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Neurology > Stroke > Flashcards

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?

A

Alteplase

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 initial management of a haemorrhagic stroke?

A

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

23
Q

What tools can be used to assess stroke?

A

FAST
ROSIER
ABCD2

24
Q

What is a TIA?

A

A sudden onset of a focal neurological deficit (of vascular origin) that resolves in 24 hours

25
Q

What are crescendo TIAs?

A

More than 1 TIA in 7 days
TIAs that are increasing in frequency and severity

26
Q

What is the definition of a stroke?

A

Sudden onset of a focal neurological deficit of vascular cause, with symptoms lasting more than 24 hours.

27
Q

What are the contraindications to thrombolysis?

A

BP > 180/110
Recent head trauma
GI or intracranial haemorrhage
Recent surgery - 2 weeks
Platelet count
INR > 1.7

28
Q

What are the symptoms of a basilar artery stroke?

A

Locked in syndrome
- Complete loss of movement with preserved consciousness and ocular movements

29
Q

What are the symptoms of an anterior spinal artery stroke?

A

Loss of pain, temperature and motor function below the level of infarction

30
Q

What is the management of a TIA?

A

300mg initial dose of aspirin
75mg aspirin daily for 3 weeks
Clopidogrel long term
Statins
Arrange urgent carotid doppler

31
Q

What are the symptoms of a basilar artery stroke?

A

Locked in syndrome
- Where the muscles of the body and face are paralysed but consciousness and eye movements are preserved

32
Q

What is the second line treatment of TIA if dual antiplatelet therapy is not suitable?

A

Clopidogrel 300mg loading dose, followed by 75mg clopidogrel OD

Consider giving alongside PPI

Neurology (35 decks)

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