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Surgery II > STROKE > Flashcards

STROKE Flashcards

1
Q

what are the risk factors of stroke?

A
  1. hypertension
  2. diabetes
  3. heart disease
  4. high blood lipid
  5. alcohol and drugs
  6. hereditary factors
  7. age sex race family history
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2
Q

what are the classifications of stroke?

A

ischemic 80%-85%
hemorrhagic 15%

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3
Q

what are the types of ischemic stroke?

A

transient ischemic attack
reversible ischemic neurological deficit
incomplete stroke
complete stroke

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4
Q

what are the types of hemorrhagic stroke?

A

intracranial and subarachnoid (primary+secondary)

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5
Q

what is the cause of primary hemorrhagic stroke?

A

Hypertension

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6
Q

what are the causes of secondary hemorrhagic stroke?

A

coagulopathy
vasculopathy
arteriovenous malformation
aneurysm
drug abuse
intracerebral tumor

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7
Q

describe TIA

A

sudden onset
resolves within 24h
no residual neurological deficit

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8
Q

describe RIND

A

lasting more than 24hr
resolves within 1 week
no residual neurological deficit

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9
Q

describe incomplete stroke

A

Infarction with residual neurological deficit that is not disabling like dysphagia and incomplete paresis

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10
Q

describe complete stroke

A

profound multimodal neurological deficit like
hemiplegia
hemianopia
hemisensory deficit

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11
Q

what’s the etiology of ischemic stroke?

A

1)large atherosclerosis
2) lacunar infarction–>penetrating artery disease
3)cardioemboilism
4)systemic hypoperfusion
5) other air/fat/tumor emoli

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12
Q

which 2 territories commonly affected by ischemic stroke?

A

carotid territory (supratentorial)
vertebrobasilar territory (infratentorial)

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13
Q

what is the clinical picture of carotid territory ischemic stroke?

A

1)decreased retinal perfusion causing transient monocular blindness (amaurosis fugax)
2) decreased cerebral perfusion causing hemiparesis - hemianesthesia- dysphagia

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14
Q

what is the clinical picture of vertebrobasilar territory ischemic stroke?

A

1) binocular visual disturbance diplopia nystagmus
2) vertigo ataxia deafness tinnitus
3) bilateral weakness and maybe unconscious
transient ischemia of brain stem and upper spinal cord

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15
Q

what is the clinical picture of hemorrhagic stroke?

A

focal neurological deficits:
manifestations of increased ICP
change in level of consciousness
headache and neck stiffness in SAH

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16
Q

what is the gold standard imaging for stroke?

A

MRI AND CT angiography

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17
Q

INVESTIGATIONS FOR STROKE?

A

ECG AND LABS (lipid profile)

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18
Q

what are the medical treatments of ischemic stroke?

A

1)thrombolytic agent TPA
2) anithrombotic therapy—-> antiplatelet aspirin and anticoagulant—> heparin and oral anticoagulant
3)medical treatment of the risk factors

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19
Q

what are the surgical treatments of ischemic stroke?

A

Decompressive craniotomy for massive strokes causing shift
carotid endarterectomy
intracranial embolectomy

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20
Q

what are the medical treatments of intracranial hemorrhage?

A

care of respiration
antihypertensive and anti epileptic drugs
fluids electrolytes and nutrients
control of intracranial pressurew

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21
Q

what are the surgical treatments of intracranial hemorrhage?

A
  1. continuous ventricular drainage
  2. craniotomy
  3. bur hole aspiration
  4. stereotactic thromolysis nad aspiration
  5. endoscopic evacuation
22
Q

describe grade 1 subarachnoid hemorrhage

A

severe excruciating hemorrhage
vomiting
dizziness
neck stiffness or pain radiating to the back of the head which is a sign of meningeal irritation by blood

23
Q

describe grade 2 subarachnoid hemorrhage

A

momentary loss of consciousness

24
Q

describe grade 3 subarachnoid hemorrhage

A

sudden coma preceded by headache and unilateral deficit after recovery

25
Q

describe grade 2 subarachnoid hemorrhage

A

sudden coma with no recover and bilateral deficits

26
Q

what are the signs of SAH?

A

mild pyrexia
signs of meningitis: neck stiffness - kernig’s and brudziniski’s signs Both +ve

27
Q

what are the investigations for SAH?

A

1) lunar puncture: diagnostic if no CT fresh blood
2) CT hyperdense shadow with bonelike density
3) angiography: through anticubital or femoral veins
4) MRA diagnosis of aneurysm, AVM and hemorrhage into tumors

28
Q

what are the complications of SAH?

A

1) rebleeding 30% within first 2 weeks and 50% within first year
2)vasospasm: caused by irritation of the vessel by blood
50% die and 50% suffer permanent deficit
3)hydrocephalus
4) seizures

29
Q

what are the medial treatments of SAH?

A

bed rest sedationn analgesia
triple H therapy: HTN hypervolemia hemodilution
anti epileptic drugs
oxygenation corticosteroids stool softener H2 antagonists
calcium antagonist: prevent vasospasm

30
Q

what are the surgical treatments of SAH?

A

1.clipping of the aneurysm
2.endovascular surgery induce
thrombosis by coils or ballon
3.trapping (2clips before and after)
4. wrapping of aneurysm

31
Q

cerebral aneurysm?

A

congenital defect in the tunica media and elastic membrane ate the apex of the vessel when it bifurcates

32
Q

what are the types of arteriovenous malformation?

A

arterial angioma
venous angioma
AAVM
telengactasia

32
Q

clinical picture of cerebral aneurysm

A

1) asymptomatic
2) pressure symptoms:
i)on the brain:migraine epilepsy
ii)on cranial nerves: 3rd nerve affected , ptosis , ophthalmoplegia
3) leakage and rupture:
i) rupture: immediate death
ii) leakage: warning, death within 2-
3 weeks

32
Q

what are the most common site of cerebral aneurysm?

A

anterior circulation 85% anterior communicating artery
posterior circulation 15% tip of basilar artery

32
Q

age group of arm?

A

10-20 years max 30

32
Q

clinical picture of AVM?

A

1) epilepsy
2) bleeding
3) weakness progressive and dementia
4) migraine

32
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A
32
Q

what are the investigations for AVM?

A

plain x-ray: patchy calcification
CT: areas of bleeding
CT+ contrast: special pattern of AVM
angiography: MRA - retrograde femoral

32
Q

what are the signs of AVM?

A

To and Fro murmur
bruit over carotid or over the skull at the site of malformation

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Surgery II (4 decks)

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