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10 - Neuro Clinicals > Stroke > Flashcards

Stroke Flashcards

1
Q

Definition stroke

A

Sudden global or focal neurological deficits due to spontaneous hemorrhage or infarct of CNS irrespective of clinical duration of symptoms

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2
Q

Why is stroke an issue in Africa

A

Younger population affected
Higher death toll

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3
Q

Pathophysiology in stroke cerebral blood flow

A

Loss of autre regulation
Less than 50% tissue at risk
Less than 25% electrical failure
Less than 15% membrane failure and death

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4
Q

Cerebrovascular disorder leading to stroke

A

Atherosclerosis and arteriosclerosis
Hypertension
Cerebral amyloid
Arteritis
Vasculitis
Aneurysm
Vascular malformations

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5
Q

Vertebral and basilar arteries supply …

A

Brainstem
Mid brain
Cerebellum

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6
Q

Anterior cerebral artery supply

A

Frontal lobe
Parietal lobe

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7
Q

Middle cerebral

A

Parietal lobe
Frontal lobe

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8
Q

Posterior cerebral

A

Occipital lobe

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9
Q

4 Strokes syndrome

A

ACA - frontal lobe , altered mental state , contralateral lower extremity weakness
MCA - contralateral hemiparesis m ipsilateral hemianiopa,
PCA
Vertebrobasilae

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10
Q

Oxford subtypes of infarctive st

A

Total anetrior circulation infarct
Partial anterior circulation intact
Lacunar infarct
Posterior circulation infarct

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11
Q

Features of posterior circulation infarction syndrome

A

Ipssilateral cranail nerve palsy
Contralateral motor or sensory deficits

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12
Q

Features of pontine hemorrhage

A
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13
Q

Features of cerebellar hemorrhage

A
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14
Q

ASCO mnemonic in infarctive stroke

A

ASTHEROEMBOLIC

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15
Q

SMASHO mnemonic in hemorrhagic stroke

A

Amyloid
Hypertension

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16
Q

Non modifiable risk factor of stroke

A

Male gender
Age
Race black
Previous vascular event (MI, stroke, PVD)
Family history
SCdx
High fibrinogen

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17
Q

Modifiable risk factors

A

Obesity
Diet
Alcohol
Smoking
BP
Polycytemia

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18
Q

Modifiable risk factors

A

Smoking
Alcohol
Sedentary life style
Diet
Obesity
Stress
Cholesterol

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19
Q

Subtypes of ischemic stroke

A

Large artery atherosclerosis ( embolus, thrombus )

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20
Q

Specific causes of stroke in developing countries

A

Sickle cell disease
Snake bite
Infective endocarditis
Cerebral malaria
HIV
COVID
Chagas’ disease

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21
Q

Path to neuronal injury in ischemic stroke

A

Ischemia -> energy failure ( low ATP)-> cell depolarization (sodium and water influx) -> release of neurotransmitter ( glutamate , AMPA, NMDA) -> calcium influx into neurons -> activation of destructive process by enzymes

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22
Q

What is penumbra

A

Functionally impaired but still structurally viable tissue

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23
Q

Differential of stroke

A

ALS
Bell’s palsy
Benign postural vertigo
Cauda equina
Cavernous sinus thrombosis
Cerebral venous thrombosis
Dissection syndrome
Epidural hematoma
Head injury
meningitis
Migraine
Mutilple sclerosis
Spinal cord infarction

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24
Q

Stroke scale defintion

A

Quantity measure of stroke related deficit
NIHSS

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25
Q

Scale of ranking stroke

A

0- no symptoms
1- no significant disability
2- slight disability
3- overeats disability
4- modesevere disability
5- severe disability

26
Q

Imaging techniques used

A

Structure - CT , MRI
Function- PET SPECT , EEG , MEG

27
Q

Why do Imaging in stroke ?

A

Hemorrhage or infarct ?
Large vessel occlusion ?
Reduced tissue perfusion ?
Irreversible damage ?
Salvageable tissue ?

