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Year 6 Cardiology > Stroke > Flashcards

Stroke Flashcards

1
Q

Anterior cerebral artery effects

A

Contralateral hemiparesis and sensory loss, lower extremity > upper

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2
Q

Middle cerebral artery effects

A

Contralateral hemiparesis and sensory loss, upper extremity > lower

Also associated with contralateral homonymous hemianopia and aphasia.

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3
Q

Posterior cerebral artery effects

A

Contralateral homonymous hemianopia with macular sparing and visual agnosia.

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4
Q

Weber’s syndrome effects

A

Ipsilateral CN III palsy and contralateral weakness of upper and lower extremity.

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5
Q

Posterior inferior cerebellar artery effects

A

Ipsilateral: facial pain and temperature loss; Contralateral: limb/torso pain and temperature loss; Ataxia, nystagmus.

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6
Q

Anterior inferior cerebellar artery effects

A

Symptoms are similar to Wallenberg’s, but: Ipsilateral: facial paralysis and deafness.

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7
Q

Retinal/ophthalmic artery effect

A

Amaurosis fugax.

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8
Q

Basilar artery effect

A

‘Locked-in’ syndrome.

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9
Q

Lacunar strokes presentation

A

Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia.

Strong association with hypertension; common sites include the basal ganglia, thalamus and internal capsule.

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10
Q

What is a stroke?

A

A stroke (cerebrovascular accident, CVA) represents a sudden interruption in the vascular supply of the brain, leading to potential irreversible damage.

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11
Q

What are the two main types of strokes?

A
  1. Ischaemic
  2. Haemorrhagic
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12
Q

What is a transient ischaemic attack (TIA)?

A

A TIA describes the sudden onset of focal neurologic symptoms lasting typically less than an hour due to a transient decrease in blood flow.

Sometimes referred to by patients as a ‘mini-stroke’.

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13
Q

What is the essential problem in ischaemic strokes?

A

‘Blockage’ in the blood vessel stops blood flow.

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14
Q

What is the essential problem in haemorrhagic strokes?

A

Blood vessel ‘bursts’ leading to reduction in blood flow.

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15
Q

What percentage of strokes are ischaemic?

A

85%

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16
Q

What percentage of strokes are haemorrhagic?

A

15%

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17
Q

What are the subtypes of ischaemic stroke?

A
  1. Thrombotic stroke
  2. Embolic stroke
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18
Q

What are the risk factors for ischaemic stroke?

A

General risk factors for cardiovascular disease include age, hypertension, smoking, hyperlipidaemia, and diabetes mellitus.

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19
Q

What are the symptoms of a stroke?

A

Features include motor weakness, speech problems (dysphasia), swallowing problems, visual field defects (homonymous hemianopia), and balance problems.

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20
Q

What is the Oxford Stroke Classification?

A

A classification system that categorizes strokes based on initial symptoms.

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21
Q

What are the criteria for Total anterior circulation infarcts (TACI)?

A

Involves middle and anterior cerebral arteries with all three of the following criteria present: unilateral hemiparesis and/or hemisensory loss, homonymous hemianopia, and higher cognitive dysfunction.

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22
Q

What mnemonic is used to raise awareness of stroke symptoms?

A

The FAST campaign:
Face - ‘Has their face fallen on one side? Can they smile?’
Arms - ‘Can they raise both arms and keep them there?’
Speech - ‘Is their speech slurred?’
Time - ‘Time to call 999 if you see any single one of these signs.’

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23
Q

What investigations are needed for suspected stroke?

A

Emergency neuroimaging using CT or MRI.

24
Q

What is the management for ischaemic strokes?

A

If ischaemic, and criteria are met, the patient should be offered thrombolysis and given aspirin 300mg as soon as possible.

25
Q

What is the management for transient ischaemic attacks (TIAs)?

A

Immediate antithrombotic therapy with aspirin 300 mg unless contraindicated, and urgent assessment if symptoms occurred within the last 7 days.

26
Q

What should be done if a haemorrhagic stroke is confirmed?

A

Consider neurosurgical consultation and supportive management, stopping anticoagulants and lowering blood pressure acutely.

27
Q

What is the first line radiological investigation for suspected stroke?

A

A non-contrast CT head scan.

28
Q

What are the two main types of strokes to differentiate in a CT scan?

A

Ischaemic stroke and haemorrhagic stroke.

29
Q

What rare third pathology might be detected in a CT scan for stroke?

A

A tumour.

30
Q

Why is it important to differentiate between stroke types?

A

Due to the increasing role of thrombolysis and thrombectomy in acute stroke management.

31
Q

What may acute ischaemic strokes show on a CT scan?

A

Areas of low density in the grey and white matter of the territory. These changes may take time to develop.

32
Q

What is the ‘hyperdense artery’ sign?

