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Nervous System > Stroke > Flashcards

Stroke Flashcards

1
Q

What is ICP?

A

A measurement of the pressure of brain tissue and the cerebrospinal fluid that surrounds the brain and spinal cord

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2
Q

What is Monro-Kellie hypothesis?

A

Intracranial volume is fixed due to non-compliant skull
Change in volume of non- compressible contents or addition of a space occupying lesion (SPOL) increases pressure

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3
Q

What is the pathology of raised ICP?

A

Reduced blood flow -> ischaemia
Reduced energy production
Pump failure on cell membrane
Cellular dysfunction
Interstitial microenvironment changes (toxic metabolites)
Membrane damage and cell death

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4
Q

What is MAP?

A

Mean arterial pressure
Difference between systolic and diastolic

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5
Q

What is CPP?

A

Central perfusion pressure
Difference between MAP and ICP

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6
Q

What is CVR?

A

Cerebro Vascular Resistance
Resistance offered by cerebral vasculature to flowing blood

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7
Q

What is autoregulation?

A

Ability of brain to maintain constant blood flow over wide range of pressures

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8
Q

What does cerebral blood flow depend on?

A

MAP
ICP
Vascular resistance
Autoregulation

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9
Q

What is stroke?

A

Sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting more than 24 hours

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10
Q

What % of strokes are ischaemic?

A

85%

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11
Q

What % of strokes are haemorrhagic?

A

15%

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12
Q

What are the causes of an ischaemic stroke?

A
  • Large artery atherosclerosis
  • Cardioembolic
  • Small artery occlusion
  • Undetermined/Cryptogenic
  • Rare causes
    • Arterial dissection
    • Venous sinus thrombosis
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13
Q

What are the causes of a haemorrhagic stroke?

A
  • Primary intracerebral haemorrhage
  • Secondary haemorrhage
    • Subarachnoid haemorrhage
    • Arteriovenous malformation
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14
Q

What are some modifiable risk factors for stroke?

A

Hypertension
Smoking
Drugs
Diet
Exercise
Diabetes
Alcohol
Obesity
High lipid intake
Atrial fibrillation

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15
Q

What are some non-modifiable risk factors for stroke?

A

Previous stroke
Age
Male
FH
Hypercoagulable states- malignancy, genetics

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16
Q

What are the frontal lobe functions?

A
  • High level cognitive functions
  • Memory
  • Voluntary eye movement
  • Motor control of speech- Broca’s area
  • Motor cortex
  • Urinary continence
  • Emotion and personality
17
Q

What are the parietal lobe functions?

A
  • Sensory cortex
  • Sensation
  • Awareness
  • Spatial orientation and visuospatial information- non dominant right hemisphere
  • Performing learned motor tasks- dominant left hemisphere
18
Q

What are the temporal lobe functions?

A
  • Primary auditory
  • Comprehension of speech- Wernicke’s
  • Visual, auditory and olfactory perception
  • Learning, memory and emotional affect
19
Q

What are the occipital lobe functions?

A
  • Primary visual cortex
  • Visual perception
  • Involuntary smooth eye movement
20
Q

What are the cerebellar functions?

A

Maintaining balance
Coordinating movement
Motor learning

21
Q

What are the signs of cerebellar damage?

A

Vertigo
Ataxia
Nystagmus
Intentional tremor
Slurred speech
Hypotonia
Exaggerated broad based gait
Dysdiadochokinesia

VANISHED

22
Q

What does blockage of the anterior cerebral artery cause?

A

Leg> arm weakness

23
Q

What does blockage of middle cerebral artery cause?

A

Face and arm> leg weakness

24
Q

What is the clinical presentation of stroke?

A

Motor- clumsy/weak limb
Sensory- loss of feelings
Speech- dysarthria/dysphasia
Neglect/visuospatial problems
Vision- loss in one eye, hemianopia
Gaze palsy
Ataxia/vertigo/incoordination/nystagmus

25
Q

What are the subtypes of stroke?

A

Total Anterior Circulation Stroke (TACS)
Partial Anterior Circulation Stroke (PACS)
Lacunar Stroke (LACS)
Posterior Circulation Stroke (POCS)

26
Q

What is the criteria for TACS?

A

Hemianopia
Complete hemiparesis/numbness
Neglect (RHS) or Dysphasia (LHS)

27
Q

What is the criteria for PACS?

A

2 of the 3 TACS criteria

28
Q

What is the criteria for LACS?

A

Weakness
Numbness

No damage to cortex- no dysphasia, neglect or hemianopia

29
Q

What is the criteria for POCS?

A

Weakness
Numbness
Hemianopia/Dysphasia (LHS)/Neglect (RHS)
Brainstem + cerebellar signs

30
Q

What is basilar artery occlusion stroke?

A

Affects brainstem
Ischaemia in pons
One of the worst strokes

31
Q

What are stroke mimics?

A
  • Seizures
  • Syncope
  • Sugar
  • Sepsis
  • Severe migraine
  • Space occupying lesions
  • Psychological
  • Vestibular disorders
  • Demyelination
  • Transient global amnesia
  • Mononeuropathy
32
Q

What are negative symptoms suggesting stroke?

A

Loss or reduction of CNS neuron function
Loss of vision
Loss of sensation
Loss of limb power

33
Q

What investigations are done for stroke?

A

Bloods- FBC, glucose, lipids, ESR
CT/MRI- infarct vs haemorrhage
ECG + Holter
Carotid doppler ultrasounds

34
Q

What is acute treatment for stroke?

A
  • IV TPA (thrombolysis) <3 hours
  • IV TPA 3-4.5 hours
  • Stoke units
  • Aspirin <48 hours
  • Thrombectomy <6 hours
35
Q

What is the criteria for thrombolysis?

A

<4.5 hours from onset of symptoms
Disabling neurological deficits
Symptoms present >60 minutes
Consent obtained

36
Q

What is the exclusion criteria for thrombolysis?

A

Blood on CT
Recent surgery
Recent bleeding episodes
Coagulation problems
BP>185 systolic or >110 diastolic
Glucose<2.8mmol/L
Glucose>22mmol/L

37
Q

What is acute treatment for TIA?

A

Antiplatelets
Antihypertensives
Statins and endarterectomy

38
Q

What measures are there for primary prevention of stroke?

A

Control risk factors: HTN, DM, High lipid content, Cardiac disease, Smoking
Lifelong coagulation: AF and prosthetic heart valves

39
Q

What measures are there for secondary prevention of stroke?

A

Antihypertensives
Antiplatelets
Lipid lowering agents
Warfarin for AF
Carotid endarterectomy

Nervous System (18 decks)

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