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Neuropsychiatric Disorders > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

Acute neurological dysfunction of a vascular cause

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2
Q

What are the main risk factors for stroke?

A

▪️ Hypertension
▪️ Diabetes
▪️ Alcohol
▪️ Cardiac disease
▪️ TIA
▪️ Older age
▪️ Male
▪️ Smoking
▪️ Obesity
▪️ Hyperlipidaemia
▪️ Physical inactivity

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3
Q

How can atherosclerosis lead to ischaemic stroke?

A

▪️ Narrowing and hardening of blood vessels with plaque build up
▪️ Substances in plaque attract platelets
▪️ This builds until a blood clot is formed which blocks the vessel

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4
Q

What are the current major issues surrounding stroke in the UK?

A

▪️ One every 5 minutes
▪️ Large proportion have depression or disability
▪️ Increased likelihood of unemployment
▪️ Only 8 out of 10 people eligible receive thrombolysis
▪️ Lack of psychologist access

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5
Q

How does stroke incidence change as we age?

A

It increases

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6
Q

What are the two main types of stroke?

A

▪️ Ischaemic
▪️ Haemorrhagic

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7
Q

What is FAST?

A

▪️ Face, Arm, Speech, Time to call 999
▪️ Rapid ambulance protocol to triage patients for thrombolysis
▪️ ~82% sensitivity and specificity

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8
Q

What speech problems may be apparent in someone who is having a stroke?

A

▪️ Dysphasia (expressive/receptive/conductive)
▪️ Dysarthria (muscle weakness)
▪️ Dyspraxia of speech (difficulty coordinating movements for speech)
▪️ Cognitive communication disorder

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9
Q

What are the main categories of stroke mimics?

A

▪️ Systemic problems with CNS effects (e.g., hypoglycaemia, delirium, ‘decompensation’)
▪️ Primary CNS problems (e.g., focal epilepsy, MS, functional presentations)
▪️ ENT (e.g., labyrinthine disturbances with nausea and vertigo)

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10
Q

How can you typically differentiate stroke from partial (focal) epilepsy?

A

The former usually causes negative phenomena (e.g., weakness) whilst the latter often produces positive phenomena (e.g., clonus)

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11
Q

What can be used to treat acute ischaemic stroke or pulmonary embolism?

A

IV alteplase as soon as possible, ideally within 3-4.5 hours of symptoms (thrombectomy)

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12
Q

What is tissue Plasminogen activator (tPa)?

A

An enzyme involved in breaking down blood clots so can be used for intravenous thrombolysis

Alteplase = biosynthetic form

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13
Q

What is tPa use in stroke associated wiht?

A

▪️ Better outcome
▪️ 12% increase in minimal/no disability
▪️ Benefit in all subgroups

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14
Q

Damage to what brain area may present with Broca’s aphasia?

A

Motor speech area in frontal lobe of dominant hemisphere (left), particularly inferior frontal gyrus

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15
Q

Damage to what brain area may present with Wernicke’s aphasia?

A

The superior temporal lobe, typically also of the dominant hemisphere

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16
Q

What is a phonemic paraphasia?

A

Sound substitution or rearrangement but still resembles intended word (e.g., “bap” for “map”)

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17
Q

What is semantic paraphasia?

A

Entire word is substituted for one of similar meaning (e.g., “knife” for “fork”)

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18
Q

What are the characteristic symptoms of Gerstmann syndrome?

A

▪️ Finger agnosia
▪️ Dyscalculia
▪️ Dysgraphia
▪️ R-L disorientation

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19
Q

How can you test for language deficits following stroke?

A

▪️ Understanding (e.g., multiple stage commands)
▪️ Expression (just listen)
▪️ Naming
▪️ Repetition
▪️ Reading
▪️ Writing
▪️ Talk about a scene - can also see emotive features and safety awareness

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20
Q

What is the most common visual problem following stroke?

A

Homonymous hemianopia (visual field loss in same half of both eyes)

21
Q

Damage to which area may result in Gerstmann syndrome?

A

Inferior parietal lobe of the dominant hemisphere, specifically around the angular gyrus

22
Q

What is visual neglect?

A

Disorder of attention whereby the individual shows a lack of response to one half of their visual field, unexplained by primary damage to the visual system

23
Q

How can neglect be subdivided/described?

A

▪️ Affected space (peripersonal, personal, extrapersonal)
▪️ Mode of output (sensory or motor)
▪️ Sensory modality (visual, somatosensory, auditory)

24
Q

When does partial or complete recovery from neglect after stroke typically occur?

A

In the first month

25
Q

What is the presence of neglect following stroke associated with?

