Stroke Flashcards

1
Q

What are the different types of Stroke?

A
  • Ischaemic (85%)
  • Haemorrhagic (15%)
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2
Q

What is the urgent management of a suspected stroke?

A

Urgent non-contrast CT to distinguish between an Ischaemic stroke and a Haemorrhagic stroke.

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3
Q

What is the Ischaemic Penumbra?

A

It describes the cerebral area surrounding the ischaemic event where there is ischaemia without necrosis. This areas is amenable to recovery with thrombolysis.

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4
Q

What causes the majority of Ischaemic strokes?

A

50% due to Large Vessel Atherosclerosis e.g. Carotid Artery Stenosis.
Causing a Thrombus and then Emboli to get stuck in a smaller cerebral Artery.

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5
Q

What are other causes of Ischaemic stroke?

A

25% cause by intracranial small vessel Atherosclerosis.
20% are Cardio-Embolic, e.g. in AF there is a thrombus formed in the LA and subsequent embolisation to the brain.
Rare causes include Primary Vascular causes (vasculitis and Atrial dissection)

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6
Q

How does a Haemorrhagic stroke occur?

A

Occurs when there is rupture of a cerebrospinal artery.

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7
Q

What is the Stroke Classification called?

A

Bamford/Oxford Classification

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8
Q

What is a TACI defined by?

A
  • Contralateral Hemiplegia or Hemiparesis, AND
  • Contralateral Homonymous Hemianopia, AND
  • Higher cerebral dysfunction (e.g. aphasia, neglect)
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9
Q

Which Vessels Does a TACI Involve?

A

The Anterior AND middle Cerebral Arteries on the affected side.

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10
Q

What is a Partial Anterior Circulation Infarct defined by?

A

2 of Contralateral hemiplegia or hemiparesis,
Contralateral homonymous hemianopia,
Higher cerebral dysfunction (e.g. aphasia, neglect)

OR

Higher Cerebral Infarct Alone

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11
Q

What Vessels could be involved in a PACI?

A

The Anterior OR Middle cerebral Cerebral Artery on the affected side.

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12
Q

What is A Lacunar Infarct (LACI) defined by?

A

A pure motor stroke,
Pure sensory stroke,
Sensorimotor stroke,
Ataxic Hemiparesis,
Or Dysarthria-Clumsy Hands syndrome.

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13
Q

Which Vessels are affected by a LACI?

A

Affects the small deep perforating arteries, typically supplying the internal capsule or thalamus.

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14
Q

What defines a Posterior Circulation Infarct (POCI)?

A
  • Cerebellar Dysfunction, OR
  • Conjugated eye movement disorder, OR
  • Bilateral motor/Sensory deficit, OR
  • Ipsilateral Cranial Nerve Palsy with Contralateral motor/sensory deficit, OR
  • Cortical Blindness/Isolated Hemianopia.
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15
Q

What vessels are involved in a POCI?

A

The Vertebrobasilar Arteries and Associated branches (supplying the cerebellum, Brainstem, and Occipital Lobe)

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16
Q

What are Posterior Stroke Syndromes?

A

Also known as posterior circulation strokes, refer to strokes that affect the posterior circulation of the brain, which includes the brainstem, cerebellum, and posterior cerebral arteries.

17
Q

What Posterior Stroke Syndrome refers to Complete Loss of Movement with Preserved Consciousness and Preserved Occular movements (often only vertical gaze)?

A

Locked In Syndrome - Caused by an Acute basilar Artery Occlusion.

18
Q

What Posterior Stroke Syndrome - Causes ipsilateral Horner’s syndrome, Ipsilateral loss of pain and Temperature sensation on the face, and contralateral loss of pain and temperature sensation over the body?

A

Wallenberg’s syndrome (Lateral Medullary Syndrome or Posterior Inferior Cerebella Artery Stroke (PICA))

19
Q

What Posterior Stroke syndrome - results in lateral pontine syndrome, a condition similar to the medullary syndrome but with additional involvement of the pontine cranial nerve nuclei?

A

An Anterior Inferior Cerebella Artery Infarct results in Lateral pontine syndrome.

The additional Involvement of the pontine cranial nerve nuclei (located in the pons) includes affecting the facial nerve causing ipsilateral facial droop, and affecting the vestibulocochlear nerve causing deafness

20
Q

What Posterior Stroke syndrome - causes an ipsilateral oculomotor nerve palsy and contralateral hemiparesis?

A

Weber’s syndrome / Medial Midbrain Syndrome (Paramedian branches of the upper basilar and proximal posterior cerebral arteries)

21
Q

What is the acute management of a stroke?

A
  • DR ABCDE manner.
  • Airway protection and aspiration precautions in patients with either depressed consciousness or presenting with swallowing impairment.
  • Non-Contrast CT
22
Q

What is the most sensitive test for confirming ischaemic infarcts?

A

A diffusion weighted MRI - This is generally used if the Diagnosis is unclear but is not normally possible in the emergency setting.

23
Q

What are some contraindications to Thrombolysis?

A
  • Recent head trauma
  • GI or Intracranial Haemorrhage
  • Recent surgery
  • Acceptable BP
  • Platelet count
    -INR
24
Q

What treatment is indicated in patients presenting within 4.5 hours of symptom onset with no contraindications to Thrombolysis?

A

Alteplase (tissue plasminogen activator)

25
Q

If Hyper-acute treatments are not offered what should patients be treated with?

A

Aspirin 300mg orally OD for 2 weeks.

26
Q

If Hyper-acute treatments are offered when is Aspirin usually started>

A

24 hours after the treatment following a repeat CT head excluding any new Haemorrhagic Stroke.

27
Q

What Investigations in Ischaemic Stroke are done post-Acute?

A
  • Carotid US (to identify critical Carotid A stenosis)
  • CT/MR Angiography (to identify intracranial and extracranial stenosis)
  • Echocardiogram (If a Cardio-embolic source is suspected.
28
Q

What investigations in Haemorrhagic stroke are done post-acute?

A

Serum toxicology screen (sympathomimetic drugs e.g. cocaine are strong risk factors Haemorrhagic stroke)

29
Q

What is the long term anti-platelet of choice in Chronic Stroke management?

A

Clopidogrel.

Warfarin or DOACs would be started in ischaemic strokes secondary to AF.

30
Q

What should be screened for in all patients who have a stroke?

A
  • Diabetes Mellitus (OGTT or Fasting plasma glucose)
  • Serum Lipids should also be checked. (all post stroke patients started on high dose atorvastatin irrespective of Cholesterol level)
31
Q

When should Patients with Carotid Artery stenosis be referred for Carotid endarterectomy?

A

With Ipsilateral Carotid artery stenosis >50%

32
Q

What occurs in Horner’s Syndrome?

A

Ptosis, miosis and anhidrosis are signs of Horner’s syndrome which occurs due to a lesion to the sympathetic trunk.