Stroke Flashcards

1
Q

On what side does ischaemia to the cerebellum cause symptoms?

A

Ipsilateral side

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2
Q

Where does the PICA supply?

A

Inferior cerebellum

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3
Q

What is the gold standard investigation for stroke?

A

Diffusion weighted MRI

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4
Q

What features are caused by an anterior inferior cerebellar artery infarct?

A

Ipsilateral deafness and facial paralysis
Sudden onset of vertigo and vomiting

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5
Q

What features are caused by a posterior inferior cerebellar artery infarct?

A

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

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6
Q

What are the risk factors for haemorrhagic stroke?

A

Anticoagulation therapy
Age
Hypertension
Arteriovenous malformation
Drugs that mimic sympathetic nervous system

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7
Q

What are the risk factors for ischaemic stroke?

A

Age
Hypertension
Smoking
Hyperlipidaemia
Diabetes
Atrial fibrillation
HRT
Oral contraceptive

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8
Q

What symptoms are seen in a total anterior circulation infarct?

A

Unilateral hemiparesis, or unilateral hemisensory loss of upper or lower limb
Homonymous hemianopia
Higher cognitive dysfunction e.g dyphasia

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9
Q

Which limbs are more typically affected in anterior circulation infarcts?

A

Lower limbs

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10
Q

Which limbs are more typically affected in middle cerebral artery infarcts?

A

Upper limbs

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11
Q

What kind of symptoms would be seen with an ophthalmic artery stroke?

A

Amaurosis fugax

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12
Q

What is the first line investigation for a suspected stroke?

A

Non-contrast CT head

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13
Q

What is the difference between stroke and Bell’s palsy?

A

Strokes are forehead sparing, whereas Bell’s palsy involves the forehead

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14
Q

What is the Bamford classification?

A

A system of classifying and diagnosing ischaemic stroke

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15
Q

What is the Bamford classification of a total anterior circulation infarct?

A

All three symptoms:
- Homonymous hemianopia
- Unilateral weakness or sensory deficit of the face, arm and leg
- Higher cerebral dysfunction

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16
Q

What is the Bamford classification of a partial anterior circulation infarct?

A

Two out of three symptoms:
- Homonymous hemianopia
- Unilateral weakness or sensory deficit of the face, arm and leg
- Higher cerebral dysfunction

17
Q

What is the Bamford classification of a posterior circulation stroke?

A

One of the following symptoms?
- Cranial nerve palsy and contralateral motor/sensory deficit
- Cerebellar dysfunction
- Bilateral sensory or motor deficit
- Conjugate eye movement disorder
- Isolated homonymous hemianopia

18
Q

What is the Bamford classification of a lacunar stroke?

A

One of the following symptoms:
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis

19
Q

What is the initial management of an ischaemic stroke?

A

300mg aspirin
Thrombolysis if presented within 4.5 hours
Thrombectomy if between 4.5-6 hours

20
Q

What drug is used in thrombolysis?

21
Q

What secondary prevention will be given after an ischaemic stroke?

A

Clopidogrel 75mg daily
Statin
Anti hypertensives
Carotid endarterectomy

22
Q

What is the second line secondary prevention of ischaemic stroke, if clopidogrel is unsuitable?

A

Aspirin plus modified release dipyridamole

23
Q

What is the initial management of a haemorrhagic stroke?

A

Aim for BP 140/90
Stop anticoagulants and antithrombotics
Reverse any anticoagulation
Refer to neurosurgery

24
Q

What tools can be used to assess stroke?

A

FAST
ROSIER
ABCD2

25
What is a TIA?
A sudden onset of a focal neurological deficit (of vascular origin) that resolves in 24 hours
26
What are crescendo TIAs?
More than 1 TIA in 7 days TIAs that are increasing in frequency and severity
27
What is the definition of a stroke?
Sudden onset of a focal neurological deficit of vascular cause, with symptoms lasting more than 24 hours.
28
What are the contraindications to thrombolysis?
BP > 180/110 Recent head trauma GI or intracranial haemorrhage Recent surgery - 2 weeks Platelet count INR > 1.7
29
What are the symptoms of a basilar artery stroke?
Locked in syndrome - Complete loss of movement with preserved consciousness and ocular movements
30
What are the symptoms of an anterior spinal artery stroke?
Loss of pain, temperature and motor function below the level of infarction
31
What is the management of a TIA?
300mg initial dose of aspirin 75mg aspirin daily for 3 weeks Clopidogrel long term Statins Arrange urgent carotid doppler
32
What are the symptoms of a basilar artery stroke?
Locked in syndrome - Where the muscles of the body and face are paralysed but consciousness and eye movements are preserved
33
What is the second line treatment of TIA if dual antiplatelet therapy is not suitable?
Clopidogrel 300mg loading dose, followed by 75mg clopidogrel OD Consider giving alongside PPI