Stroke Flashcards
What are the risk factors for stroke?
Hypertension
Diabetes
Hyperlipidaemia
CVS disease
Atrial fibrillation
Smoking
Vasculitis
Thrombophilia
The pill
Carotid artery disease
What causes a haemmorhagic stroke?
Hypertension mainly (60-70%)
Amyloid (20%)
Excess alcohol
Hypercholesteralaemia
Haemorrhagic transformation
What happens to the brain in ischaemic stroke?
Hypoxia leads to anoxia leads to infarction leads to necrosis.
Oedema and secondary haemmorhage can cause more damage.
What does the carotid vascular system supply?
Most of the hemispheres and cortical deep white matter.
What does the vertebro-basilar system supply?
brain stem, cerebellum, occipital lobes
Symptoms of stroke?
Motor (clumsy or weak limb)
Sensory (loss of feeling)
Speech: Dysarthria/Dysphasia
Neglect / visuospatial problems
Vision: loss in one eye, or hemianopia
Gaze palsy
Ataxia/ vertigo / incoordination / nystagmus
What are the symptoms of ACA occlusion?
Paralysis of contra-lateral foot and leg.
Sensory loss of contra-lateral toes, foot and leg.
Impairment of gait and stance.
What are the symptoms of MCA occlusion?
Contra-lateral sensory impairment and paralysis of face, arms and leg.
Contra-lateral hemianopia.
Gaze paralysis
Aphasia if on dominant (left) side.
Neglect for half of external space if non-dom stroke.
Symptoms of lacunar stroke?
4 types
1. Pure motor
2. pure sensory
3. Dysarthria - clumsy hands
4. Ataxic hemiparesis
What are the symptoms of a posterior circulation stroke?
Brainstem dysfunction:
Coma, drop atacks, vertigo, nausea, vomiting, cranial nerve palsies, ataxia.
Hemiparesis
Visual field deficits
Crossed sensori-motor deficits
What should acute stroke therapies be/do?
- Restore blood supply
- Prevent extension of ischaemic damage
- Protect vulnerable brain tissue
- Avoid reperfusion injury
- Be non-toxic
How should acute strokes be treated?
If no haemmorhage use alteplase (thrombolysis). Efficacy of thrombolysis is highly time-sensitive. (Generally use within 5 hours)
Thrombectomy
How should stroke be diagnoses?
Initial brain CT (then monitoring with CT for post thrombolysis complications)
MRI later (bit slow initially, fast field cycling may be used more in future)
Outline secondary prevention in strokes?
Clopidogrel 75mg daily
Atorvastatin 80mg (not immediately)
Carotid endarterectomy or stenting if carotid artery disease
Treat hypertension and diabetes
What are the three categories on the Glasgow Coma Scale (GCS)?
Best score 15
Comatosed less than or equal to 8
Unresponsive 3
