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ENT, neuro, eyes > Stroke > Flashcards

Stroke Flashcards

1
Q

Hemianospia vs homonymous hemianopia?

A

Neglect is the inattention of visual space unilaterally
Homonymous hemianopia is physical visual loss to same half of both eyes

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2
Q

Differenve in exam hemianospia vs homonymous hemianopia?

A

Test - HH would not see finger waggle on one side consistently
Neglect - can see individual finger waggle on both sides but not at the same time

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3
Q

3 criteria of stroke

A

Unilateral weakness
Homonymous hemianopia
Higher cerebral functions eg dysarthria (UMN signs)

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4
Q

TACS vs PACs criteria

A

TACS - all 3
PACS - 2/3

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5
Q

Lacunar stroke signs

A

NOT cortical
Ataxia
Dysarthria
Motor or sensory

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6
Q

Storke mimics to check

A

Hyponatremia, calcemia, glycaemia

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7
Q

When does the NIHSS score indicate thrombolysis?

A

<4 or >25

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8
Q

What is the difference between neglect and homonymous hemianopia?

A

Neglect is attention problem to one side of body - can’t see two fingers wiggling at same time
HH is physical vision loss to the same side on both eyes - can’t see one finger waggle on one side of body in BOTH eyes

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9
Q

Stroke symptoms if ACA affected

A

Contralateral hemiparesis and sensory loss
Lower extremity >upper

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10
Q

Middle CA symptoms of stroke

A

Contralateral hemipareseis and sensory loss
Upper extremity >lower extremity
Controlateral HH, aphasia

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11
Q

Posterior cerebral artery symptoms

A

Contralateral HH w macular sparing
Visual agnosia

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12
Q

What is webers syndrome

A

Branches of PCA that supply midbrain stroke

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13
Q

Symptoms of webers syndrome

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

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14
Q

What is wallenberg syndrome + what affected in it

A

Lateral medullary syndrome - posterior inferior cerebellar artery stroke

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15
Q

Symptoms of wallenberg syndrome

A

Ipsilateral - facial pain and temperature loss
Contralateral limb/torso pain and temp loss
Ataxia, nystagmus

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16
Q

What is lateral pontine syndrome

A

Anterior inferior cerebellar artery stroke

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17
Q

Lateral pontine syndrome symptoms

A

Similar to wallenbergs but also ipsilateral facial paralysis and deafness
Sudden onset vertigo and vomitting

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18
Q

What artery stroke causes amourosis fugax

A

Retinal/opthalmic artery

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19
Q

Basilar artery stroke causes

A

Locked in syndrome

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20
Q

Lacunar stroke features

A

Present with isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong ass w HPTN
Basal ganglia, thalamus + internal capsule

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21
Q

Causes of stroke

A

85% ischaemic - thrombosis infarcts, cerebral emboli
8.3% IC haemorrhage
5.4% SA haemorrhage
1.2% undefined

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22
Q

WHICH LOBES SUPPLIED BY WHCIH ARTERIES IF HAVE TIME

A
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23
Q

What is malignant middle cerebral artery syndrome

A

Younger ischaemic patients if large MCA infarct
Significant oedma -> brain cimpression
May need craniotomy

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24
Q

What is the area around an infarct that is salvageable but critically endagenered in a stroke

A

Penumbra

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25
Q

What is a thalamic stroke

A

Bleed ruptures into ventricles

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26
Q

Management of brainstem/PCS stroke

A

Urgent CT angiogram of basilar artery and mechanical thrombectomy considered

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27
Q

What causes total anterior circulation stroke

A

Proximal MCA or ICA occlusion

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28
Q

What are the clinical features of a Total anterior circulation syndrome stroke

A

Hemiparesis AND
Higher cortical dysfunction (dysphasia or visuospatial negelect) AND
homonymous hemianopia

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29
Q

Clinical features of a partial ACS stroke

A

Isolated higher cortical dysfunction OR
Any 2 of hemiparesis, higher cortical dysfunction, hemianopai

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30
Q

What artery blockage causes a PACS

A

Branch of MCA occlusion

31
Q

Clinical features of a Posterior circulation syndroem/POCS

A

Isolated hemianopai (PCA), brainstem or cerebellar syndromes

32
Q

What blood vessel occlusion can cause POCS

A

Vertberal, basilar, cerellar or PCA vessels

33
Q

Clinical features of lacuna syndrome - LACS

A

Pure motor stroke OR pure sensory OR sensorimotor OR ataxic hemiparesis OR clumsy hand-dysarthria

34
Q

What vessels can be occluded in lacuna syndrome

A

MCA/ICA occlusion

35
Q

What symptoms would you expect to see in an ICA blockage

A

Aphasia - neglect non dominant hemisphere
Contralateral HH, motor/sesnory loss to face, arm, leg
Conjugate ispilateral eye deviate

36
Q

Symptoms of MCA stroke

A

Aphasia or neglect
Contralateral HH, motor/sensroy loss to face/arm > leg eg UPPER BODY symptoms

37
Q

ACA stroke symptoms

A

Apathy, abulia, disnhibition
Conjugate eye deviation
Contralateral motor/sensory loss leg >arm eg LOWER body

38
Q

PICA stroke symptoms

A

Ipsilateral palatal weakness, horners syndrome
Wallenberg syndrome
Ipsilateral ataxia
Decreased pain/temp contralteral body

39
Q

AICA stroke symptoms

A

Ipsilateral deafness
Facial motor/sensory loss
Limb ataxia
Pain/temp contralteral body reduced

40
Q

Basilar stroke symptoms

A

Altered consciousness
Oculomotor abnoamlaties
Facial paresis
Ataxia
Quadraperesis

