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Year Two - Neurology System > Stroke > Flashcards

Stroke Flashcards

1
Q

What is another term for strokes?

A

Cerebrovascular Accidents

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2
Q

What are strokes?

A

They are defined as a condition in which there is an acute insult in the vascular supply of the brain

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3
Q

What are the two classifications of strokes?

A

Ischaemic Strokes

Haemorrhagic Strokes

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4
Q

What is the most common stroke classification?

A

Ischaemic Strokes

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5
Q

What are ischaemic strokes?

A

They occur when the blood supply to an area of brain tissue is reduced due to clot formation, resulting in tissue hypoperfusion

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6
Q

What are the two subclassifications of ischaemic strokes?

A

Thrombotic Stroke

Embolic Stroke

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7
Q

What is a thrombotic ischaemic stroke?

A

It is deifined as clot formation locally within a cerebral vessel within the brain

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8
Q

What is an embolic ischaemic stroke?

A

It is defined as clots mobilisation to the cerberal vessels, which originate in other regions of the body

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9
Q

What is the most common cause of embolic strokes?

A

Atrial Fibrillation

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10
Q

What are haemorrhagic strokes?

A

They occur when there is rupture of a blood vessel or abnormal vascular structure within the brain

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11
Q

What are the two subclassifications of haemorrhagic strokes?

A

Intracerebral Haemorrhage

Subarachnoid Haemorrhage

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12
Q

What are intracerebral haemorrhage strokes?

A

It is defined as bleeding within the brain secondary to a ruptured blood vessel

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13
Q

What are subarachnoid haemorrhage strokes?

A

It is defined as bleeding outside of the brain tissue, occurring between the pia mater and arachnoid mater

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14
Q

What are the thirteen risk factors associated with strokes?

A

Older Age

Stroke History

Hypertension

Atrial Fibrillation

Carotid Artery Disease

Arteriovenous Malformation

Hyperlipidaemia

Diabetes Mellitus

Vasculitis

Smoking

Alcoholism

Obesity

Drug Administration

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15
Q

What two drugs are associated with strokes?

A

Anticoagulant Therapy

Combined Oral Contraceptive Pill

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16
Q

What are the six clincial features of strokes?

A

Facial Motor Weakness

Limb Motor Weakness

Visual Field Defects

Dysphasia

Dysphagia

Ataxia

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17
Q

What are the four aphasia classifications?

A

Wernicke’s Aphasia

Broca’s Aphasia

Conduction Aphasia

Global Aphasia

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18
Q

What lesion results in Wernicke’s aphasia?

A

Superior temporal gyrus, which is supplied by the inferior division of the left middle cerebral artery

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19
Q

What is Wernicke’s aphasia?

A

‘What?’ as the patient doesn’t understand a command

It results in sentences that make no sense, word substitution and neologisms but speech remains fluent. The comprehension is impaired

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20
Q

What lesion results in Broca’s aphasia?

A

Inferior frontal lobe/gyrus, which is supplied by the superior division of the left middle cerebral artery

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21
Q

What is Broca’s aphasia?

A

Broca sounds like ‘broken’ as the patient’s word-flow is broken

It is when speech is non-fluent, laboured, and halting. The repitition is impaired. The comprehension is normal

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22
Q

What lesion occurs conduction aphasia ?

A

Arcuate fasiculus, which is the connection between Wernicke’s and Broca’s area

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23
Q

What is conduction aphasia?

A

It is when speech is fluent, however repetition is poor. They are aware of the errors they are making. The comprehension is normal

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24
Q

What lesion results in global aphasia?

A

It is defined as large lesion affecting the superior temporal gyrus, inferior temporal gyrus and arcuate fasiculus

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25
Q

What are the nine anatomical classifications of strokes?

A

Anterior Cerebral Artery Strokes

Middle Cerebral Artery Strokes

Posterior Cerebral Artery Strokes

Weber’s Syndrome

Anterior inferior Cerebellar Artery Strokes

Posterior inferior Cerebellar Artery Strokes

Ophthalmic Artery Strokes

Basilar Artery Strokes

Pontine Haemorrhages

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26
Q

What is global aphasia?

