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Medicine > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the revised definition for stroke

A

Stroke is defined as a sudden global or focal neurological deficit resulting from spontaneous hemorrhage or infarction of the central nervous system with objective evidence of infarction irrespective of duration of clinical symptoms

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2
Q

What are the two stroke types

A

Ischemic and hemorrhagic

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3
Q

What causes ischemic stroke

A

Obstruction blocks blood flow to part of the brain

It may be caused by:
Large artery atherosclerosis
Small vessel occlusion
Cardioembolic
Cryptogenic causes

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4
Q

What causes hemorrhagic stroke

A

A weakened vesse wall ruptures causing bleeding in the brain

It may be caused by:
Structural lesions
Medications (Anticoagulants)
Amyloid angiopathy
Systemic disorders (DIC, snake bite)
Hypertension
Undetermined

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5
Q

What is the clinical presentation of the stroke

A

The vessel affected and the parenchyma it supplies dictates the signs and symptoms of stroke
A basic understanding of the vascular supply of the brain is paramount in localizing a stroke and thus in making treatment decisions

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6
Q

What are some arteries in the anterior circulation

A

Carotid artery
Middle cerebral artery (hemisphere dominance)
Anterior cerebral artery

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7
Q

What are the posterior circulation arteries

A

Vertebral arteries
Basilar artery
Posterior cerebral artery

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8
Q

What are some clinical features of a middle cerebral artery infarction - stem occlusion

A

Contralateral hemiplegia
Contralateral hemisensory loss
Contralateral gaze palsy
Contralateral hemianopia
Global dysphasia (Left sided lesion)
Anosognosia and amorphosynthesis
(Right sided lesion)
Altered sensorium (due to edema)

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9
Q

What are some clinical features of anterior cerebral artery infarction

A

Contralateral:
a. paralysis of leg and foot with paresis of arm
b. cortical sensory loss over leg and foot
c. presence of primitive reflexes
Urinary incontinence
Gait apraxia
Mutism, delay and lack of spontaneity of motor acts
Apraxia of left sided limbs (with left sided lesion and corpus callosum involvement)

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10
Q

What arteries make up the posterior circulation

A

Paired vertebral arteries
Basilar artery
Paired posterior cerebral arteries
Short penetrating branches and short and long circumferential branches

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11
Q

The basilar artery supples which structures

A

Midbrain
CST: contralateral hemiparesis
CN 3 & 4: vertical diplopia
Coma

Pons
CST: contralateral or bilateral hemiparesis
CN 5: facial numbness
CN 6: horizontal diplopia
CN 7: facial weakness
CN 8: dizziness & nausea locked in syndrome

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12
Q

The vertebral artery supplies which structures

A

Medulla
CN 9: cough & throat discomfort
CN 10: hoarse voice
CN 9 &10: decreased gag reflex
CN 11: weakness in head turn, shoulder shrug
CN 12: tongue weakness & dysarthria
Cerebellar findings (ipsilateral)
Trunk and limb pain and temp abnormal (contralateral)
Horner’s Syndrome (ipsilateral)

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13
Q

What kind of findings do posterior circulation strokes produce

A

Crossed findings and cranial nerve abnormalities

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14
Q

Anterior circulation strokes produce what kind of signs and symptoms

A

Contralateral signs and symptoms

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15
Q

What is the investigation of choice in stroke

A

Computerised tomography (CT) head is the investigation of choice in stroke
It should be done within 48h primarily to exclude hemorrhage. It helps determine the nature, size, site of stroke and exclude other disorders
CT can detect >90% of all strokes

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16
Q

What are some differential diagnosis for stroke

A

Opportunistic processes in HIV disease
Subdural haematoma
Mass lesions
Todd’s palsy
Venous sinus thrombosis
Acute encephalopathy

17
Q

Strokes could mimic which symptoms

A

Focal seizures
Migraine
Hypoglycemia
Syncope
Hysteria

18
Q

What are some specific measures for caring for an acute stroke patient

A
  1. Anti-platelet therapy
    •All ischaemic strokes should have aspirin immediately
    300mg for 2wks followed by 75-150mg afterwards for life.
    •Aspirin prevents 15 deaths or major disability/1000 patients treated within 1-2 wks
    •Aspirin prevents 1/5th of recurrent strokes when used over long-term
    •Patients intolerant of aspirin should be given either clopidogrel or dipyridamole
  2. Blood pressure control
    •BP rises after an acute stroke and tends to fall spontaneously after that
    •Avoid precipitous lowering of BP during the first 24-48hrs for ischemic stroke
    •Acute drops in BP can reduce perfusion to an already ischemic brain
    •Consider BP lowering if BP is persistently elevated

Aim for acute reduction of BP when these are present:
Hypertensive encephalopathy
Left ventricular failure
MI

  1. Thrombolysis
    •A recent development in stroke management
    •Dramatically improves the outcome in some ischaemic stroke patients
    •Alteplase- iv tissue recombinant plasminogen activator (rtPA), thrombolytic agent
19
Q

Rehabilitation is one of the most important aspects in the care of stroke patients. Early mobilization and rehabilitation help improve outcomes. Physiotherapy maximizes functional recovery. Occupational therapy is necessary for functional assessment. Speech and language therapy helps with aphasia, dysarthria and dysphagia
True or false

A

True

20
Q

What are some complications of stroke

A

Neurological worsening is common in the first 48 hours of stroke due to
1.Brain swelling
2.Extension of the original stroke
3.Complications
Poor prognosis associated with
4.Coma
5.Extensive stroke
6.Large haemorrhage

Acute complications
Aspiration pneumonia
Pulmonary embolism
Urinary tract infections

Chronic complications
Spasticity
Contractures
Pain
Depression (>50% ) responds to TCA or SSRI
Dementia
Seizures (late 6-12 months). Responds to phenytoin

21
Q

What are some prevention mechanisms for stroke

A

Primary prevention must include public education concerning necessary lifestyle changes. Includes decreasing total salt intake, stopping smoking, dietary changes, increasing exercise
Secondary prevention includes targeting known disease and risk factors for stroke
Tertiary measures are important to cope with increasing burden and disability

22
Q

What is transient ischemic attack (TIA)

A

TIA is a sudden focal neurological deficit that completely resolves in less than 24h
•Usually lasts minutes not hours
•Arises from thromboemboli from internal carotid arteries
•Other sources AF, heart disease
•Presentation determined by vascular territory involved
•Amaurosis fugax
•All TIA must be investigated and managed urgently
•Annual risk for stroke after a TIA is around 10%
•If TIA lasts >1-2h, the risk of stroke is greatest over the next 48h

23
Q

What are some general measures in caring for a stroke patient

A

Start neurological observations hourly and change to 4 hourly if stable- GCS, vitals, SaO2
Monitor blood glucose, If > 11mmol/l start insulin sliding scale
Treat pyrexia
IV fluids in dehydrated patients, unable to swallow
Evaluate swallowing after 24h*
Urinary catheterization if incontinent or in retention
Prevent constipation by adequate hydration and laxatives
Prevent pressure sores by supervising 2 hourly turning
Decrease the risk of DVT by using compression stockings

Medicine (38 decks)

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