A

It corresponds with the responsible arterial clot and tends to be visible immediately.

33
Q

What do acute haemorrhagic strokes typically show on a CT scan?

A

Areas of hyperdense material (blood) surrounded by low density (oedema).

34
Q

What is the National Clinical Guideline for Stroke?

A

The National Clinical Guideline for Stroke was published in 2023 and is a partial update of the 2016 Royal College of Physicians (RCP) guidelines.

35
Q

What should be maintained within normal limits in the management of acute stroke?

A

Blood glucose, hydration, oxygen saturation, and temperature should be maintained within normal limits.

36
Q

What is the guideline for blood pressure management in acute ischaemic stroke?

A

Blood pressure should not be lowered in the acute phase of ischaemic stroke unless there are complications or they are being considered for thrombolysis.

37
Q

When should blood pressure control be considered in acute ischaemic stroke patients?

A

Blood pressure control should be considered for patients who present within 6 hours and have a systolic blood pressure > 150 mmHg.

38
Q

What is the recommended aspirin dosage for acute ischaemic stroke?

A

Aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded.

39
Q

When should anticoagulants be started for patients with atrial fibrillation after an ischaemic stroke?

A

Anticoagulants should not be started until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke.

40
Q

When should statin treatment be commenced for patients with high cholesterol after an ischaemic stroke?

A

If cholesterol is > 3.5 mmol/l, patients should be commenced on a statin, although many physicians will delay treatment until after at least 48 hours.

41
Q

What are the standard criteria for thrombolysis with alteplase or tenecteplase?

A

Thrombolysis is administered within 4.5 hours of onset of stroke symptoms and haemorrhage has been definitively excluded.

42
Q

What does the 2023 National Clinical Guideline for Stroke recommend regarding thrombolysis timing?

A

Patients with an acute ischaemic stroke, who were last known to be well more than 4.5 hours earlier, should be considered for thrombolysis if treatment can be started between 4.5 and 9 hours of known onset.

43
Q

What is the blood pressure requirement before thrombolysis?

A

Blood pressure should be lowered to 185/110 mmHg before thrombolysis.

44
Q

What are absolute contraindications to thrombolysis?

A

Absolute contraindications include previous intracranial haemorrhage, seizure at onset of stroke, and suspected subarachnoid haemorrhage.

45
Q

What are relative contraindications to thrombolysis?

A

Relative contraindications include pregnancy, concurrent anticoagulation (INR >1.7), and active diabetic haemorrhagic retinopathy.

46
Q

What is mechanical thrombectomy?

A

Mechanical thrombectomy is a treatment option for patients with an acute ischaemic stroke, requiring significant resources and senior personnel.

47
Q

What are the recommendations for thrombectomy timing?

A

Thrombectomy should be offered as soon as possible and within 6 hours of symptom onset, together with intravenous thrombolysis if within 4.5 hours.

48
Q

What is the modified Rankin scale recommendation for thrombectomy?

A

NICE recommends a pre-stroke functional status of less than 3 on the modified Rankin scale for thrombectomy consideration.

49
Q

What is the recommendation for secondary prevention after an ischaemic stroke?

A

Clopidogrel is now recommended ahead of combination use of aspirin plus modified-release dipyridamole.

50
Q

When is carotid endarterectomy recommended?

A

Carotid endarterectomy is recommended if the patient has suffered a stroke or TIA in the carotid territory and has stenosis > 50%.

51
Q

What is the time frame for performing carotid endarterectomy?

A

It should be performed as soon as possible within 7 days.

52
Q

What is hemianopia?

A

Hemianopia is a visual field loss on one side of the vertical midline.

Example: A person with right hemianopia cannot see objects on their right side.

53
Q

What is Lateral medullary syndrome?

A

Lateral medullary syndrome, also known as Wallenberg’s syndrome, is caused by a stroke in the posterior inferior cerebellar artery.

Symptoms include ipsilateral ataxia, nystagmus, dysphagia, facial numbness, and cranial nerve palsy (e.g., Horner’s).

54
Q

What are the ipsilateral symptoms of Lateral medullary syndrome?

A

Ipsilateral symptoms include ataxia, nystagmus, dysphagia, facial numbness, and cranial nerve palsy.

Example: Horner’s syndrome can occur as a result of this condition.

55
Q

What are the contralateral symptoms of Lateral medullary syndrome?

A

Contralateral symptoms include limb sensory loss.

56
Q

What is Weber’s syndrome?

A

Weber’s syndrome is characterized by ipsilateral oculomotor nerve (III) palsy and contralateral weakness.

57
Q

What are the symptoms of Weber’s syndrome?

A

Symptoms include ipsilateral III palsy and contralateral weakness.

Year 6 Cardiology (36 decks)

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