Stroke Flashcards
What is the primary causes of ICH stroke? [1]
What are secondary causes? [3]
Primary:
* Hypertension (microaneurysm)
Secondary:
* Trauma
* Tumour
* AV malformation
* Venous thrombosis
* Coagulopathy
* Drugs (cocaine)
Pathophysiology of ICH
What are potential complications of ICH? [3]
herniations (if bleed big enough)
* subfalcine hernia;
* transtentorial hernia (ascending or descending)
* tonsillar hernia
Raise ICP - reduces brain perfusion
Hydrocephalus: blood into ventricles can clog up CSF drainage pathways / cerebral aquaduct is block
Pathophysiology of ICH
What are potential complications of ICH? [3]
herniations (if bleed big enough)
* subfalcine hernia;
* transtentorial hernia (ascending or descending)
* tonsillar hernia
Raise ICP - reduces brain perfusion
Hydrocephalus: blood into ventricles can clog up CSF drainage pathways / cerebral aquaduct is block
Management of ICH
What would need to check what medicaton a patient is on and why? [2]
Confirm if on aspirin and warfarin & stop.
Warfarin worsens the severity of hemorrhage and dramatically increases the risk of mortality from ICH.
Management of ICH
What should you do if ICH patient has raised BP? [1]
Why is this a tricky problem to manage? [2]
Lower BP (if more than 150 mmHG systolic ) to about 140 mm HG
Higher chance of AKI
Patients might have **secondary raised ICH **- then reducing cerebral blood flow if lowering BP
(conflicting evidence on cost / benefit)
Ischaemic stroke
Which artery is affected in this ischaemic stroke [1]
MCA
Ischaemic stroke pathophysiolgoy
Describe the ischaemic stroke cascade at microscopic level [4]
Cellular ischaemia:
- Na / K+ pump failure
- Causes depolarisation
- Causes Ca2+ food in
- Cascade of enzymes that respond to ischaemia (like caspases)
- Causes cell death
Ischaemic stroke pathophysiolgoy
Describe the core - penumbra effect of ischaemic stroke
Non-end artery is very likely to have collateral flow to perfuse the core area that is suffering from stroke.
Causes reduced impact / salvigable if treatment rapid
Label A
Penumbra
Define ischaemic penumbra
Ischemic penumbra denotes the part of an acute ischemic stroke that is at risk of progressing to infarction but is still salvageable if reperfused.
It is usually located around an infarct core which represents the tissue which has already infarcted or is going to infarct regardless of reperfusion.
Ischaemic stroke
Which pathologies cause ischaemic stroke?
- Atherosclerosis of small vessels (25%)
- Atherosclerosis of large vessels (50%) carotid stenosis is 10% of all stroke
- Carotid dissections (<5%)
- Cardiac / AF (15%)
- Vasculitis (<1%)
Which cause of ischaemic stroke increases in younger patients? [1]
Carotid dissections
Risk factors for stroke?
What are the key medical conditions that increase risk of stroke? [4]
Hypertension
Hypercholesteroamia
Diabetes
Cardiac - AF
Whats important to think about age & stroke?
Increases with age but also 1/10 happens in people under 50
How does increasing BP increase risk of stroke? [1]
Absolute risk of stroke doubles with every 10 mmHG of systolic rise in BP
State what each arrow is pointing to [5]
TIA treatment?