A

It is when individuals are only able to communicate through gestures

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27
Q

What are anterior cerebral artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the anterior cerebral artery

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28
Q

What are the two clinical features of anterior cerebral artery strokes?

A

Contralateral Hemiparesis

Contralateral Sensory Loss

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29
Q

Which extremities are affected in anterior cerebral artery strokes?

A

Lower Extremeties

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30
Q

What are middle cerebral artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the middle cerebral artery

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31
Q

What are the four clinical features of middle cerebral artery strokes?

A

Contralateral Hemiparesis

Contralateral Sensory Loss

Contralateral Homonymous Hemianopia

Aphasia

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32
Q

Which extremities are affected in middle cerebral artery strokes?

A

Upper Extremities

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33
Q

What are posterior cerebral artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the posterior cerebral artery

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34
Q

What are the two clinical features of posterior cerebral artery strokes?

A

Contralateral Homonymous Hemianopia & Macular Sparing

Visual Agnosia

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35
Q

What is another term for Weber’s syndrome?

A

Ventral midbrain syndrome

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36
Q

What is Weber’s syndrome?

A

It is defined as a cortical stroke affecting the areas of the midbrain supplied by the branches of the posterior cerebral artery

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37
Q

What are the two clinical features of Weber’s syndrome?

A

Ipsilateral CN III Palsy

Contralateral Upper/Lower Weakness

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38
Q

What are the three clinical features of CN III palsy?

A

Eyelid Ptosis

‘Down & Out’ Eye Restriction

Dilated, Fixed Pupil

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39
Q

What is another term for anterior inferior cerebellar artery strokes?

A

Lateral pontine syndrome

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40
Q

What are anterior inferior cerebellar artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the anterior inferior cerebellar artery

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41
Q

What are the six clinical features of anterior inferior cerebellar artery strokes?

A

Contralateral Limb Pain

Contralateral Temperature Loss

Ipsilateral Facial Paralysis

Ipsilateral Deafness

Ataxia

Nystagmus

42
Q

What are another two terms for posterior inferior cerebellar artery strokes?

A

Lateral medullary syndrome

Wallenberg syndrome

43
Q

What are posterior inferior cerebellar artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the posterior inferior cerebellar artery

44
Q

What are the six clinical features of posterior inferior cerebellar artery strokes?

A

Contralateral Limb Pain

Contralateral Temperature Loss

Ipsilateral Facial Pain

Ipsilateral Temperature Loss

Ataxia

Nystagmus

45
Q

What is another term for opthalmic artery strokes?

A

Retinal artery strokes

46
Q

What are ophthalmic artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the ophthalmic artery – which is a branch of the internal carotid artery

47
Q

What is a clinical feature of ophthalmic artery strokes?

A

Ipsilateral Amaurosis Fugax

48
Q

What are basilar artery strokes?

A

They are defined as cortical strokes affecting the areas of the brain supplied by the basilar artery

49
Q

What is a clinical feature of basilar artery strokes?

A

Locked In Syndrome

50
Q

What is locked in syndrome?

A

It is defined as the inability to mobilise or speak, however the ability to follow eye movement commands remains intact

51
Q

What are pontine haemorrhages?

A

They are defined as the rupture of pontine arteries, which radiate from the basilar artery on the brainstem to the pons

52
Q

What are the three clinical features of pontine haemorrhages?

A

Quadriplegia Limb Paralysis

Bilateral Pinpoint Pupils

Reduced Glasgow Coma Score

53
Q

What are the four Bamford classifications of strokes?

A

Total Anterior Circulation Stroke (TACS)

Partial Anterior Circulation Stroke (PACS)

Posterior Circulation Syndrome (POCS)

Lacunar Stroke (LACS)

54
Q

What are total anterior circulation strokes (TACS)?

A

They are defined as large cortical strokes affecting the areas of the brain supplied by both the anterior cerebral artery and the middle cerebral artery

55
Q

What are the three clinical features of total anterior circulation strokes?

