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Year 2- CNS > Stroke > Flashcards

Stroke Flashcards

1
Q

When do risks of stroke increase?

A

With age

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2
Q

Public awareness of stroke has been raised using which campaign?

A

FAST

(Facial weakness
Arm weakness
Slurred speech
Time to call 999)

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3
Q

Define stroke.

A

Sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage lasting more than 24hrs

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4
Q

What % of stroke are ischaemic compared to haemorrhagic?

A

85% are ischaemic
15% of haemorrhagic

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5
Q

What is meant by a transient ischemic attack?

A

Sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage lasting less than 24hrs

->stroke basically but less than 24hrs

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6
Q

What happens in haemorrhagic stroke?

A

Blood leaks into brain tissue

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7
Q

What happens in ischaemic stroke?

A

Clot stops blood supplying an area of the brain

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8
Q

Give some of the common causes of ischaemic stroke.

A

Large artery atherosclerosis e.g. carotid artery
Cardioembolic
Small artery occlusion

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9
Q

What is the most common causes of a cardioembolic ischaemic stroke?

A

Atrial fibrillation

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10
Q

What is another name for small artery occlusion?

A

Lacune strokes

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11
Q

What may a secondary haemorrhagic stroke follow?

A

Subarachnoid haemorrhage
Arteriovenous malformation

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12
Q

What are some of the non-modifiable risk factors for stroke?

A

Age
Male
Previous stroke
FH

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13
Q

What are some of the modifiable risk factors for stroke?

A

Oestrogenic pills (small increase in risks)
HRT (small increase in risk)
Cocaine
Smoking
Poor diet
Diabetes
Hypertension
Atrial fibrillation

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14
Q

What is the most important modifiable risk factor of stroke?

A

Hypertension

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15
Q

What does chronic hypertension due to vessels?

A

Exacerbates atheroma and increases the involvement of smaller distal arteries

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16
Q

Small end arteries coming off large arteries experience higher pressure and are more likely to have a lacunar ischaemic stroke or a small vessel haemorrhage.
Which areas of the brain is this more likely to occur?

A

Brainstem
Basal ganglia
Subcortical areas

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17
Q

How many times more likely are smokers to get a cerebral infarction?

A

2x more likely

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18
Q

How many times more likely are smokers to get an arachnoid haemorrhage?

A

3 x more likely

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19
Q

How many times more likely are those with diabetes to develop a stroke?

A

3 x more likely

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20
Q

What does hypertension, cigarette smoke and diabetes contribute towards in arteries?

A

Low density lipoprotein deposition in arterial walls

-> risk between development of atheroma in blood vessel walls and stroke

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21
Q

What can drinking small amounts of alcohol do to risk of stroke?

A

Decreases risks

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22
Q

What can drinking large amounts of alcohol do to risk of stroke?

A

Increases risk

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23
Q

Who is more likely to get atrial fibrillation?

A

Those of older age

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24
Q

How many times more likely is someone with atrial fibrillation to develop a stroke?

A

5 x greater risk of embolic stroke

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25
Q

How does atrial fibrillation link to higher morbidity and mortality of stroke?

A

Tend to be larger clots leading to more severe strokes

->therefore longer hospital stays

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26
Q

In those with AF, is there any benefit in reducing ischaemic stroke if the patient takes antiplatelets, like aspirin?

A

No

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27
Q

In those with AF, is there any benefit in reducing ischaemic stroke if the patient takes anticoagulants, like warfarin?

A

Yes
-> reduces risks by 2/3

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28
Q

Which type of drug have less risk of bleeding than warfarin?

A

DOACS like edoxaban and apixaban

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29
Q

Which two arteries make up the anterior circulation of the brain?

A

2x anterior cerebral artery
2x middle cerebral arteries

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30
Q

Which two arteries make up the posterior circulation of the brain?

A

2 vertebral arteries which join to form 1 basilar artery

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31
Q

In terms of making the diagnosis of stroke, which questions should be asked to work out the type of stroke?

A

What is the neurological deficit?
Where is the lesion?
What is the lesion?
Why has the lesion occurred?
What are the potential complications and prognosis?

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32
Q

List the functions of the frontal lobe.

A

High level cognitive function
Memory
Voluntary eye movement
Motor control of speech
Motor cortex
Urinary continence
Emotion and personality

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33
Q

List the functions of the parietal lobe.

