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Y3 Conditions > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke

What are the main pathological causes of ischaemia stroke?

A
  • atherosclerosis
  • arterial disease
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2
Q

Stroke

What are the risk factors for ischaemic stroke?

A

The principal risk factors are those for atherosclerosis: age, smoking, dyslipidaemia, diabetes, obesity, inactivity and genetic/ethnic factors

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3
Q

Stroke

What is a TIA?

A

TIAs cause sudden loss of function, usually lasting for minutes only, with complete recovery and no evidence of infarction on imaging.

*The previous classical definition of a duration of less than 24 hours is no longer used. *

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4
Q

Stroke

What is Amaurosis fugax?

A

a sudden transient loss of vision in one eye

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5
Q

Stroke

What arteries perfuse these areas?

A
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6
Q

Stroke

A problem with which part of the circulation might bring about these symptoms?

  • Amaurosis fugax
  • Aphasia
  • Hemiparesis
  • Hemisensory loss
  • Hemianopic visual loss
A

Anterior circulation
Carotid system

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7
Q

Stroke

A problem with which part of the circulation might bring about these symptoms?

  • Diplopia, vertigo, vomiting
  • Choking and dysarthria
  • Ataxia
  • Hemisensory loss
  • Hemianopic visual loss
  • Bilateral visual loss
  • Tetraparesis
  • Loss of consciousness (rare)
  • Transient global amnesia (possibly)
A

Posterior circulation
Vertebrobasilar system

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8
Q

Stroke

What scoring system can we use to stratify stroke risk after TIA in order to guide management?

How do we interpret the score?

A

ABCD score

**A score of <4 is associated with a low risk whereas >6 is high-risk for a stroke within 7days of a TIA. **

This scoring system is now no longer used to guide management, but may still inform prognosis

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9
Q

Stroke

How should we investigate a TIA?

A
  • Doppler ultrasound of the internal carotid arteries
  • cardiac echo
  • ECG and 24-hour tape
  • MRI brain
  • MR or CT angiography
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10
Q

Stroke

An acute onset (over minutes) of what kind of symptoms are characteristic defining features of ischaemic stroke?

A

‘negative’ symptoms indicating focal deficits in brain function
- weakness
- sensory loss
- dysphasia
- visual loss

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11
Q

Stroke

Complete middle cerebral artery occlusion results in devastating stroke with what kind of features?

A
  • contralateral hemiplegia and facial weakness
  • hemisensory loss and neglect syndromes
  • eye deviation towards the affected side
  • aphasia
  • hemianopia
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12
Q

Stroke

A complete occlusion of what artery would cause these symptoms:
- contralateral hemiplegia and facial weakness
- hemisensory loss and neglect syndromes
- eye deviation towards the affected side
- aphasia
- hemianopia

A

MCA

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13
Q

Stroke

What are the typical features of an anterior cerebral artery infarct?

A
  • hemiparesis affecting the leg more than arm
  • frontal lobe deficits (apathy or apraxia)
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14
Q

Stroke

Infarct of what artery would cause this picture:
* hemiparesis affecting the leg more than arm
* frontal lobe deficits (apathy or apraxia)

A

ACA

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15
Q

Stroke

How might an infarct in the posterior cerebral artery present?

A
  • Homonymous hemianopia results from unilateral lesions
  • cortical blindness from bilateral lesions
  • neglect syndromes + visual agnosias
  • confusion or memory impairment.
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16
Q

Stroke

The ____ supplies the thalamus, and posteromedial temporal lobe and infarction of these structures causes ____ or ____.

A

The PCA supplies the thalamus, and posteromedial temporal lobe and infarction of these structures causes confusion or memory impairment.

17
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19
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20
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21
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22
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23
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24
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25
Q

Stroke

How should we investigate a stroke pt?

A
  • CT
  • cardiac investigations (?AF)
26
Q

Stroke

What does FAST stand for?

A

F ace – sudden weakness of the face
A rm – sudden weakness of one or both arms
S peech – difficulty speaking, slurred speech
T ime – the sooner treatment can be started, the better.

27
Q

Stroke

Outline stroke management.

A

Thrombolysis significantly increases the chances of having no or minimal disability after stroke, by reducing infarct size
Earlier treatment within the 4.5-hour time window significantly improves outcome, so every minute counts.

28
Q

Stroke

  • Thrombolysis should commence as soon as possible and up to how long after an acute stroke?
A

4.5hrs

29
Q

Stroke

Which has a worse mortality rate?
ischamic stroke or haemorrhagic stroke?

A

haemorrhagic

30
Q

Stroke

Risk factors for ischaemic stroke:

10

A
  • Family history
  • Smoking
  • Hypertension
  • Diabetes
  • Elderly
  • Atrial fibrillation
  • Carotid artery stenosis
  • Hyperlipidaemia
  • Sickle cell disease
  • Hypercoagulopathies
31
Q

Stroke

Risk factors for haemorrhagic stroke:

9

A
  • Family history
  • Hypertension
  • Haemophilia
  • Elderly
  • Alcohol abuse
  • Anticoagulation use
  • Vascular malformation
  • Use of illicit sympathomimetic substances
  • Cerebral amyloid angiopathy
32
Q

Stroke

Risk factors for TIA:

9

A
  • Family history
  • Hypertension
  • Smoking
  • Atrial fibrillation
  • Elderly
  • Valvular disease
  • Diabetes
  • Carotid artery stenosis
  • Alcohol abuse
33
Q

Stroke

What are the first line investigations for ischaemic stroke?

A
  • non-contrast ct head
  • bloods
  • ech
34
Q

Stroke

What bloods might be get for ischaemic stroke?

A
  • FBC
  • U&Es
  • creatinine
  • Glucose
  • Troponin
  • prothrombin time
  • INR (if on Warfarin or has known chronic hepatic condition such as cirrhosis)
35
Q

Stroke

What drug is given for ischaemic stroke if pt presents to hospital wihtin 4.5hrs? Why?

A

alteplase
- thrombolysis

36
Q
A

Y3 Conditions (55 decks)

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