41
Q

Who to call if someone presenting with stroke

A

ED, stroke, radiology, neurosurgery , thrombolysis if suspicion

42
Q

What score is used to reognise stroke in acute symptom onset cases

A

Rosier - recognition of stroke in emergency room

43
Q

Questions on the Rosier score

A

Negative scores
Loss of consciousness or syncope?
Seizure activity?
Positive scores
New acute onset or wake from sleep of asymmetric face, arm or leg weakness (1 point each), visual field defect, speech disturbance

44
Q

What bedside test is important to do in stroke presentation

A

BM - <3.5 treat urgently and reassess

45
Q

What score on ROSIER means stroke is likely

A

> 0
-2 to +5 possible

46
Q

Time frame for treating ischaemic stroke with alteplase

A

Within 4.5 hours of onset of stroke symptoms
Rule out IC haemorrhage w CT head

47
Q

Contraindications to thrombolysis in stroke

A

Anticoag use prev 24 hour unless INR <1.7 or on warfarin
HPTN>185/110 DESPITE lowering
Platelets<100 or bleeding tendency
Prev history IC bleed
Recent ischaemic stroke or major surgery
Trivial non disabling or rpaidly resolving symptoms

48
Q

What is the NIHSS score

A

Assesses motor, global and sensory deficits and scores

49
Q

What score on NIHSS relates to whcih severity

A

0 = none
0-4 = minor stroke
5-15 = moderate stroke
16-20= mode to severe stroke >21 = severe

50
Q

What arteris are proximal large arteries and why is this significant

A

Terminal bit ICA
proximal MCA
basilar artery
->1/3 of strokes but <30% thrombolysis is effective in these

51
Q

What use in proximal large artery occlusions

A

Mechanical thromextomy within 6 hours of onset

52
Q

Anticoag to use in stroke

A

300mg aspirin ASAP within 24 hours for 2 weeks or until discharge
Alteplase - confirm no haemorrhage CT head 24 hrs then aspirin 300mg
Long term - 75mg clopidogrel OD

53
Q

MOA clopidogrel

A

P2Y12 inhibtior - ADP receptor - platelet activation and fibrin cross linking)

54
Q

What is Malginant MCA infarct

A

TACS w progressive neuro deterioration due to progressive oedema, raised ICP and cerebral herniation

55
Q

Primary causes of haemorrhagi stroke

A

HPTN and cerebral amyloid angiopathy

56
Q

Which cause is more likely in haemorrhagic stroke based on findings

A

HPTN in deep portions cerebral hemisheres eg putamen, thalamus, pons, cerebellum
CAA - older patients w lobar bleeds

57
Q

What use in CAA investgiatons

A

MRI
Boston criteria - evidence of mutliple haemorrhages/microbleeds

58
Q

Haemorrhageic stroke secondary causes

A
  • underlying vascular bnormlaities
  • AV malformation, aneurysm (blood in temporal lobe and sylvian fissure)
  • Cavernoma - abnormal clump og blood vessles
  • Coagulopathies
  • Oral anticoagulants
  • Non cerebral thrommbolytic drugs
  • Systemic diseases
  • Rare causes eg cerebral VTE, illicit drugs - amphetamines
  • Cancer
59
Q

What is most useful predictor for severity of stroke

A

ICH volume
>60ml one cerebral hemisphere cant be compesnated -> cerebral herniation and death

60
Q

ICH score criteria

A

GCS score 3-4 (2) , 5-12, 13-15 (0)
ICH volume < or >30
IVH yes or no
Infratentorial origin ICH yes or no
Age >80 or <80
0-6 total potnetial score

61
Q

What does ICH score measure

A

30 day mortality likely hood from haemorrhagic stroke

62
Q

Acute care for ICH

A

1 - rapid anticoagulation reversal
2 - Intensive BP lowering to 130-40 (if BP>150 and within 6 hrs onset)
Immediate referral to neurosurgery if sutibale

63
Q

Patients for neurosurgery referral

A

good premorbid function and any of GCS>9, posterior fossa ICH, obstructed 3rd or 4th ventricle, haematoma>30ml

64
Q

Predictors of haematoma expansion

A

ICH volume >30 and IVH
Spot sign on CT
High blood glucose
LowGCS/NIHSS
High BP
High score in 9 and 24 point and PREDICT A+B models
Coag - low fibrinogen, high D dimer and INR
Elevated WCC, IL-6, CRP
Time interval from onset of symptoms <6 hours

65
Q

What investigation is more sensitive for TIA and used in clinic

A

MRI brain diffusion weighted and blood sensitive sequeneces - SWI

66
Q

What is todds paresis

A

Focal weakness in part or all of body after seizure, can last up to 48 hours

67
Q

Stroke diagnosis investigations

A
  • Bloods - FBC, ESR, LFTs, lipids, Hba1c, TSH, coag
  • Brain scan - CT/MRI
  • extracranial vessel imaging - carotid doppler
  • ECG+/- cardiac imaging
68
Q

TIA secondary precention

A
  • Control BP
  • Antiplatelets - clopidogrel 75mg
  • Cholesterol reduction - atorvastatin
  • Lifestyle advice
69
Q

What do in symptomatic carotid artery stenosis

A

Urgent carotid endartectomy

70
Q

What is most frequent cause of stroke in yuong people

A

Cervical artery dissection

71
Q

Who is cerebral venous sinus thrombosis seen in

A

Young women 20-35

72
Q

Features of cerebral venous thrombosis

A

Headache and stroke like symptoms
Risk - prothrombotic tendency, local infection eg sinusitis, dehydration or widespread malignancy, seizures

73
Q

Investifation fro central venous sinus thrombosis

A

CT venography or MR

ENT, neuro, eyes (34 decks)

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