A

It results in the following three clinical features…

  • Unilateral Weakness of Face/Limbs
  • Homonymous Hemianopia
  • Higher Cerebral Dysfunction
56
Q

What are two higher cerebral dysfunction clinical features?

A

Dysphasia

Visuospatial Disorder

57
Q

What are partial anterior circulation strokes (PACS)?

A

They are defined as small cortical strokes affecting either the upper division or lower division of the middle cerebral artery

58
Q

What are the three clinical features of partial anterior circulation strokes (PACS)?

A

It results in two of the following clinical features…

  • Unilateral Weakness of Face/Limbs
  • Homonymous Hemianopia
  • Higher Cerebral Dysfunction
59
Q

What are posterior circulation syndromes (POCS)?

A

They are defined as cortical strokes affecting the arteries supplying the posterior circulation – vertebrobasilar arteries

60
Q

What are the five clinical features of posterior circulation syndromes (PCOS)?

A

It results in one of the following clinical features…

  • Bilateral Motor/Sensory Deficit
  • Cranial Nerve Palsy & Contralateral Motor/Sensory Deficit
  • Conjugate Eye Movement Disorder
  • Cerebellar Dysfunction
  • Isolated Homonymous Hemianopia
61
Q

What are the three cerebellar dysfunction clinical features?

A

Vertigo

Nystagmus

Ataxia

62
Q

What are lacunar strokes (LACS)?

A

They are defined as subcortical strokes affecting perforating arteries around the internal capsule, thalamus and basal ganglia

63
Q

What are the four clinical features of lacunar strokes (LACS)?

A

Pure Sensory Stroke

Pure Motor Stroke

Sensori-Motor Stroke

Ataxic Hemiparesis

64
Q

What four investigations are used to diagnose strokes?

A

FAST Screening Tool

ROSIER Scoring System

Blood Tests

Non-Contrast CT Scans

65
Q

How is the FAST screening tool used to diagnose strokes?

A

It is used to identify strokes within the community

66
Q

What is the FAST screening tool?

A

Face Drooping

Arm Weakness

Slurred Speech

Time To Call 999

67
Q

How is the ROSIER scoring system used to diagnose strokes?

A

It is used by medical professionals in order to differentiate between acute strokes and stroke mimics

68
Q

What is the ROSIER scoring system?

A

Loss of Consciousness = -1 Point

Seizure Episode = -1 Point

Asymmetric Facial Weakness = + 1 Point

Asymmetric Arm Weakness = + 1 Point

Asymmetric Leg Weakness = + 1 Point

Speech Disturbance = +1 Point

Visual Field Defect = +1 Point

69
Q

What ROSIER score indicates stroke diagnosis?

A

> 0

70
Q

When are blood tests used to investigate strokes?

A

They are used to investigate strokes in those who present under 55 years old and with no obvious cause

71
Q

How are blood tests used to investigate strokes?

A

They are used to screen for autoimmune and thrombophilia disorders

72
Q

What six blood tests are used to investigate strokes?

A

Antinuclear Antibodies (ANA)

Antiphospholipid Antibodies (APL)

Anticardiolipin Antibodies (ACL)

Lupus Anticoagulant (LA)

Coagulation Factors

ESR Levels

73
Q

When are non-contrast CT scans used to diagnose strokes?

A

They are the first line imaging investigation used to diagnose strokes

74
Q

What is the feature of acute ischaemic strokes on non-contrast CT scans?

A

There is hypodense (black) material within the grey/white matter of the brain, alongside a hyperdense (white) artery

75
Q

What is the feature of acute haemorrhagic strokes on non-contrast CT scans?

A

There is hyperdense (white) material surrounded by low density

76
Q

What is the pharmacological management option of ischaemic strokes?

A

Thrombolysis

77
Q

When is thrombolysis used to manage ischaemic strokes?

A

When individuals present within 4.5 hours of clinical feature onset, and haemorrhagic stroke has been definitively excluded with CT scans

78
Q

When is thrombolysis used to manage ischaemic strokes - in > 80 year olds?

A

When individuals present within 3 hours of clinical feature onset, and haemorrhagic stroke has been definitively excluded with CT scans

79
Q

What is thrombolysis?

