STROKE Flashcards
What is a stroke?
A stroke is a medical condition that occurs when the blood supply to a part of the brain is interrupted or reduced preventing brain tissue from getting oxygen and nutrients.
What is a Transient Ischemic Attack (TIA)?
A Transient Ischemic Attack (TIA) is often called a ‘mini-stroke’ and occurs when there is a temporary decrease in blood supply to part of the brain.
What is cerebrovascular disease?
Cerebrovascular disease is a condition that affects the blood vessels in the brain leading to strokes and other neurological injuries.
What are the two main types of strokes caused by cerebrovascular disease?
The two main types of strokes are ischemic strokes (80%) and hemorrhagic strokes (20%).
Why is cerebrovascular disease significant in public health?
Cerebrovascular disease is significant because it is the third leading cause of death in developed countries and a major cause of long-term disability.
What are Transient Ischaemic Attacks (TIAs)?
TIAs are transient episodes of neurological dysfunction caused by focal brain spinal cord or retinal ischaemia without acute infarction.
What are the common causes of TIAs?
The common causes of TIAs include atherosclerotic thromboembolism and cardioembolism related to the cerebral circulation.
Why is the diagnosis and management of TIAs important?
Diagnosis and management of TIAs are important to prevent a potentially devastating stroke.
What happens to brain tissue during ischaemic stroke due to oxygen deprivation?
Brain tissue may undergo metabolic changes leading to cell death.
What is the ischaemic penumbra?
The ischaemic penumbra is an area of threatened but potentially salvageable brain tissue surrounding an infarct.
What are the primary causes of ischaemic strokes?
Ischaemic strokes are primarily caused by thromboembolism from the cerebral vasculature heart or aorta.
How does atherosclerosis contribute to ischaemic strokes?
Atherosclerosis leads to thrombus formation at plaque sites which can obstruct blood flow in the brain.
What complications can occur following a large anterior circulation ischaemic stroke?
Complications may include increased mass effect intracranial pressure and secondary hemorrhage into the infarct.
What are the most common causes of ischaemic strokes and transient ischaemic attacks (TIAs)?
Atherosclerotic thromboembolism of the cerebral vasculature and emboli from the heart.
Why is imaging necessary before starting treatment for suspected strokes?
To differentiate between haemorrhagic and ischaemic strokes as they require different treatments.
What is the ABCD2 score used for in the context of TIAs?
It is a clinical scoring system used to assess the risk of stroke following a TIA.
What is the recommended time frame for administering thrombolytic therapy in acute ischaemic strokes?
Within 4.5 hours of symptom onset.
What factors can complicate the differentiation of strokes from other neurological conditions in the emergency department?
Atypical presentations and the overlap of symptoms with other conditions.
What is the benefit of admitting stroke patients to a dedicated stroke unit?
Improved outcomes due to a multidisciplinary approach to management.
What are the non-modifiable risk factors for ischaemic stroke?
Increasing age gender and family history.
What is the most important modifiable risk factor for stroke prevention?
Hypertension.
Which cardiac condition is the most significant risk factor for TIA and stroke?
Atrial fibrillation (AF).
What are the CHADS2 and CHA2DS2-VASc scores used for?
To standardize the approach to primary stroke prevention in patients with non-valvular AF.
What lifestyle factors contribute to increased stroke risk?
Diabetes smoking and hypercholesterolaemia.
What is the role of carotid endarterectomy in asymptomatic patients with carotid stenosis?
Its role is controversial; intensive medical therapy is often preferred.
What are some common stroke mimics that can lead to misdiagnosis?
Common stroke mimics include seizures hypoglycaemia systemic infection brain tumour and toxic/metabolic disorders.
Why is it important to differentiate between stroke and its mimics?
Differentiating between stroke and its mimics is crucial because it affects treatment decisions such as the use of thrombolysis.
List at least three conditions that can mimic a stroke.
Three conditions that can mimic a stroke are seizures (with Todd paresis) hypoglycaemia and hypertensive encephalopathy.
What role do clinical investigations play in the differential diagnosis of stroke?
Clinical investigations help identify contributing factors to stroke/TIA and guide therapy differentiating it from other conditions.
What is Todd paresis and how is it related to stroke mimics?
Todd paresis is a postictal neurological deficit following a seizure which can mimic stroke symptoms.
What is the primary imaging modality used in the diagnosis of transient ischemic attacks (TIAs)?
A head CT or MRI scan is indicated for all patients with TIA.
