Stroke Flashcards
What is stroke?
blood vessel disease
a BV gets affected
ischaemia/lack of blood flow to brain
What are focal neurological symptoms?
- you can classify which area of brain is affected by the certain symptoms
What is the major burden of stroke?
- rarely kills
- causes disability
- loss of independence
- financial/family burdens
Name the 2 types of stroke
- ischaemic (block of BV chasing hypoxia)
- haemorrhagic (rupture of BV chasing bleeding)
What is the most common variety of stroke?
- ischaemic (80-85%)
Causes of hemorrhagic stroke?
- high BP
- weakened BV due to a) structural abnormalitites (e.g. anuerysm) b) arteriovenous malformation c) thrombolysis d) inflammation of vessel wall (vasculitis)
Causes of ischaemic stroke?
- thrombus
- embolic
- hypoperfusion
What type of ischaemic stroke affects smaller BV?
- thrombotic
What type of ischaemic stroke occlude larger BV?
- embolic
What is hypo perfusion?
- area of narrowing in blood vessel
- requires systolic bp of ~140 to perfuse
- drop in BP
- not enough blood to supply brain
Describe mechanism of atherosclerotic stroke
risk factor - atherogenesis - plaque - rupture - platelets - thrombosis - ischaemia
or
plaque - vessel stenosis - low blood flow - ischaemia
Non-modifiable risk factors for stroke?
- age
- fam history
- gender
- race (South Asians)
- previous stroke
Modifiable risk factors
- HYPERTENSION
- smoking
- obesity
- atrial fibrillation
- inactivity
- congestive heart failure
- alcoholism
What treatment is recommended in all patients with ischaemic stroke?
- statins
- reduces hyperlipidaemia
6 essential questions to consider when diagnosing stroke?
- is this a stroke
- what kind of stroke
- what caused stroke
- have you tried your best to answer q3
- is patient on appropriate secondary prevention following investigation
- have i answered patients questions
What conditions can stroke mimic?
- hypoglycaemia
- seizures
- migraine
- hyperglycaemia/ hyponatremia
- space occupying lesson (e.g. brain tumours)
- functional hemiparesis
What should you look for on examination?
- AF
- signs of cardiac failure
- neurological exam
What is the only investigation to differentiate between types of stroke?
- imaging
- CT +/- angiography
- MRI +/- angiography
What investigations can diagnose an ischaemic stroke?
- bloods
- large BV occlusion: carotid scanning; CT/MR angiography of aortic arch (for atheroembolism)
- cardioembolism: establish whether patient has AF; ECG (detects old ischaemic changes); left-ventricular hypertrophy
- echocardiogram
Where can embolic stroke arise from?
- blood vessel: atheroembolism
- heart: cardioembolism
How can we distinguish between athero/cardioembolism?
- athero: infarcts dame side as affected carotid artery
- cardiac: infarcts in >1 arterial territory; bilateral
- investigation for hemorrhagic stroke?
- imaging (investigate cause of bleeding)
What type of hemorrhagic stroke can hypertension cause?
- deep haemorrhage
- usually in older patients
If a young person has a haemorrhagic stroke (who is normotensive?)
- lobar haemorrhage
- investigate for underlying aneurysm
- arteriovenous malformation
What is the medical management for stroke?
- aspirin (75mg)
- dipyridamole MR (200mg twice daily)
- statins
- anticoagulation in AF
- anti-hypertensives (even in normotensives)
What will stop future stroke?
- antihypertensives (e.g. ACEI + diuretic)
antihypertensives with 2 largest benefits against stroke?
- perindopril
- indapamide
Can surgery help stroke?
- haematoma evacuation
- relieves intracranial pressure
- carotid endarterectomy: manages stroke disease
