Stroke Flashcards

1
Q

What are the presentations of a stroke of the frontal lobe

A

Contra lateral movements of the arm leg face and trunk are affected

Broca’s area is the expressive centre for speech

Prefrontal areas - personality, initiative and sequencing

Cortical inhibition of bladder and bowels

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2
Q

Stroke in the parietal lobe

A

Sensory cortex present in the post central gyrus

Wernickes area receptive area comprehension

Handling numbers and doing calculations (dominant)

Concepts of body image and awareness of external environment (non dominant)

Visual pathways - deep in Myers’s loop

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3
Q

Damage to the temporal lobe due to a stroke may present as dysfunction of

A

The auditory cortex
Learning and memory
Olfactory sensation
Emotional behaviour
Visual pathways

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4
Q

What is the difference between positive features and negative features

A

Loss of function is due to negative features such as paralysis

Abnormal stimulation is due to positive features that ma present as seizures and tremors

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5
Q

What can cause ischaemic strokes

A

Atheromatous narrowing of the carotid or vertebral artery

Arterial embolism from a distant site

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6
Q

Large artery atheroma affects which main vessels

A

Carotid

MCA, PCA and ACA

Perforating vessel - lacunar infarction

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7
Q

Other than large vessel atheroma what else can cause occlusion of vessels

A

= small vessel disease
Vasculitis
Carotid dissection (traumatic or spontaneous)

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8
Q

What are other causes of ischaemic stroke other than atheromatous plaque or dissection

A

Atheroma 50%

Heart causes: 25% such as AF, valve disorders and endocarditis, PFO, myxoma)

Small end arteries 25%

Fat and air v rare

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9
Q

Causes of haemorrhagic stroke

A

Hypertension
Artero-venous malformation AVM
Aneurysm
Cerebral amyloid angiopathy CAA
Coagulation disorders or medication related

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10
Q

What deficits are associated with carotid artery occlusion

A

Contra lateral hemiplegia, hemisensory disturbance

Homonymous hemianopia

Deterioration in consciousness level

Gaze palsy (eyes deviated to the ide of palsy)

Dominant hemisphere - global aphasia

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11
Q

Deficits in branch vessel occlusion: MCA

A

Contra lateral hemiplegia, hemianesthesia and hemianopia

Dominant hemisphere = aphasia, acalculia and agraphia

Non dominant = neglect, dressing apraxia and failure to recognise faces

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12
Q

Deficits in perforating vessel stroke

A

Pure motor stroke
Pure sensory stroke

Dysarthria
Ataxic hemiparesis
Sensorimotor stroke

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13
Q

Total anterior circulation infarct TACI

A

Hemi motor and sensory deficit
Hemianopia
Cortical dysfunction

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14
Q

Partial anterior circulation infarct

A

Any 2 from total anterior circulation infarct deficits OR isolated cortical dysfunction

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15
Q

Deficits associated with lacunar infarct

A

Pure motor hemiplegia
Pure sensory loss
Motor and sensory loss

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16
Q

Deficits associated with posterior circulation infarct: POCI

A

Vertigo
Diplopia
Ataxia

17
Q

What is the acute treatment for stroke

A

For an infarct - thrombolysis (clot buster) with tPA or thrombectomy if can treat very soon after onset of symptoms…. Then aspirin and statins

18
Q

Acute treatment for stroke if caused by haemorrhage

A

Lower BP to 160/90 at least and reverse anti-coagulation

19
Q

What are the principles of stroke rehab

A

MDT assessment within 24-48 hrs
Swallowing - nearly 50% struggle with this
Nutritional status
Cognitive impairment
Communication
Mobility

20
Q

What does rehab focus on

A

Setting goals
Screening for depression and anxiety
Physiotherapy to improve mobility
Addressing difficulties with ADLs
Training of carers to handle patient at home

21
Q

What are the long term problems post stroke

A

Mobility
Continence (bladder and bowel)
Cognition
Self care
Communication deficits
Chronic pain

22
Q

What is mortality like post stroke

A

19% at 0-30 days

12% at 30 days to 1 year

23
Q

What are predictors of poor recovery

A

Older age
Comorbidities
How severe the stroke was
Absence of a partner?
Visuospatial defects

24
Q

Complications of stroke

A

VTE
Infections such as oenumonia and UTI
Dysphagia and malnutrition
Seizures
Central post stroke pain syndrome
Spasticity
Depression
Stroke recurrence
Falls
Dehydration

25
Q

What are the non modifiable risk factors for stroke

A

Age
Sex (men more often but women die more often)
Race/ethnicity ( African descent)
Genetics

26
Q

What are the modifiable risk factors for stroke

A

Hypertension
Hyper cholesterol anemia
Smoking
Inactivity
A Fib
Heart disease
Diabetes
Alcohol