A

Sensory cortex
Sensation
Awareness of parts of the body
Spatial orientation
Ability to perform learned motor tasks

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34
Q

List the functions of the temporal lobe.

A

Primary auditory receptive area
Comprehension of speech (Wernicke’s)
Visual, auditory and olfactory perception
Learning
Memory
Emotion

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35
Q

Where would the motor homunculus be?

A

Precentral gyrus

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36
Q

Where would the sensory homunculus be?

A

Postcentral gyrus

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37
Q

Describe the symptoms of a middle cerebral artery stroke.

A

Upper limb and facial weakness
Less so leg weakness

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38
Q

Describe the symptoms of a anterior cerebral artery stroke.

A

Mainly leg weakness

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39
Q

What is controlled by the cerebellum?

A

Balance and coordination

40
Q

How many of the 12 cranial nerves arise from the brainstem?

A

10/12

41
Q

What could happen if there is a stroke in the brainstem?

A

Cranial problems on the ipsilateral side
Hemiparesis or arm/leg weakness on contralateral side.

-> contralateral hemiparesis and weakness due to the crossing over of cortical tracts in the medulla

42
Q

What are the functions of the occipital lobe?

A

Primary visual cortex
Visual perception
Involuntary smooth eye movement

43
Q

If you damage one optic nerve, what happens?

A

Loss of vision/visual changes in one eye, same eye as damaged nerve

44
Q

Describe the clinical presentation of a stroke.

A

Sudden onset of symptoms.
Motor issues- clumsy or weak limb
Sensory- loss of feeling
Dysarthria/dysphasia- speech problems
Neglect/visuospatial problems
Vision loss in one eye or hemianopia
Gaze palsy
Ataxia/vertigo

45
Q

Describe the onset of stroke symptoms.

A

Rapidly, suddenly

46
Q

What do stroke symptoms depend on?

A

Area of the brain affected

47
Q

Is is normal to have abnormal movements, like a jerk or tremor, after a stroke?

A

No

48
Q

Is a severe headache normal after a stroke?

A

No

49
Q

If a patient has positive visual phenomena*, what is it more likely to be than a stroke?

*just loads of weird changes to vision as far as I can work out

A

A migraine

50
Q

Which classification is used for stroke?

A

OSCP

51
Q

What are the four categories of OCSP (Oxford Community Stroke Project Classification)?

A

TACS
PACS
LACS
POCS

52
Q

TACS?

A

Total anterior circulation stroke

53
Q

PACS?

A

Partial anterior circulation stroke

54
Q

LACS?

A

Lacunar stroke

55
Q

POCS?

A

Posterior circulation stroke

56
Q

Agnosia?

A

Patient unable to recognize objects, persons or sounds using one or more of their senses.

57
Q

Anosagnosia?

A

When patient doesn’t think they’re paralysed when they are

58
Q

Propsopagnosia?

A

Inability to recognise faces

59
Q

Which area of the brain would likely be affected if a person had neglect symptoms like agnosia?

A

Parietal lobe

60
Q

Blockage of which types of artery usually causes TACS?

A

Carotid or middle meningeal

61
Q

What are the symptoms of TACS?

A

Complete hemiparesis/numbness
Loss of vision on one side (hemianopia)
Loss of awareness on one side

62
Q

What are some of the symptoms of POCS?

A

Loss of balance/coordination
Vertigo
Double vision
Dysarthria
Visual loss

63
Q

Basilar artery occlusion can lead to one of the worst strokes. Why is this?

A

Basilar artery supplies brainstem which help us breathe and remain conscious

64
Q

What can basilar artery occlusion cause to happen in the pons?

A

Ischaemia in pons

65
Q

List things which can mimic strokes

(mostly also begin with letter S)

A

Seizures
Syncope (hypertension)
Sugar (hypoglycaemic or hyperglycaemic) in diabetes
Sepsis and previous stroke
Severe migraine
Space occupying lesions

Vestibular disorders
Demyelination
Transient global ischaemia
Mononeuropathy
Psychological

66
Q

Migraines give positive symptoms whilst strokes give negative symptoms.
What is meant by positive symptoms?

