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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the criteria for an anterior circulation stroke (Oxford Stroke Classification)?

A

Unilateral Hemiparesis +/- Hemisensory loss of face, arm or leg
Homonymous Hemianopia
Higher Cerebellar function (eg. Dysphagia)

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2
Q

Criteria for a lacunar stoke

A

isolated hemiparesis (Unilateral weakness of the face and arm, arm and leg or all three),
hemisensory loss (pure sensory loss)
OR
hemiparesis with limb ataxia

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3
Q

Criteria for a posterior circulation infarct

A

One of the following symptoms:

Isolated Homonymous hemianopia
Cerebellar and brainstem syndromes
Loss of consciousness

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4
Q

What is the gold standard investigation for stroke?

A

Non-contrast head CT

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5
Q

treatment for ischaemia stroke

A

Thrombolysis

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6
Q

Contraindications for thrombolysis

A

> 4.5 hours since symptoms onset
previous intracranial haemorrhage, uncontrolled hypertension, pregnancy

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7
Q

If thrombolysis contraindicated, what is the next treatment option for ischaemia stroke?

A

300mg/day Aspirin

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8
Q

Signs of raised intracranial pressure

A

Papilloedema
Cushing reflex
Mydriasis (dilated pupil)
Headache

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9
Q

Most common cause of a subarachnoid haemorrhage

A

Saccular (Berry) aneurysms and Arteriovenous malformations

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10
Q

Presentation of a subarachnoid haemorrhage

A

Sudden, very severe “thunderclap” headache, often occipital
Neck stiffness and a positive Kernig’s sign
Vomiting
Coma and death

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11
Q

Gold standard investigations of a subarachnoid haemorrhage

A

Within 6 hours ; non contract head CT
> 6 hours since symptom onset : Lumbar puncture (wait 12 hours to see xanthochromia (yellow in CSF))
Should see normal or raised opening pressure

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12
Q

Treatment of a subarachnoid haemorrhage

A

Support (oxygen, analgesia, fluids)
Oral Nimodipine (reduce vasospasm)
Definitive: coils by interventional radiologist

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13
Q

What is an epidural haematoma?

A

A bleed between the dura mater and the skull

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14
Q

Aetiology of an epidural haematoma

A

Usually low impact traumas to the head that rupture the middle meningeal artery underneath the pterion

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15
Q

clinical presentation of an epidural haematoma

A

LOC followed by a lucid interval and then LOC again
Lemon shaped/ Leniform haematoma (restricted by suture lines of the skull)
Headache
Possible hemiparesis
Unilateral fixed and dilated pupil
Babinski +
Cushing triad (bradycardia, hypertension and deep/irregular breathing)

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16
Q

Treatment for epidural haematoma

A

ABCDE
Stop anticoagulants (warfarin)
Treat underlying Coagulopathy conditions
Temporary anticonvulsants (eg. Phenytoin, levetriacetam)
ICP reducing agents (Mannitol, barbiturates)

17
Q

What is a subdural haematoma?

A

Bleeding between the dura and arachnoid mater

18
Q

Aetiology of a subdural haematoma

A

Head injury (high impact, RTA, falls, sudden changes in speed)
Alcohol abuse
> 65 years old
Blood thinning medications (warfarin)
Violence (shaken baby syndrome)

19
Q

Clinical presentation of a subdural haematoma

A

visual defects
facial weakness, limb weakness or sensory disturbance
Ataxia
seizures
Reduced level of consciousness

20
Q

Head CT finding for subdural haematoma (acute and chronic)

A

crescent haematoma

Acute: Hyperdense appearance (bright white)
Chronic: hypo dense appearance (black/grey)

21
Q

Anterior Cerebral Artery lesion features

A

Contralateral hemiparesis and sensory loss, lower extremity > upper extremities

22
Q

Middle Cerebral Artery lesion features

A

Contralateral hemiparesis and sensory loss, upper extremity > lower

Contralateral homonymous hemianopia

Aphasia

23
Q

Posterior cerebral artery lesion features

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

24
Q

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

A

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

25
Q

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

A

Ipsilateral: facial pain and temperature loss

Contralateral: limb/torso pain and temperature loss

Ataxia, nystagmus

26
Q

Anterior inferior cerebellar artery (lateral pontine syndrome)

A

Symptoms are similar to Wallenberg’s, but:
Ipsilateral: facial paralysis and deafness

27
Q

Retinal/ophthalmic artery

A

Amaurosis fugax

28
Q

Basilar artery

A

‘Locked-in’ syndrome

Neurology (11 decks)

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