Why is MRI preferred over CT for detecting posterior territory ischemic lesions in stroke patients?
MRI is more sensitive than CT in detecting posterior territory ischemic lesions especially in the brain stem.
What is the role of CT perfusion studies in acute stroke management?
CT perfusion studies help identify areas of irreversibly infarcted brain and at-risk ischemic brain.
What imaging technique is used to evaluate carotid stenosis in TIA patients?
Carotid ultrasound is the traditional first-line study for carotid stenosis.
What is the significance of diffusion-weighted imaging (DWI) in acute stroke diagnosis?
DWI is highly sensitive for detecting early ischemia or infarction within an hour of stroke onset.
When is a transesophageal echocardiogram (TOE) indicated in the evaluation of TIAs?
TOE is indicated when TTE results are inconclusive and there is ongoing concern for a cardioembolic source.
What is the Alberta Stroke Program Early CT Score (ASPECTS) used for?
ASPECTS is used to quantify the degree of acute ischemic change on CT scans in stroke patients.
What are the advantages of using CT angiography (CTA) in stroke evaluation?
CTA provides rapid imaging of vessels and can identify large vessel occlusions.
What factors determine the treatment strategy for stroke patients?
The treatment strategy is determined by the nature and site of the neurological lesion and its underlying cause.
What is the recommended blood pressure management for patients eligible for thrombolytic therapy in ischemic stroke?
Blood pressure should be reduced to less than 185/110 mm Hg prior to treatment and maintained below this level for 24 hours.
What is the ABCD2 score used for in the context of transient ischemic attacks (TIAs)?
The ABCD2 score is used for risk stratification to evaluate the early risk of stroke following a TIA.
What is the role of antiplatelet therapy in the management of TIAs and minor strokes?
Aspirin should be started at a dose of 300 mg and maintained at 75 to 150 mg/day to prevent further ischemic events.
What are the indications for thrombolysis in acute ischemic stroke?
Thrombolysis is indicated for patients with significant neurological deficits and no evidence of hemorrhage on CT treated within 3 to 4.5 hours of symptom onset.
What are the potential risks associated with thrombolysis in stroke treatment?
The primary risk is spontaneous intracranial hemorrhage (SICH).
What is the significance of clot retrieval in the management of ischemic stroke?
Clot retrieval can improve neurological outcomes in patients with large vessel occlusion up to 6 hours after symptom onset.
What is the recommended approach for managing elevated temperature in stroke patients?
Elevated temperature should be controlled and may indicate other underlying issues.
What is the role of surgery in the treatment of symptomatic carotid stenosis?
Urgent surgery may be beneficial for symptomatic carotid stenosis of 70% to 99% in patients with TIAs and minor strokes.
What is the importance of pre-hospital care in stroke management?
Pre-hospital care focuses on rapid identification and transport to stroke centers for timely treatment.
What is one controversy regarding thrombolysis in stroke management?
Thrombolysis beyond 3 hours post-onset is controversial.
What role do advances in neuroimaging play in stroke management controversies?
Advances in neuroimaging may improve patient selection for vessel opening strategies.
What is a key area of research in interventional therapies for acute ischemic stroke?
Research is focused on prolonging treatment windows and increasing recanalization rates.
What is the current status of neuroprotective therapies in stroke management?
Neuroprotective therapies cannot be recommended outside of clinical trials.
What is a recent trend in managing patients with Transient Ischemic Attacks (TIA)?
Management is shifting towards an outpatient model of care.
What is subarachnoid haemorrhage (SAH)?
SAH is the presence of extravasated blood within the subarachnoid space.
What is the primary clinical feature of SAH?
Severe sudden headache.
What is the initial investigation of choice for diagnosing SAH?
A computed tomography (CT) scan of the brain without contrast.
What should be done if a CT scan for SAH is negative?
Follow up with a lumbar puncture and examination of the cerebrospinal fluid.
Why is early diagnosis and treatment of SAH important?
Early occlusion of the aneurysm reduces complications and improves outcomes.
What is a common cause of subarachnoid haemorrhage?
Head trauma is the most common cause of SAH.
What is a sentinel haemorrhage in the context of SAH?
A warning leak that occurs hours to days prior to the major bleed.
What is the risk of re-bleeding after SAH?
The risk of re-bleeding is maximal in the first 2 to 12 hours after the initial bleed.
What treatment is typically preferred for SAH?
Endovascular treatment is the treatment of choice in most cases.
