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Neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

Definition

A

Rapidly developing clinical signs of focal disturbance of cerebral function, last >24hrs or leading to death with no appararent cause of the vascular origin

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2
Q

Types

A

Ischaemic - 80%
Intra-cranial haemorrhage
Sub-arachnoid haemorrhage

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3
Q

Ischaemic stroke

A

blocakge of blood vessels to the brain by a clot

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4
Q

Ichaemic stroke can occur by?

A

Thrombosis: A clot may form in an artery that is already very narrow.

Embolic: A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain.

Systemic hypoperfusion - global hypoxia

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5
Q

Thrombotic stroke

A

Large vessel - Atheosclerosis artery

Small vessel disease - liphyalnosis (wall thickenging and reduced lumen) –> lacunar type stroke

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6
Q

Embolic stroke

A 
cardiac 
-AF
-MI 
Aortic 
>3mm atheroma 
Arterial 
-atheroma 
-dissection
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7
Q

Circle of willis !

A
  • Four blood vessels supply the brain
  • 2 carotids supply front
    o Split into the anterior and middle cerebral arterys
  • 2 artery’s supply back
    o 2 vertebral combine to form the basilar artery
    o The split to form posterior cerebral arterys
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8
Q

Pathophysiology of ischaemic stroke

A
  • Embolism or thombus present
  • Depending on size of clot, it lodges into relevant size of vessel (large vessel, large clot)
  • Rapid decline in cerebral blood flow
  • Results in excitotoxicity:
    o Neurons release glutamate (excitatory neurotransmitter)
    o Glutamate activates calcium and sodium entry into the cell
    o Sodium entry, water follows, cell swells and dies
    o Calcium entry
     Activates enzymes and proteases
     Apoptosis
     Oxidative damage
     Inflammation
    o Leads to cell death
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9
Q

Anterior cerebral artery supplies

A

Anterior and Medial side of brain

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10
Q

Middle cerebral artery supplies

A

lateral side of the brain

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11
Q

Posterior cerebral artery supllies

A

occiptal lobes

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12
Q

Map of tissue death

A

Core- tissue that has died
Penumbra - damaged, but slvageable tissue
Oligaemia - area of low flow

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13
Q

Risk factors for ischaemic stroke

big 5

A
  • hypertension
  • smoker
  • diabetes
  • hypercholesterolaemia
  • famil history
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14
Q

Intracerebral haemorrhage pathophysiology

A
  • Blood pressure, tends to cause deep haemorrhage (haemorrhage aound basal ganglia)
  • Blood pressure is high around the base of the brain, as vessles extend out towards the edge, pressure drops
  • Small BVs are at high risk of rupture in the presence of high blood pressure
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15
Q

Risk factors for intracerebral haemorrhage

A
  • Hypertension!!!!!!!
  • Anticoagulants, anti-platelet, warfarin
  • Dementia
  • Amyloid deposits (cerebral amyloid angiopathy)
  • Vascular malformations (drug abuse in youn
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16
Q

Clinical manifestations of stroke

A 
Face 
Arms 
Speech 
Time
(FAST)

TACS, PACS, POCS, LACS

17
Q

TACS (total anterior circulation syndrome)

Artery affected

A

Total anterior circulation syndrome (TACS)
It is diagnosed when it causes all 3 of the following symptoms:
1) Contra-lateral hemiparesis
2) Contra-lateral hemianopia
3) Higher dysfunction (e.g Dysphasia, Visuospatial disturbances)
+- contralateral hemisensory loss

proximal middle cerebral, or internal cereral artery

18
Q

PACS (partial anterior circulation syndrome)

A

Partial anterior circulation stroke (PACS)
When 2 of the above 3 are present or when higher dysfunction alone.

Branch of middle cerebral artery

19
Q

POCS (Posterior circulation stroke)

A 
It can cause the following symptoms:
•	Cranial nerve palsy (ipsilateral) with contralateral motor/sensory defect 
•	Bilateral motor or sensory defect 
•	Eye movement disorder 
•	Cerebellar signs 
•	Isolated homonymous hemianopia 
.
Posterior, basilar, cerebellar and vertebral arteries

The hallmark of posterior circulation stroke is that of crossed findings; with
cranial findings on the side of the lesion and motor or sensory findings on the
opposite side

20
Q

LACS (lacunar stroke)

A 
Lacunar stroke (LACS)
Can have the following presentations:
•	Pure motor stroke/hemiparesis
•	Ataxic hemiparesis
•	Dysarthria/clumsy hand
•	Pure sensory stroke
•	Mixed sensorimotor stroke

Internal capsule (pure motor), Thalamus (pure sensory) or Pons (ataxia, Contralateral hemiparesis and ipsilateral cerebellar signs)

Perforating artery/small vessel disease

21
Q

Transient Ischaemic Attack (TIA)

A

Transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without acute infarction and over within 24hours

22
Q

Baseline investigations

A

Glucose

  • too high dont treat with thromboylsis
  • hypoglycaemia (neurological deficit)

FBC, U7Es, LFTS, blood glucose, coagulation profile

ECG- look for atrial fibrillation

CT- easy & quick (eclude mimics, distinguish between haemorrhagic/ischaemic, confrim diagnosis, detects complications and salvagebale tissu)

Vascular
-CT angiogram/MR angiogram/doppler ultrasound

23
Q

Ichaemic vs haemorrhagic

A 
Cannot distinguish clinically 
ICH more likely if: 
-	Decreased conscious level 
-	Vomiting 
-	Severe headache 
-	Warfarin 
-	Systolic BP >220 mmHg 
-	Progressive symptoms 
These results are not absolute, cannot without scan
24
Q

Treatment of stroke

ACUTE THERAPY

A
  1. admitt to stroke unit
  2. thrombolysis if within 4.5 hours
    - give IV alteplase
    - only for ischaemic stroke
  3. after 4.5 hours
    - aspirin 300mg at FRONT DOOR
  4. neurointervention - if thromboylsis fails (retrieve the clot)

NOTE- if AF give warfarin

25
Q

Treatment of stroke

Damage limitation

A

decompress hemicranectomy

  • to relieve pressure
  • young patients
26
Q

Treatment of stroke

Further prevention

A

aspirin + dipyridamole = clopidogrel

Antihypertensives- ACEI- stable patient

Statins

27
Q

Other rehabilitation

A 
Rehab 
- physio 
-speech therapy 
-occupation therapy 
Smoking cessation 
Dietician 
Pyschology
28
Q

Prognosis ischaemic

A 
early mortality - 20% 
independence at 6 motnhs - 60% 
risk of recurrence 
-10% at 1 month 
-18% at 3 months
29
Q

Prognosis haemorrhagic stroke

A
  • Early mortality = 60%
  • Independence at 6 months = 20%
  • Risk of recurrence – 2 % per year
30
Q

Intracerebral Haemorrhage treatment

A
  1. ABCs
  2. Admitt stroke unit
  3. prevent haemotoma expansion
    - reverse anticoagulants (prothrombin complex concentrate preferreed)
    - lower bP ??
  4. Neurosurgery only indicated if posterior fossa haemotoma
  5. treat pyrexia
  6. DVT prophylaxis
  7. Nutrition
  8. Early rehab
31
Q

Complications of stroke

A 
Brain oedema 
Pneumonia 
Urinary tract infections 
Seizures 
Clinical depression 
Bedsores 
DVT

Neuro (16 decks)

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