A

It involves administration of thrombolytic drugs, such as altepase, which are tissue plasminogen activators used to rapidly break down clots and reverse stroke clinical features

80
Q

What investigation is conducted 24 hours following thrombolysis? Why?

A

CT Scan

In order to monitor for post thrombolysis complications, such as intracranial/systemic haemorrhage

81
Q

How do we manage post thrombolysis complications?

A

We stop aspirin and administer hypertensives

82
Q

What are the ten absolute contraindications of thrombolysis?

A

Previous Intracranial Haemorrhage

Stroke In Preceding 3 Months

Seizure At Stroke Onset

Intracranial Neoplasm

Lumbar Puncture In Preceding 7 Days

Oesophageal Varices

Gastrointestinal Haemorrhage In Preceding 3 Weeks

Active Bleeding

Pregnancy

Uncontrolled Hypertension > 200/120mmHg

83
Q

What are the five relative contraindications of thrombolysis?

A

Concurrent Anticoagulation

Haemorrhagic Diathesis

Suspected Intracardiac Thrombus

Active Diabetic Haemorrhagic Retinopathy

Major Trauma In Preceding 2 Weeks

84
Q

What should be conducted when individuals present outwith of the thrombolysis window?

A

Secondary prophylaxis aspirin

85
Q

What is the surgical management option of ischaemic strokes?

A

Thrombectomy

86
Q

When is thrombectomy used to manage ischaemic strokes - in addition to thrombolysis?

A

When individuals present within 6 hours of clinical feature onset with a confirmed thrombus involving the proximal anterior circulation – demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)

87
Q

What is thrombectomy ?

A

It involves surgical removal of a thrombus from a blood vessel

A catheter is inserted into the femoral/radial artery, which is attached to an expandable mesh structure, and guided towards the affected cerebral vessel

The mesh structure is then expanded into the clot and removed from the circulation

88
Q

In which circumstance, do we extend the target time of thrombectomy up to 24 hours?

A

When advanced brain imaging indicates substantial salvageable brain tissue is still present, with a limited infact core volume

89
Q

What are the three secondary prophylaxis pharmacological management options of strokes?

A

Antiplatelet Drugs

Anticoagulant Drugs

Statin Drugs

90
Q

When are antiplatelet drugs used to prophylactically manage strokes?

A

It is the first line management option used in all ischaemic stroke patients

91
Q

What antiplatelet drug regime is used to prophylactically manage strokes?

A

It is recommended that aspirin 300mg once daily is administered immediately and continued for a period of 2 weeks

They should then be switched to clopidogrel 75mg once daily lifelong

92
Q

What antiplatelet drug is recommended when clopidogrel is contraindicated?

A

Modified release dipyridamole, alongside low dose aspirin

93
Q

When are anticoagulant drugs used to prophylactically manage strokes?

A

When ischaemic stroke occurs in individuals with atrial fibrillation

It is recommended that it is commenced lifelong 2 weeks post-stroke, after aspirin treatment, alongside clopidogrel

94
Q

Name three anticoagulant drugs used to prophylactically manage strokes

A

Warfarin

Direct Factor Xa Inhibitors

Direct Thrombin Inhibitors

95
Q

When are statin drugs used to prophylactically manage strokes?

A

They are used to manage ischaemic stroke patients with cholesterol levels > 3.5mmol/l

It is recommended it is not administered until 48 hours after clinical feature onset, due to the risk of haemorrhagic transformation

96
Q

What is the surgical prophylactic management option of strokes?

A

Carotid Artery Endarterectomy

97
Q

When are carotid artery endarterectomies used to manage strokes?

A

When individuals have suffered strokes within the carotid territory, in which there is carotid stenosis > 70%

98
Q

What is carotid artery endarterectomy?

A

It involves surgical removal of atherosclerotic plaques from the carotid arteries

99
Q

What nerve is at risk of damage during carotid artery endarterectomy?

A

Hypoglossal Nerve

100
Q

What is the Barthel scale?

A

It is used to measure disability to dependence in activities of daily living in stroke patients

Year Two - Neurology System (25 decks)

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