Stroke Flashcards
What are the 2 types of strokes?
Ischaemic or haemorrhagic
What is a transient ischaemic attack (TIA)?
Transient neurological dysfunction secondary to ischaemia without infarction. Symptoms last less than 24 hrs although normally they last for much shorter
1) What is an ischaemic stroke?
2) What is a hemorrhagic stroke?
3) What are the 2 subtypes of ischaemic strokes?
4) What are the 2 subtypes of hemorrhagic strokes?
5) Name a risk factor shared by both ischaemic and haemorrhagic strokes
6) Name a risk factor for each stroke that is not a risk factor for the other
1) Blockage in the blood vessel stops blood flow
2) Blood vessel rupture leading to reduction in blood flow to brain tissue
3) Embolic (embolism causes stroke) and thrombotic (thrombus causes stroke)
4) Intracranial and subarachnoid
5) Cardiovascular disease such as angina, myocardial infarction and peripheral vascular disease, previous stroke or TIA, hypertension
6) Atrial fibrillation (cardio-embolic), smoking, hyperlipidaemia
diabetes mellitus = ischaemic. Arteriovenous malformation, anticoagulation therapy, taking sympathomimetic drugs i.e. cocaine =(haemorrhagic)
Name 3 potential features of a stroke
- Motor weakness
- Dysphasia (speech problems)
- Swallowing problems
- Visual field defects
- Balance problems
1) Name 2 symptoms associated with a cerebral infarct
2) Brainstem infarct symptoms are often more severe - name 1 of these
3) Lacunar infarcts are around which areas of the brain?
4) How can lacunar infarcts present?
1) Contralateral hemiplegia: initially flaccid then spastic, contralateral sensory loss, homonymous hemianopia, dysphasia
2) Quadriplegia and lock-in-syndrome
3) Basal ganglia, internal capsule, thalamus and pons
4) Pure motor, pure sensory, mixed motor and sensory signs or ataxia
1) Why is neuroimaging important in a suspected stroke?
2) What is the gold standard investigation?
3) What other investigation can also be used?
1) Assess whether a patient may be suitable for thrombolytic therapy to treat early ischaemic strokes
2) Diffusion weighted MRI (often not practical in emergency setting)
3) CT scan (non-contrast)
Management of ischaemic strokes
1) If certain criteria are met, the patient should be offered what?
2) What is the criteria for this?
3) What is this medication, and give an example of a drug from the group?
4) What other drug is given after hemorrhagic stroke has been excluded
5) What else can be done if the stroke is caught early enough?
1) Thrombolysis + thrombectomy
2) The patients present within 4.5 hours of onset of stroke symptoms and has not had a previous intracranial haemorrhage, uncontrolled hypertension etc
3) Tissue plasminogen activator (TPA) i.e. alteplase
4) Aspirin
5) Mechanical thrombectomy (mechanical removal of clot)
What are the 2 aspects of TIA management?
Aspirin and secondary stroke preventions
Name 2 secondary preventions of stroke
- Clopidogrel (antiplatelet)
- Atorvastatin (statin)
- Carotid endarterectomy or stenting in patients with carotid artery disease
- Treat modifiable risk factors such as hypertension and diabetes
Name an aspect of the management of a hemorrhagic stroke
- Supportive therapy
- Stop any anticoagulants, antithrombotics etc
- Admission to ICU/stroke care unit
1) What dose, and for how long is aspirin given after a stroke?
2) How long is clopidogrel given for?
1) 300mg, 2 weeks
2) Lifelong
Contralateral hemiparesis and sensory loss in the lower extremity > upper extremity is characteristic of stroke in what artery?
Anterior cerebral artery
Contralateral hemiparesis and sensory loss in the upper extremity > lower extremity is characteristic of stroke in what artery?
Middle cerebral artery
Locked in syndrome is associated with a stroke due to what artery?
Basilar artery
Contralateral homonymous hemianopia is associated with a stroke in what 2 vessels?
- Middle cerebral artery
- Posterior cerebral artery