A

Excess CNS neurone electrical discharges

67
Q

Migraines give positive symptoms whilst strokes give negative symptoms.
What is meant by negative symptoms?

A

Loss or reduction of CNS neurone function

68
Q

Give some examples of positive symptoms in the following categories:
1. visual
2. somatosensory
3. motor

A
  1. Flashing lights, zigzags. lines, objects
  2. Pain, paraesthesia
  3. Jerky limb movements
69
Q

Give some examples of negative symptoms.

A

Loss of vision
Loss of power
Loss of sensation

70
Q

So, if there are positive symptoms, it is likely to be a ???

A

Migraine

71
Q

And if there are negative symptoms, it is more likely to be a ???

A

Stroke

72
Q

Which investigations are carried out for all/most patients with stroke?

A

Routine blood tests
CT or MRI
ECG + Holter
Carotid doppler stenosis

73
Q

Why is CT or MRI done in patients with a stroke?

A

To determine if it’s of haemorrhage or ischaemic cause

74
Q

Why is an ECG done in someone with a stroke?

A

Looking for AF and signs of left ventricular hypertrophy

75
Q

When would you not give a patient thrombolytic drugs?

A

If they have bleeding in the brain

76
Q

Which type of imaging is good to show up bleeding in the brain?

A

CT

77
Q

What are the three aims of treatment for acute ischaemic stroke?

A

Restore blood supply
Prevent extension of ischaemic damage
Protect vulnerable brain tissue

78
Q

Which three symptoms need to be present for a diagnosis of TACS?

A

Unilateral weakness of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction e.g. dysphasia, visuospatial disorder

79
Q

Which symptoms must a patient have to be diagnosed with a PACS?

A

Two of the following:

-Unilateral weakness of the face, arm and leg
-Homonymous hemianopia
-Higher cerebral dysfunction e.g. dysphasia, visuospatial disorder

80
Q

Which symptoms need to be present to diagnose someone with POCS?

A

One of the following:

-Cranial nerve palsy and a contralateral motor/sensory deficit
-Bilateral motor/sensory deficit
-Conjugate eye movement disorder e.g. horizontal gaze palsy
-Isolated homonymous hemianopia

81
Q

Which symptoms would have to be present in order to diagnose a LACS?

A

One of the following:
-Pure sensory stroke
-Pure motor stroke
-Semsori-motor stroke
-Ataxic hemiparesis

82
Q

What is the treatment of choice for a large vessel occlusions?

A

Thrombectomy, removal or the clot in less than six hours

->however, not very realistic as not many patients eligible or will get it done in less than six hours

83
Q

Even admission to a stroke unit helps with the treatment of stroke.
Name some of the members of the stroke unit team.

A

Clinical staff
Stroke nurse
Physiotherapists
OT
Speech and language therapists
Dietician
Psychologist
Orthoptist

84
Q

Which acute stroke treatment has the biggest effect on the individual pateint?

A

Thrombolysis and thrombectomy

85
Q

Which acute stroke patient has the biggest effect on the MOST patients?

A

Stroke unit admission

-> small effect but many more people can benefit from it

86
Q

Thrombolysis is more effective when?

A

More effective the quicker it’s given from symptom onset

87
Q

When should thrombolysis be given?

A

<4.5hrs

->better to give as soon as possible but must wait an hour to confirm the symptoms are due to stroke

88
Q

When should thrombolysis not be given?

A

Blood seen on CT
Recent surgery
Recent episodes of bleeding
Coagulation problems

89
Q

At which BP levels would it be unsuitable to give thrombolysis?

A

Systolic > 185
Diastolic > 110

90
Q

At which glucose levels would it be unsuitable to give thrombolysis?

A

Less than 2.8 mmol/L
More than 22mmol/L

91
Q

What is a warning sign of a stroke?

A

A transient ischaemic attack

->10% of strokes reoccur within first 2 weeks after TIA

92
Q

What is an effective treatment if there in symptomatic internal carotid artery stenosis?

A

Carotid endarterectomy

93
Q

Which drugs can help in the secondary prevention of strokes?

A

Anti-hypertensives
Anti-platelets
Lipid lowering agents

94
Q

Which drug should be given in those with AF who have had a stroke to reduce their risks of developing another?

A

Warfarin

95
Q
A

Year 2- CNS (49 decks)

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