Stroke Flashcards
another name for stroke?
cerebrovascular accident
what is a stroke?
Acute onset of focal neurological symptoms/signs lasting >24 hours due to an interruption of blood supply
what are the 2 main types of stroke- which is more common?
Ischaemic (85%)= Occur when blood supply in a cerebreal vascular territory is reduced secondary to stenosis or complete occlusion of a cerebral artery
Haemorrhagic (15%)= when there is a rupture of the cerebrospinal artery
what are the 3 most common types of iscahemic stroke?
-Large vessel atherosclerosis 50% (e.g. atherosclerotic plaques)
-Lacunar 25% (deep intracranial small vessel atherosclerosis)
-Cardioembolic 20% (e.g. in atrial fibrillation there is stasis of blood flow in the left atrium, predisposing to thrombus formation in the left atrium, and subsequent embolisation to the brain)
what are the subtypes of haemorrhagic stroke?
-Primary/intracerebral (can be caused by hypertension, aneurysms)
-SAH causing bleeding on surface of brain
strong risk factors for stroke?
-hypertension (biggest risk factor)
-increase in age
-FH of stroke
-smoking
-diabetes mellitus
-afib
what scoring is used to assess risk of having a stroke after a TIA and help decide if you want to admit patient?
(risk assessment score)
ABCD2 score
higher score= higher risk of stroke
what is the scoring system used for recognising stroke in community?
FAST score
Face
Arms
Speech
Time
What artery is involved in TACS (total anterior circulation)
Involves middle cerebral artery and anterior cerebral artery
TACS presentation?
Unilateral motor loss involving at least two of face, arms and leg and/or sensory loss
AND
Higher cerebral dysfunction (e.g. dysphagia, neglect)
AND
Homonymous hemianopia
what artery is involved in PACS?
Partial occlusion of the anterior circulation
-either ACA or MCA (more sites say MCA but some say either)
PACS presentation?
2 out of 3 of TACS presntation:
Unilateral motor loss in at least 2 of arm, face and leg and/or sensory loss
AND/OR
Homonymous hemianopia
AND/OR
Higher cerebral dysfunction
what artery is affected in lacunar syndrome/ LACS
small deep penetrating artery that supplies the subcortical parts of the brain (basal ganglia, internal capsule, thalamus and pons)
-supplies brainstem and white matter
presentation of LACS/ lacunar syndrome?
There should be NO higher cerebral dysfunction
Should be one of:
-pure sensory stroke
-pure motor stroke
-sensorimotor stroke
-clumsy hand dysarthria (slight weakness and clumsiness of hand with slurred speech)
-ataxic hemiparesis (poor muscle control/ weakness)
Vasculature involved in POCS- posterior circulation syndrome?
Involves PCA, basilar, vertebral and cerebellar arteries
presentation POCS?
Defined by one of the following:
-Cranial nerve palsy and a contralateral motor/sensory deficit
-Bilateral motor/sensory deficit
-Conjugate eye movement disorder (e.g. horizontal gaze palsy)
-Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
-Isolated homonymous hemianopia
what scoring system is used to recognise a stroke in the emergency room?
ROSIER SCORE
score>0 means likely stroke
what is the first investigation that should be done if suspected stroke and why?
CT- to distinguish between ischaemic and haemorrhagic
how will ischaemic stroke and haemorrhagic stroke present differently on CT?
haemorrhagic- blood looks white
iscahemic- ischaemia looks dark
how may an ischaemic stroke present on a diffuse weighted MRI
it may appear very white and bright
presentation of cortical events in dominant hemisphere and how do you know if a patients dominant hemisphere is left/right?
Right handed= right hemisphere is dominant
Left handed= left hemisphere is dominant
Dominant hemisphere cortical events often affect language
presentation of cortical events in non dominant hemisphere and how do you know if a patients non dominant hemisphere is left/right?
Right handed= right hemisphere is dominant
Left handed= left hemisphere is dominant
Non-dominant hemisphere cortical events affect spatial awareness
what type of vessel occlusions benefit most from mechanical thrombectomy?
proximal MCA
internal carotid
patient is unable to swallow but needs treatment for ischaemic stroke- how is aspirin given?
PR
what is given for long term management after intial treatment of stroke?
clopidogrel
atorvastatin
A 68 year old lady presents with right sided arm weakness, right sided facial droop and slurring of speech. On examination of her visual fields, she is found to have a right sided inferior homonymous quadrantanopia.
Which structure is likely to be have been damaged to produce these signs?
Left parietal lobe
PITS
parietal= inferior
temporal= superior
occlusion of which artery is associated with ‘locked in syndrome’
locked in syndrome= paralysis of all voluntary muscles except for the ones that control the movements of the eyes
Basilar artery
locked in the basement!
