Stroke Flashcards

1
Q

What is a stroke?

A

Acute and sudden onset of symptoms.
Focal neurological deficit not global.
Pattern of symptoms and signs attributable to one part of the brain and a particular vascular system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a TIA?

Explain

A

Transient Ischaemic Attack (TIA)

It is a brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia:
symptoms typically less than an hour, without evidence of infarction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does a TIA differ from a stroke?

A

It differs only in duration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long does a TIA last?

A

Typically less than an hour.
Many patients with TIA’s lasting more than 2 hrs will have infarction on MRI scan.
Requires urgent assessment as many high risk for full CVE (full cardiovascular events).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are transient focal neurological events?

A

Focal fit/partial seizure, transient global amnesia, demyelination, hypoglycaemia, peripheral nerve compressions migraine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should TIA patients be assessed?

A

Within 1 week,
24 hrs if high risk.

23% strokes preceded by TIA, 17% same day, 9% day before, 40% in 7 days prior to stroke.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most severe form of stroke?

A

TACS > PACS > LACS

TACS >50% dead at 90 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is TACS?

which artery?

A

Total anterior circulating syndrome

Extensive middle cerebral artery infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the signs of TACS?

A

All of:

  1. Unilateral weakness (+/or sensory deficit) or face, arm and leg.
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction (dysphasia, visuospatial disorder).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is PACS?

A

Partial anterior circulating syndrome

Branch of middle cerebral area infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the signs and symptoms of TACS?

A

Any 2 of the 3 components of TACS:

  1. Unilateral weakness (+/or sensory deficit) of face, arm and leg.
  2. Homonymous hemianopia
  3. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

DYSPHASIA ALONE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is LACS?

A

Lacunar syndrome

Tiny deep infarcts usually silent (80%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the signs and symptoms of LACs?

A

One of:

a. unilateral weakness of face and arm, arm and leg or all three
b. pure sensory stroke
c. ataxic hemiparesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is POCS?

A

Posterior circulating syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the signs and symptoms of POCS?

A

One of:

  1. Cerebellar or brainstem syndromes.
  2. Loss of consciousness.
  3. Isolated homonymous hemianopia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is ABCD^2 score?

A

Age, BP, Clinical symptoms, Duration, Diabetes

It predicts stroke at 2 days

Age >60 yrs
SBP >1400 mmHg or DBP >90mmHg
speech impairment
unilateral weakness
duration 10-59 mins
duration > 60 mins
diabetes
17
Q

What are the risk factors of stroke?

A
  • hypertension
  • diabetes
  • smoking
  • hyperlipidaemia
  • carotid stenosis
  • atrial fibrillation
18
Q

What is the single most important modifiable risk for stroke?

A
Hypertension. 
risk of stroke 2-4x risk. 
risk doubles every 7.5mmHg
Small reduction in BP results in large reductions in recurrence of stroke. 
aim 140/85. diabetic 130/80
19
Q

How do you treat a stoke?

A

Thrombolysis:
IV tPA within 4.5hrs of ischaemic stroke.
IV tPA = Intravenous tissue plasminogen activator.
Requires CT to exclude haemorrhage.

Acute treatment:
General medical care of STROKE UNIT.
if infarct aspirin 300mg OD.
pressure sore prevention/TED stockings. Hydration and nutrition. Antipyretic. Active glucose monitor.

20
Q

What is a stroke unit?

A

Hydration, nutrition, handling, pressure, continence, early mobilisation, fever (<38) glucose (<10mmols/L), oxygen, TED stockings, vigilant observations for complication.
> prevents complications e.g. pneumonia, infections and early recurrence (aspirin)
> control blood glucose and body temp
> avoid aggressive BP lowering

21
Q

What is secondary prevention of a stroke?

A
Thromboprophylaxis
Hypertension
Cholesterol management, 
Glucose management
Rhythm
Carotid stenosis

Antiplatelet therapy:

  • clopidogrel
  • aspirin combined with dipyridamole.

warfarin and NOACs - secondary prevention if AF or PAF

22
Q

What are the oral manifestations related to stroke?

A

Related to antihypertensive drugs

  • xerostomia
  • gingival hyperplasia
  • lichenoid reaction
  • cough and/or loss/alteration of taste (aguesia/dysgeusia)

most antihypertensive drugs have drug interactions with LA and analgesics,

23
Q

What is the most important modifiable risk factor for stroke?

A

Hypertension

24
Q

What scoring system is used to predict stroke risk?

25
Regarding Bamford classification of strokes, which type of stoke would result from an extensive middle cerebral artery infarction?
TACS
26
Using Bamford classification of strokes, which is the most common type of stroke?
PACS PACS>LACS>POCS>TACS
27
Using Bamford classification of strokes, which type of stoke would be associated with nystagmus, unsteady gaits and acute visual loss?
POCS
28
Regarding Bamford Classification, which stroke has the highest mortality rate at 90 days?
TACS