Stroke Flashcards
1
Q
Definition
A
Sudden onset neurological deficits of vascular basis with infarction of CNS tissue
2
Q
Pathophysiology of ischemic stroke
A
- Arterial thrombosis
a. Large vessel->occlusion, stenosis of carotid, vertebral, IC arteries->insufficient flow beyond lesion->atherosclerosis, vasculitis, dissection
b. Small vessel->chronic HTN and diabetes= wall thickening and -ve luminal diameter->small penetrating= basal ganglia, internal capsule and thalamus - Cardioembolic->AF, RHD, prosthetic heart, recent MI, endocarditis
- Systemic hypoperfusion= global cerebral ischemia->affects watershed zones
3
Q
Pathophysiology of hemorrhagic
A
- Intracerebral hemorrhage
a. HTN most commonly->rupture of small microaneurysms (Charcot Bouchard) in putamen, thalamus, cerebellum, pons
b. Trauma
c. Amyloid angiopathy
d. Vascular malformation
e. Vasculitis
f. Drug use->cocaine - SAH
4
Q
What is hypertensive encephalopathy
A
Acute severe HTN (typically dBP >130 or sBP >200) can cause hypertensive encephalopathy – abnormal fundoscopic exam (papilledema, hemorrhages, exudates, cotton-wool spots), focal neurologic symptoms, nausea, vomiting, visual disturbances and change in LOC.
5
Q
Stroke syndrome with ACA
A
Contralateral leg paresis and sensory loss
6
Q
Stroke syndrome with MCA
A
- Contralateral weak/sensory loss of face and arm
- Cortical sensory loss
- CL homonymous hemianopia or quadrantonopia
- If left: aphasia
- If right: neglect
- Eye deviation to the side of the lesion and away from the weak side
7
Q
Stroke syndrome with PCA
A
- CL homonymous hemianopia or quadrantonopia
- Midbrain findings: CN 3/4 palsy, pupillary changes, hemiparesis
- Thalamic findings: sensory loss, amnesia, -ve LOC
- If bilateral->cortical blindness or prosopagnosia
8
Q
Stroke syndrome with basilar
A
“Locked in”
- Quadriparesis
- Dysarthria
- Impaired eye movement
9
Q
Stroke syndrome with PICA
A
Lateral medullary/Wallenburg
- Ipsilateral ataxia
- Ipsilateral horners
- Ipsilateral facial sensory loss
- CL limb impaired pain/temperature
- Nystagmus
- Vertigo
- NV
- Dysphagia
- Dysarthria
- Hiccups
10
Q
Stroke syndrome with anterior spinal artery
A
Medial medullary
- CL hemiparesis
- CL propioC and vibration
- IL tongue weakness
11
Q
Lacunar infarcts
A
Deep hemispheric white matter
- Pure motor hemiparesis->posterior limb of Internal capsule, CL arm, face, leg
- Pure sensory
- Ataxic hemiparesis: IL ataxia, leg paresis
- Dysarthria-clumsy hand syndrome: dysarthria, facial weak, dysphagia, mild hand weak/clumsiness
12
Q
Stroke mimics
A
SAH SDH Hypoglycemia IE Tumor Fitting Vasculitis Encephalitis Dural sinus thrombosis
13
Q
Acute management
A
- ABC
- Vital sign monitoring, oxygen, IVF (without glucose), NBM, NGT
- Check glucose, IV cannula
- Urgent help->specialist, consultant
- AMPLE: onset, when last well, mimics: post ictal, hypoglycemia, migraine, conversion, recent stroke/epilepsy/MI/AF/Surgery/Trauma/Bleeding/Hx hemorrhagic/HTN, DM/current drugs/Medicine-anticoagulation, insulin, antiHTN
- Investigations: non contrast CT, ECG, CBC, UEC, Cr, Coagulation, glucose, Troponins
- Indications for thrombolysis->alteplase
- Aspirin 150-300mg PO via NGT
- Admit to stoke unit
- TEDs?
- Monitor regularly- vitals, blood glucose levels
- Assessment of swallowing
- Do not lower BP unless >220/110
- oxygen if hypoxic
- Paracetamol if fever
- Early mobilisation, hydration, enoxaparin
- Rehabilitate early
- With-hold BP lowering medication for 5 ays unless ++high
- Etiological investigation->further imaging, ECHO, holter
14
Q
Prevention of second stroke
A
- Identify underlying cause
- Aspirin 70-150mg PO daily
- Warfarin if AF
- ACEi
- Statin therapy
- Exercise, diet, weight loss, smoking cessation
- Diabetes management
15
Q
CHADS
A
CHADS2 Stroke risk stratification for patients with atrial fibrillation Congestive heart failure (1 point) Hypertension sBP >160 mmHg/treated hypertension (1 point) Age >75 yr (1 point) Diabetes (1 point) Prior Stroke or TIA (2 points)