A

▪️ Delayed recovery (if unilateral)
▪️ Problems with ADLs
▪️ Greater risk of falls
▪️ Longer stays in rehabilitation
▪️ Need for more assistance at discharge

26
Q

What is the presence of delirium following stroke associated with?

A

▪️ Worse effects of stroke
▪️ Greater mortality, both inpatient and at 12-months
▪️ Greater functional impairment
▪️ Increased risk of dementia
▪️ More likely to be discharged to a nursing home/institution

27
Q

How can we reduce the risk of delirium post-stroke?

A

▪️ Treat primary mechanism (e.g., inflammation)
▪️ Better sleep
▪️ Improve environment
▪️ Recovery at home

28
Q

How might a brain stem stroke (basilar artery) present?

A

▪️ Severe impact
▪️ Locked in syndrome
▪️ Major sensory and motor deficits
▪️ Little cognitive dysfunction

29
Q

How does arterial fibrillation increase the risk of stroke?

A

Increases risk of blood clot formation

30
Q

What brain area is involved in neglect?

A

The parietal lobe, contralateral to the side of extinction

31
Q

What is Anton’s syndrome?

A

Denial of visual loss due to cortical blindness, typically due to bilateral lesions of the primary visual cortex

32
Q

What are the four clinical classifications of stroke according to the Oxfordshire Community Stroke Project (OCSP) classification?

A

▪️ TACS - total anterior circulation stroke
▪️ PACS - partial anterior circulation stroke
▪️ LACS - lacunar syndromes
▪️ POCS - posterior circulation strokes

33
Q

What are the benefits of the OCSP?

A

▪️ Clinically based
▪️ Helps with aetiology
▪️ Predicts volume of brain involved
▪️ ‘Predicts’ recovery

BUT not validated in hyperacute situation

34
Q

What are the main subtypes of the TOAST classification of stroke?

A
  1. Large artery atherosclerosis
  2. Cardioembolism
  3. Small artery disease
  4. Other determined aetiologies
  5. Undetermined aetiology
35
Q

What is small vessel disease?

A

A condition that causes the narrowing of the small blood vessels and damage of their walls

36
Q

What are the main risk factors for small vessel disease?

A

▪️ Hyaline arteriosclerosis (accumulation of various serum proteins, thickening the walls)
▪️ Hypertension, diabetes, smoking

37
Q

What are the proposed causes of small vessel disease?

A

▪️ Incorporation of plasma proteins into the vessel wall causes breakdown of the BBB
▪️ Collagen replaces smooth muscle cells and reduces distensibility of the vessels (less elastic, increased risk of damage)

38
Q

Which structures in the CNS are most commonly affected by SVD?

A

▪️ Lenticulostriate perforating branches
▪️ Basilar and posterior artery perforators
▪️ Periventricular white matter

39
Q

What are lacunar infarcts?

A

Small infarcts caused by occlusion of a singular penetrating branch of a large cerebral artery

40
Q

What neurological clinical consequences may be seen with SVD?

A

▪️ Lacunar strokes
▪️ Cognitive change/dysfunction

41
Q

What are the main types of lacunar infarct?

A

▪️ Pure motor
▪️ Pure sensory
▪️ Motorsensory
▪️ Ataxic hemiparesis
▪️ Clumsy hand-dysarthria syndrome

42
Q

What techniques can be used for blood vessel imaging in the brain?

A

▪️ Carotid dopplers
▪️ CT angiogram
▪️ MR angiogram
▪️ Formal angiogram - digital subtraction angiography

(Perfusion computed tomography - PCT)

43
Q

How might a stroke to the posterior circuit present?

A

▪️ Constellation of brainstem symptoms
▪️ Altered consciousness
▪️ Nausea/vomiting
▪️ Crossed signs

44
Q

What intervention might you consider for a middle cerebral artery stroke?

A

Decompressive hemicraniectomy

45
Q

What is a carotid artery dissection and how does it typically present?

A

▪️ Tear or separation of layers of the carotid
▪️ Can be non-traumatic or with mild trauma
▪️ Relatively common cause of stroke in younger patients
▪️ May be associated with sequelae such as stroke, TIA, or subarachnoid haemorrhage

46
Q

What percentage of strokes are accounted for by intracerebral haemorrhage?

A

~15%

47
Q

What risk factors are associated with spontaneous intracranial haemorrhage (sICH)?

A

▪️ Systemic arterial hypertension
▪️ Alcohol abuse
▪️ Male
▪️ Increasing age
▪️ Smoking

48
Q

What secondary vascular changes may be seen with ICH?

A

▪️ Small vessel disease
▪️ Arterial aneurysms
▪️ Arteriovenous malformation

Neuropsychiatric Disorders (30 decks)

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