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Dunedin RACP Study Course > Stroke > Flashcards

Stroke Flashcards

1
Q

Sub-categorisation of Ischaemic strokes by aetiology

A

Atherosclerotic (in-situ)
* Large vessel
* Small vessel

Artery to artery embolism
* Extracranial vessel stenosis
* Dissection

Cardioembolic

Paroxysmal Embolism

Other

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2
Q

RFs Haemorrhagic stroke

A
  • HTN
  • Hypocholesterolemia
  • Heavy EtOH use
  • Cerebral amyloid angiopathy
  • Antithrombotic therapy
  • Underlying structural pathology
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3
Q

Where does ASA come off of

A

Vertebral arteries

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4
Q

Where does PICA come off of

A

Vertebral arteries

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5
Q

Order of cerebellar arteries (post/inf to sup/ ant)

A

PICA
AICA
SCA

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6
Q

Where does AICA come off of

A

Basilar artery

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7
Q

Anterior Cerebral artery syndrome

A
  • Leg>Arm/Face
  • Motor&raquo_space;sensory
  • Dysexecutive, abulia, urinary incontinence
  • Dysphasia (dominant)
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8
Q

Posterior Cerebral Artery syndrome

A
  • Homonymous Haemianopia
  • Behavioural change, memory issues
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9
Q

Middle cerebral artery syndrome

A
  • Face/Arm > Leg
  • Dysphasia (dominant)
  • Dyspraxia/Neglect (non-dominant)
  • Homonymous Haemianopia
  • Motor and Sensory
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10
Q

Basilar Artery/vertebral artery syndrome

A
  • Locked in syndrome (sparing EOM)
  • Initially vertigo, ataxia, diplopia, isolated limb symptoms
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11
Q

Small vessel/ lacunar stroke syndromes (5)

A
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12
Q

Gerstmann syndrome brain area

A

Inferior parietal lobule of dominant hemisphere

Angular and supramarginal gyri (Brodman area 39 and 40) near the temporal and parietal junction

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13
Q

Gerstman syndrome Sx

A
  • Dysgraphia/agraphia
  • Dyscalculia/acalculia
  • Finger agnosia
  • Left-right disorientation
  • +/- aphasia
  • +/- apraxia
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14
Q

Lateral Medullary syndrome synonyms

A
  • Wallenberg Syndrome
  • PICA syndrome
  • Vertebral artery syndrome - misnomer really as can cause other issues
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15
Q

Lateral Medullary syndrome Sx

A

Contralateral
* trunk/limb numbness (pain/temp)

Ipsilateral
* Facial numbness (pain/temp)
* Skew deviation/room tilt
* Dysphagia/hoarseness/gag
* Horner’s syndrome
* Limb ataxia

  • Palatal myoclonus
  • Vertigo/nystagmus
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16
Q

Top of the Basilar Syndrome

A
  • Ptosis
  • Dilated pupils
  • Ocular motor deficits
  • Somnolence (thalamic infarction), hallucinations, dreamlike behaviour
  • Motor function otherwise preserved

Can cause full basilar thrombosis -> locked in

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17
Q

Balint syndrome

A
  • B/L parietal/occipital junction lesions e.g. watershed
  • Simultagnosia
  • Oculomotor apraxia
  • Optic ataxia
18
Q

Anton syndrome

A
  • Bilateral occipital lesions
  • Cortical blindness
19
Q

Benedikt syndrome,

Webber syndrome

A
  • Midbrain stroke
  • Posterior cerebral artery or penetrating branches of basilar artery
  • CN III palsy
  • Ataxia/choreoathetosis

Webber syndrome
* Similar to Benedikt except more hemiplegia than limb ataxia

20
Q

Anterior spinal artery syndrome

A
  • Loss of power distally
  • +/- Loss of temp/pain
  • Posterior column unaffected
21
Q

Spinal cord syndrome with syringomyelia

A

Central cord syndrome

22
Q

Location of haemorrhage in cerebral amyloid angiopathy

A

Lobar Haemorrhage

23
Q

Location of haemorrhages in deep haemorrhages

A

B: Basal Ganglia
C: Thalamus
D: Pons
E: Cerebellum

(A is a lobar haemorrhage)

24
Q

Main RF for lobar cerebral haemorrhage

A

Cerebral amyloid angiopathy

25
Q

Main RF for deep cerebral haemorrhage

A

HTN

26
Q

ICH treatment

A

Lower blood pressure to ~140 systolic

Reverse anticoagulation

Surgical interventions
* Posterior-fossa – most evidence of benefit
* Supratentorial – no clear benefit unless declining; primarily reduces mortality
* New microsurgeries hold some promise – ongoing clinical trials

Determine underlying cause

27
Q

Mian Ros for SAH

A

aneurysm, smoking, hypertension, female, methamphetamines, cocaine

28
Q

SAH Px

A
  • Thunderclap Headache
  • Photophobia, neck stiffness, confusion, focal neurology, seizures
29
Q

Ix for SAH

A
  • Head CT ideally with CTA (rarely conventional angiogram now) – 98.7% sensitive <6 hrs
  • Lumbar puncture for xanthrochromia (develops 12 hours post HA) (+ RBCs in the 100s to 1000s in 3% of people with normal CT)
  • MRI with SWI
  • maybe better than LP even really
30
Q

SAH treatment

A
  • ABC
  • Lower BP (SBP <140) to prevent rebleeding
  • Clip/coil aneurysm to fix the underlying problem
  • Oral Nimodipne to prevent vasospasm
31
Q

Occlusion areas amenable to ECR

A
32
Q

CI to thrombolysis (Bleeding risk)

A

*Known history of ICH
*Prior stroke or serious head injury within 3months

*Sustained Blood Pressure >185/110

*Dabigatran within 48 hrs/high TT/unable to give idarucizumab
*Heparin within the last 48hrs with elevated PTT
*PT >15seconds
*Platelet count <100,000 uL

*Major surgery within past 14days
*Gastrointestinal or urinary tract hemorrhage within 21d
*Arterial puncture at noncompressible site <7days

33
Q

Strongest modifiable RF for stroke?

A

HTN

34
Q

Anti-paltelets after stroke

A

DAPT for 21 days then SAPT

35
Q

Stein with best evidence for stroke prevention?

A

atorvastatin

36
Q

PSK9i in stroke prevention

A

Evolocumab good

37
Q

Dose reduction criteria dabigatran

A

Use reduced dose of 110mg dose if
* >80 years of age
* CrCl 30-50 mL/min and HAS-BLED score is щ3,
* between 75-80 years of age with a low CHA2 DS2 -VAS c score and HAS-BLED щ2,

If CrCl <30ml/min DO NOT USE

38
Q

Dabigatran reversal

A

Idarucizumab (praxbind)

39
Q

CEA indication post stroke

A

CEA if symptomatic (<3/12) and
* Ipsilateral 70-99% stenosis
* Ipsilateral 50-69% stenosis in highly selected cases and low surgical risk (<3%)

40
Q

PFO closure indications

A

Cryptogenic stroke/ TIA

PFO on bubble study

in 6-9 months

Preferably young (<60)

41
Q

Left atrial appendage occlusion

A
  • May be considered in high stroke risk with genuine contraindication to anticoagulants

Dunedin RACP Study Course (31 decks)

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