28
Q

Early neuroprotection in stroke

A

Maintain homeostasis by
Treat severe hypertension
Maintain blood sugar
Early fluid and energy replacement
Swallowing assessment
Tx fever and antipyretic
Treatment of infection
Early mobilization and rehab

29
Q

Steps in anti platelet therapy

A

Confirm with ct scan
300-75mg aspirin in infarct
Aspirin + early mobilisation in DVT

30
Q

Hypertension treatment in strok

A

Reduce slowly
ACEi, ARBs, diuretics

31
Q

Contraindication for thrombolysis therapy in stroke

A
32
Q

What is tPA

A

In early presentation of stroke patient (4-5h)

33
Q

Determinants of hogh stroke mortality in Ghana

A

Health seeking behavior of African
Inadequate facilities
Late institution of neruoprotectine measures
Complications of stroke s
Lack of imaging facilities
Lack of multidisciplinary teams
Low awareness , treatment and control of hypertension
Primordial

34
Q

Clinical Classification of strokes from anterior carotid circulation and posterior carotid circulation

A

Total anterior circulation stroke TACS

Partial anterior circulation stroke PACS

Lacunar stroke LACS

Posterior circulation stroke POCS

35
Q

2 types of hemorrhage leading to stroke

A

Intracerebral hemorrhage

Subarachnoid hemorrhage

36
Q

Main neuroimaging techniques used to detect stroke

A

CT scan (baseline )
MRI when uncertainty of diagnosis
CT angiography /CT perfusion for characterization of ischemia

37
Q

Vascular imaging techniques used in stroke

A

Ultrasound Doppler for carotid and vertebral arteries in the neck

Transcranial Doppler

MR angiography
CT angiography

38
Q

Blood tests done in stroke

A

Blood glucose - diabetes mellitus
TGs , cholesterol - Hyperlipidemia
FBC - polycythemia
ESR & Immunology - ANCAs for vasculitis
Genetic testing for CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy

39
Q

Investigation technique used only in subarachnoid hemorrhage

A

Lumbar puncture

40
Q

Cardiovascular investigation in stroke

A

ECG
Echocardiography

41
Q

Possible neurological presentation of stroke patient

A

Unilateral Weakness - sudden, rapidly progressive , UMN weakness of face , increased tone

Speech disturbance - dysphasia ( frontal and parietal lobe), dysarthria

Visual deficit

Contralateral Visuospatial dysfunction

Ataxia - cerebellum damage

Headache (severe mostly in SAH )

Seizure

Coma especially in SAH or intracerebral hemorrhage

42
Q

Mortality of stroke over a month

A

20%

43
Q

Morbidity of stroke over a month

A

1/2with physical disability

44
Q

Main cause of cerebral infarction in stroke

A

Secondary thromboembolic disease to atherosclerosis

45
Q

Main type of secondary thromboembolic dx leading to infarctive stroke

A

Cardiac embolism 20%
Thrombosis in situ 20%
Rare causes - endocarditis, vasculitis , cerebral venous dx

46
Q

Disease causes of intracerebral hemorrhage

A

Complex small vessel disease with disruption of vessel wall
Amyloid angiopathy
Impaired blood clotting
Vascular anomaly
Substance misuse

47
Q

Differentials of structural stroke

A

Primary cerebral tumor
Metastatic cerebral tumor
Extradual / subDural hematoma
Demyelination
Peripheral nerve lesions
Cerebral abscess

48
Q

Differentials of functional stroke

A

Todds paresis
Hypoglycemia
Migrainous aura
Focal seizures
Manières dx
Conversion disorder
Encephalitis

49
Q

TACS common symptoms

A

Hemiparesis
Higher cerebral dysfunction
Hemisensory loss
Homonymous hemianopia

50
Q

TACS commonest cause

A

Middle cerebral artery occlusion

51
Q

PACS commonest symptoms

A

Isolated motor loss
Isolated higher cerebral dysfunction
Mixture of higher cerebral dysfunction and motor loss

52
Q

Main cause of PACS

A

Occlusion of branch of middle cerebral artery or anterior cerebral artery

53
Q

LACS commonest symptoms

A

Pure motor stroke
Pure sensory stroke
Sensory motor stroke
No higher cerebral dysfunction or hemianopia

54
Q

LACS commonest cause

A

Thrombotic occlusion of small perforating arteries

55
Q

POCS main symptoms

A

Homonymous hemianopia
Cerebellar dysfunction
Cranial nerve syndromes

56
Q

POCS commonest cause

A

Occlusion in vertebral basilar or posterior cerebral artery

57
Q

What is progressing stroke

A

Stroke with focal neurological deficit worsenin after the patient first present

58
Q

What is a complete stroke

A

Focal deficits persists and is not progressing

59
Q

1st Step in management of stroke

A

Bedside test swallowing for safe medications, food, hydration

60
Q

Management of ischemic stroke

A

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10 - Neuro Clinicals (6 decks)

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