anything supplied by the vertebral arteries, including the Basilar, inferior cerebellar, Posterior Cerebral, superior cerebellar and anterior cerebellar arteries.
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10
Q

What are the four classes of stroke?

A
  • TACS – Total Anterior Circulation Syndrome.
  • PACS – Partial Anterior Circulation Syndrome.
  • POCS – Posterior Circulation Syndrome.
  • LACS – Lacunar Syndrome/ Stroke.

Labelled with ‘I’ or ‘H’ depending on whether it is ischaemic or haemorrhagic.

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11
Q

What does the basilar artery supply?

A

Pons and provides the three pairs of arteries that supply the cerebellum (SCA, AICA and PICA).

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12
Q

What symptoms indicate a total anterior circulation stroke (TACS)?

A

All three of the following:

  • Unilateral weakness.

Face, arm and legs (could have sensory changes).

  • Homonymous hemianopia.

One side of the visual field in both eyes.

  • Higher cortical dysfunction.

Speech, visuospatial problems, memory, planning etc.

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13
Q

A TACS is a larger cortical stroke in the ? (unilateral).

A

Middle/Anterior Cerebral artery areas

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14
Q

A PACS is a cortical stroke in the ?

A

middle and/or anterior cerebral artery areas.

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15
Q

What symptoms indicate a partial anterior circulation stroke?

A

Two of the following:

  • Unilateral weakness.
  • Homonymous hemianopia.
  • Higher cortical dysfunction.
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16
Q

Wernicke’s and Broca’s areas are supplied by the ?.

A

Middle Cerebral Artery

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17
Q

A POCS affects the ?

A

posterior circulation - brainstem and cerebellar arteries

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18
Q

What symptoms indicate a POCS?

A

One of the following:

  • Bilateral motor or sensory deficit.
  • Cerebellar/ brainstem signs e.g. ataxia.
  • Isolated homonymous hemianopia.
  • Cranial nerve palsy and contralateral motor/ sensory deficit.

Most nuclei are within the brainstem.

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19
Q

What is LACS?

A

Small vessel disruption, no evidence of larger scale cerebral dysfunction.

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20
Q

What symptoms indicate lacunar syndrome?

A

One of the following:

  • Unilateral weakness.
  • Pure sensory or pure motor.
  • Ataxic hemiparesis.

Weakness and ataxia on the same side.

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21
Q

Occlusion of small vessels can cause lacunar syndrome. Give an example of a small vessel.

A
  • Lenticulostriate.

Come off the Middle Cerebral artery to supply the frontal basal ganglia regions.

  • Thalamogeniculate.

Supplies the thalamus and geniculate region.

  • Brainstem perforating vessels.
22
Q

What causes watershed infarcts?

A

Systemic hypotention causing infarct in the areas of overlap of supply.

Almost always in both sides.

23
Q

Where do watershed infarctions occur?

A

Occur at the border between cerebral vascular territories where the tissue is furthest from arterial supply and thus most vulnerable to reductions in perfusion.

24
Q

What is the most common watershed infarct?

A

ACA - MCA infarct caused by occlusion of carotid artery.

25
Q

What is a common symptom of an ACA-MCA watershed infarct?

A

Man in a barrel syndrome - loss of trunk sensation/ motor function and aphasia.

26
Q

MCS-PCA infarct affects ?.

A

visual processing

27
Q

Do spinal watershed infarcts usually affect the posterior or anterior supply?

A

Anterior as there is only one vessel.

28
Q

What are the two watershed areas of the spinal cord?

A
  • T4 – T8 – watershed area between Radicular arteries (Thoracic and Great Radicular artery).
  • L1 – watershed between Great Radicular artery and Ascending Sacral arteries.
29
Q

There are around ? adolescent/ childhood strokes in the UK each year. Are they usually ischaemic or haemorrhagic?

A

200

ischaemic

30
Q

List some contributing factors towards adolescent strokes.

A
  • Hereditary.
  • CHD/ AHD.
  • Congenital abnormalities.
  • Trauma.
  • Infection.
  • Metabolic.
  • Neoplasia.
31
Q

What are dissociated signs?

A

Sensory and motor signs are on opposite sides or that the facial signs are opposite to those in the body.

32
Q

Damage to the subthalamic nuclei can result in hemiballismus. What is this?

A

Hyperkinetic movement disorder characterised by violent limb movements on one side of the body.

33
Q

What causes a transient ischaemic attack (TIA)?

A

Transient loss of perfusion to an area.

Signs and symptoms are identical to a full stroke and will depend on the location of the loss.

34
Q

Is there always a full recovery and resolution of symptoms from a TIA?

A

Yes

35
Q

What are the two most common causes of TIA?

A
  • Carotid insufficiency.
  • Vertebrobasilar insufficiency.
36
Q

What is Amourosis fugax?

A

Specific type of TIA.

Transient loss of vision caused by loss of perfusion in the retinal or ophthalmic artery for the affected eye.

37
Q

A patient who has experienced a TIA is at risk of having a full stroke within ?.

A

a year

38
Q

Name two common scales that can be used to assess risk of stroke.

A
  • ABCD2.
  • CHADVASC.
39
Q

What is ROSIER and what is it used for?

A

Recognition of Stroke in the Emergency Room.

Used in the ED to test for classic signs/symptoms of stroke.

40
Q

What is the first urgent step with managing suspected stroke?

A

Determine if its haemorrhagic or ischaemic.

41
Q

When would you consider urgent neuroimaging?

A

Only when there is a strong indication (from Hx) it may be haemorrhagic stroke.

Note, you cannot give thrombolytics if it is haemorrhagic.

42
Q

Give an example of a thrombolytic.

A

Alteplase.

43
Q

You have a ? hour window to use thrombolytics after symptom onset.

A

4.5

44
Q

300 mg ? is normally given for two weeks prior to commencing LT anti-thrombotic treatment.

Normally, patients are switched to ? after two weeks.

A

Aspirin, clopidogrel

45
Q

What is diffusion weight imaging?

A

Variant of T2 MRI and is used to determine the extent of infarct.

Detects movement of water in the tissue.

46
Q

What is stroke penumbra?

A

the penumbra is the part of the brain that is sandwiched between brain regions committed to die and those that receive enough blood to communicate. Therefore, it is ischemic brain tissue that has just enough energy to survive for a short time but not enough to communicate and function. looking at stroke penumbra can show the extent of damage caused by iscahemic stroke.

47
Q

When a signal is high (bright) on a DWI, what does it mean?

A

Low water movement, indicating cellular swelling/reduced extracellular space/ tissue death.

48
Q

Patients often suffer from post-stroke pain. When does this normally start?

A

A couple of months following the stroke and is caused by the damage to the neurons. Causes neuropathic pain.

49
Q

What is used to treat post-stroke pain?

What other treatment is used post-stroke?

A

Antidepressants (tricyclic) as it is a neuropathic pain.

Other:

Physiotherapy, speech and language therapy, occupational therapy

50
Q

Progressive strokes can lead to the development of ? as a result of cortical and subcortical damage.

A

vascular dementia

51
Q

What are some pathophysiological features in a stroke?

A
  • High glucose and cholesterol.
  • Low clotting factors.
  • High WBC count.
  • High pH O2.
  • Low CO2.
52
Q

What damage is caused in vascular dementia?

A

Cortical and subcortical damage.

B3 CTB (13 decks)

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