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Behaviour > Stroke > Flashcards

Stroke Flashcards

0
Q

two main types of stroke

A

Ischaemic stroke *85%

Haemorrhagic (inc SAH)

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1
Q

definition of stroke

A

neurological deficit related to an atraumatic vascular event

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2
Q

what events are NOT included in the current definition of stroke

A

Extradural haematoma

Subdural haematoma

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3
Q

what is a TIA

A

neurovascular event with symptomatic resolution within 24 hours

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4
Q

what are the cardinal features of stroke?

A

FOCAL
NEGATIVE
ACUTE
obey arterial territory –> if > 3 territories unlikely to be a stroke

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5
Q

what is the cushing’s reflex

A

sudden increase in systemic blood pressure and decrease in heart rate in response to an increase in intracranial pressure

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6
Q

What is todd’s paresis?

A

After seizure weakness

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7
Q

What is the significance of crossed signs after a stroke

A

It indicates that there is injury to the brainstem

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8
Q

What is amaurosis fugax?

A

The sensation of a “curtain coming down” in one eye. It is indicative of micro embolism in the retinal circulation

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10
Q

What does papilloedema show?

A

That there has been a gradual increase in ICP as in a venous cerebral event such as CVST

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11
Q

what are the features of an extradural haemorrhage

A

lentiform appearance on imaging
follows linear skull vault fractures, usually affecting middle meningeal artery
patient presents with euro signs after a lucid interval
surgery is often indicated

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12
Q

what are the features of a subdural haemorrhage

A

crescent shape on CT/MRI
acute hyper dense
chronic hypodense
accumulation of blood in the subdural space following the rupture of a vein

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13
Q

what is ABCDD

A

risk of two day recurrent stroke risk based on:

  • age
  • blood pressure
  • clinical features
  • duration
  • diabetes
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14
Q

what would defect in anterior cerebral artery show

A

weak leg (+/-shoulder) on contralateral side

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15
Q

what would defect in middle cerebral artery show

A

weak arm and face on contralateral side:

  • hemiplegia
  • hemianopia
  • aphasia
  • visuospatial problems
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16
Q

what would defect in the posterior cerebral artery show

A

eye problems

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17
Q

what is the presentation of cerebral haemorrhage

A

as with ischaemic stroke but with

  • sudden onset headache
  • sudden and progressive neuro defects
  • most likely to lose consciousness
  • raised ICP –> cushion’s (late)
18
Q

what is the presentation of subarachnoid haemorrhage

A

sudden headache and vomiting
meningism
LoC

19
Q

what is the presentation of CVST

A

subacute raised ICP –> papilloedma can develop

  • younger pts w/DVT risk factors
  • no respect for arterial territories
  • absence of sinuses on venograms
20
Q

what is the criteria for thrombolysis in stroke

A

must be ischaemic stroke
within 3 hrs
must be stable and no risk factors for intra-cranial haemorrhage

21
Q

on CT what do hyper dense vessels suggest

A

thrombus if localised

if all bright –> increased haematocrit

22
Q

what is more accurately seen (in the case of stroke) on CT

A

thrombus

23
Q

what does the loss of normal grey white differentiation of head CT suggest

A

early infarction

gets darker late

24
Q

what is head MRI good for in the context of stroke

A

small infarcts

25
Q

atherosclerosis of the lenticulostriate arteries causes what

A

lacuna infarction

associated with chronic hypertension

26
Q

where is venous infarction likely to haemorrhage

A

at the top of the brain

27
Q

what is Charcot-Bouchard aneurysms

A

aneurysms of microvasculature associated with chronic hypertension
causes vascular coiling
often in lenticulostriate arteries

28
Q

where are the common sites for Berry aneurysms

A

between PCA and ICA
between anterior communicating and ACA
at the bifurcation of the MCA

29
Q

what are Berry aneurysms associated with

A

coarctation of the aorta
polycystic kidney disease
renal artery stenosis

30
Q

what is the average cerebral blood flow

A

50mls/100g/min

accounts for 20% of resting CO

31
Q

what does profound hypotension cause in the context of cerebral iaschaemia

A

inadequate CBF for metabolic needs

impaired cellular metabolism

decreased neuronal activity

32
Q

autoregulation maintains CBF at what pressure

A

between 50-150mmHg

33
Q

what can impair auto regulation in the brain

A 
increasing age
head trauma
SAH
ischaemic stroke
cerebral hypoxia
high pCO2
34
Q

which cells are most vulnerable to hypoxic injury in the brain

A

pyramidal cells in the hippocampus and purkinje cells of the cerebellum

35
Q

what is laminar necrosis

A

loss of layers of neurones following global ischaemia

36
Q

what is penumbra

A

area of oedematous cells around the dead cells which have the potential to be saved

37
Q

how is oedema caused in hypoxia

A

hypoxia causes failure of the NaKATPase leading to XS Na

water follows Na into the cell

cells burst and die

this can also increased ICP
this can intern reduce blood supply to the brain

38
Q

besides hypoxia, what else causes intracellular accumulation of Na in the brain

A

continued depolarisation of neutrons in the affected area

caused by cessation of ATP dependant reuptake of glutamate

this is call EXCITIOXICITY

39
Q

what does excitotoxicity cause in the brain following stroke

A

failure of AMPA and NMDA receptors

  • -> Ca levels in cells are excessive:
  • release of free radicals -> necrosis
  • inflammatory cytokines
  • Ca also causes apoptosis in the penumbra
40
Q

which clinical signs are most likely to present in an anterior circulation infarct

A 
aphasia/dysphasia
hemiparesis
amaurosis fugax
sensory loss
hemianopic visual loss
41
Q

which clinical signs are most likely to present in a posterior circulation infarct

A 
diplopia, vertigo, vomiting
chocking/dysarthria
hemianopic visual loss
sensory loss
transient glocal amnesia
tetraparesis

Behaviour (10 decks)

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