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CNS CLERKSHIP > Stroke > Flashcards

Stroke Flashcards

1
Q

What is “stroke”?

A

Experiencing persisting neurological complications of CV disease.

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2
Q

Name the three subcategories of stroke.

A
  • Haemorrhage.
  • Subarachnoid haemorrhage.
  • Infarct.
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3
Q

What percent of all stroke presentations are stroke mimics?

A

1/3.

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4
Q

What scoring system is used to calculate likelihood of stroke?

A

ROSIER.

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5
Q

CT is not sensitive for bleeding/blood after how long?

A

One week.

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6
Q

What is TACS - Total Anterior Circulation Syndrome?

A
  • Hemiplagia involving at least two of: face, arm and leg +/- hemisensory loss.
  • Homonymous hemianopia.
  • Cortical signs (dysphasia, negletc etc.).
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7
Q

What is the most severe type of stroke?

A

TACS - total anterior circulation syndrome.

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8
Q

How many patients are alive and independent after one year following TACS?

A

5%.

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9
Q

What is PACS - Partial Anterior Circulation Syndrome?

A

2 out of 3 features present in TACS (hemiplagia, homonymous hemianopia, cortical signs).
OR
Isolated cortical dysfunction e.g. dysphasia.
OR
Pure motor/sensory signs less severe than in lacunar syndromes e.g. monoparesis.

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10
Q

How many patients are alive and independent after one year following PACS?

A

55%.

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11
Q

What are lacunar infarcts?

A

Small infarcts in the deep parts of the brain e.g. basal ganglia, thalamus, white matter and in the brain stem.

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12
Q

What causes lacunar syndrome?

A

Occlusion of a single deep penetrating artery in deep parts of the brain or brainstem.

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13
Q

Lacunar syndrome affects what?

A

Any two of:

  • Face.
  • Arm.
  • Leg.
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14
Q

Which stroke has best prognosis?

A

Lacunar syndrome.

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15
Q

How many patients are alive and independent after one year following LACS?

A

60%.

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16
Q

What causes POCS - posterior circulation syndrome?

A

Cerebral infarct interrupts blood supply to unilateral posterior brain.

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17
Q

Symptoms and signs suggestive of POCS?

A
  • CN palsies.
  • Bilateral motor and/or sensory deficits.
  • Conjugate eye movement disorders.
  • Isolated homonymous hemianopia.
  • Cortical blindness.
  • Cerebellar deficits without ipsilateral motor/sensory signs.
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18
Q

How many patients are alive and independent after one year following POCS?

A

roughly 60%.

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19
Q

A stroke affecting the right side of the brain will affect what?

A
  • The left side of the body.
  • Creativity.
  • Music.
  • Spatial orientation.
  • Artistic awareness.
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20
Q

A stroke affecting the left side of the brain will affect what?

A
  • Right side of the body.
  • Reasoning.
  • Spoken language.
  • Number skills.
  • Written language.
21
Q

Dominant (left) hemisphere cortical events often affect?

A

Language - major implications for rehab.

22
Q

Non-dominant (right) hemisphere cortical event affect?

A

Spatial awareness - neglect.

23
Q

Causes of ischaemic cerebrovascular disease?

A
  • Cardiac embolism source.
  • Intracranial small-vessel disease.
  • Rare causes.
  • Atherothromboembolism (50%).
24
Q

Type 1 Small Vessel Disease Classification?

A

Arteriosclerotic (age/risk factor related.

25
Q

Type 2 Small Vessel Disease Classification?

A

Sporadic and hereditary cerebral amyloid angiopathy.

26
Q

Type 3 Small Vessel Disease Classification?

A

Genetic small vessel disease distinct from cerebral amyloid angiopathy.

27
Q

Given an example of a genetic small vessel disease distinct from cerebral amyloid angiopathy.

A

CADASIL.

28
Q

Type 4 Small Vessel Disease Classification?

A

Inflammatory and immunologically mediated.

- e.g. Churg-Strauss, Wegener’s granulomatosis.

29
Q

Type 5 Small Vessel Disease Classification?

A

Venous collagenosis.

30
Q

Type 6 Small Vessel Disease Classification?

A

Other small vessel disease e.g. post radiation angiopathy.

31
Q

Atrial fibrillation is associated with what increase in risk of stroke?

A

5 fold.

32
Q

how many stroke are due to AF?

A

one in six.

33
Q

What may cause Primary intracerebral haemorrhage?

A

Hypertension.

- Amyloid angiopathy.

34
Q

What may cause secondary intracerebral haemorrhage?

A
  • Arteriovenous malformation.
  • Aneurysm.
  • Tumour.
35
Q

Primary intracerebral haemorrhage in the lobar region is likely to be related to?

A

Cerebral amyloid angiopathy.

36
Q

A deep primary intracerebral haemorrhage is likely to be related to?

A

Effects of BP.

37
Q

Pathophysiology of intracranial hypertension in early haematoma expansion?

A
  • Continued arterial bleeding.
  • Secondary bleeding into perilesional tissue.
  • Subsequent perilesional oedema.
38
Q

Acute management of CVA?

A
  • Thrombolysis/thrombectomy.
  • Imaging.
  • Swallow assessment.
  • Nutrition and hydration.
  • Antiplatelets.
  • Stroke unit care.
  • DVT prophylaxis.
39
Q

Secondary prevention of CVA?

A

Medication, lifestyle and carotid surgery.

Rehab and recovery.

40
Q

What should be considered when deciding to thrombolyse or not?

A
  • Age.
  • Time since onset.
  • Previous intracerebral haemorrhage or infarct.
  • Atrophic changes.
  • BP.
  • Diabetes.
  • Benefit?
41
Q

What sign may show on CT in CVA?

A

Hyperdense middle cerebral artery sign.

42
Q

Describe IV tPA.

A
  • Adiministration limited to <4.5 hour from symptom onset.
  • Large and proximal clots less likely to re-canalise.
  • Overall recanalisation rates 40-50%.
43
Q

Describe cardioembolic strokes.

A

Fibrin dependent - “red thrombus”.

44
Q

Describe atheroembolic strokes.

A

Platelet dependent “white thrombus” - Acute Coronary syndrome.

45
Q

Stroke investigations?

A
  • Full lipid profile.
  • BP.
  • Carotid scan.
  • ECG.
  • Consider: 72 hour ECG or echocardiogram.
46
Q

ABCD of medical stroke prevention?

A

A: antithrombotic therapy - antiplatelet + anticoagulant.
B: BP.
C: cholesterol.
D: diabetes and DONT smoke.

47
Q

Low cholesterol is associated with increased risk of which stroke?

A

Haemorrhagic.

48
Q

What is carotid endarterectomy?

A

Surgical removal of plaque build up that causes narrowing in the carotid arteries.

49
Q

Carotid endarterectomy reduces recurrent stroke at 2 years by what percent?

A

65% reduction in recurrent stroke at 2 years.

CNS CLERKSHIP (43 decks)

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