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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the definition of a stroke

A

An acute neurological deficit last more than 24 hours caused by cerebrovascular aetiology

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2
Q

What is the definition of a TIA

A

Stroke signs and symptoms that resolve within 24 hours

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3
Q

What percentage of strokes are ischaemic

A

Roughly 85%

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4
Q

What are the causes of an ischaemic stroke

A

Cerebral vessel thrombosis Arterial emboli (AF, endocarditis, MI) Atherthromboembolism (from carotids)

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5
Q

What are some causes of a haemorrhagic stroke

A

High BP Trauma Aneurysm rupture

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6
Q

What is the time window for thrombolysis for an ischaemic stroke

A

3-4.5 hours

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7
Q

What medication is used in thrombolysis

A

Alteplase - recombinant tissue plasminogen activator

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8
Q

What is the time window for endovascular intervention for ischaemic strokes

A

Within 6 hours from onset

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9
Q

Give 3 contraindications for thrombolysis in acute stroke

A

Haemorrhage Past CNS bleed Anticoagulants or INR >1.7 BP >220/130

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10
Q

A 70 year old man presented with right sided weakness and dysphasia. These symptoms lasted for 2 hours then resolved. The patient has a BP of 135/85 and no other co-morbidities. What is this patients ABCD2 score and what does this suggest

A

Age - >65 (1 pt) BP - >140/90 (1 pt) Clinical features - unilateral weakness (2 pts), speech disturbance w/o weakness (1 pt) Duration of symptoms - >60 mins (2 pts), 10-59 mins (1 pt) Diabetes (1 pt) This patient has a score of 5. Patients with a score of 4 or above should be assessed by a specialist within 24 hrs. A score of 6 or above strongly predicts a stroke

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11
Q

What is Hoffman’s sign?

A

Equivalent of Babinski in the upper limbs- elicit by flicking the DIP of the middle finger and watching (especially the thumb) for finger flexion

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12
Q

What suggests a lacunar stroke vs large vessel stroke?

A

Lacunar- classically involves only motor or sensory hemideficit.

Large vessel-both

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13
Q

What should you look for in patients with a right hemiparesis?

A

Speech abnormalities

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14
Q

How would you like to complete an examination of a patient with signs suggestive of a stroke?

A

Complete neuro exam Assess visual field defects (homonymous hemianopia) Assess speech Fundoscopy for papilloedema (SOL) Measure BP Assess pulse (AF) Auscultate for carotid bruits Check urinalysis (glycosuria) Ask patient which is their dominant hand

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15
Q

How would you differentiate a cerebral from a brainstem stroke?

A

Higher cerebral function abnormalities –> cerebral stroke

Cerebellar abnormalities, eye movement abnormalities or Horner’s syndrome –> brainstem

Also “crossed signs (i.e. pathology on both signs of the body) –> brainstem stroke

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16
Q

A patient with unilateral arm weakness > leg weakness is suggestive of a stroke in which artery?

A

MCA- predominantly affects the arms and face due to supply of motor homunculus

17
Q

A patient with unilateral leg weakness > arm weakness is suggestive of a stroke in which artery?

A

ACA- predominantly affects the legs due to supply of motor homunculus

18
Q

What visual field deficit is most likely after a stroke?

A

Homonymous hemianopia

19
Q

What is the most sensitive imaging for an acute infarct?

A

Diffusion-weighted MRI

20
Q

What is the medical management of acute stroke?

A

Thrombolysis within 4.5 hours (alteplase) Aspirin 300mg PO/PRr once haemorrhagic stroke excluded

21
Q

What further work up would you do on a patient who has had a stroke?

A

ECG ± 24 hour tape Thrombophilia screen Imaging- including echo for mural thrombus

22
Q

What secondary prevention measures can you take in a patient who has had a stroke?

A
  • Risk factor management:
    • Statin- start after 48 hour
  • Anticoagulants:
    • Aspirin/clopidogrel 300mg for 2 weeks
      • Then clopidogrel 75mg OD (preferred)
      • Or aspirin 75mg + dipyramidole 200mg
    • Warfarin instead if:
      • Cardioembolic stroke
      • Chronic AF
      • Start from 2 weeks post stroke (INR 2-3)
    • NB not aspirin and warfarin together
  • Carotid endarterectomy if good recovery + ipsilateral stenosis
23
Q

What rehabilitation is important to consider?

A

Requires a dedicated stroke unit

MENDS:

  • MDT:
  • Eating: Swallow and malnutrition screening
  • Neurorehab: Physio and speech
  • DVT prophylaxis
  • Sores- avoid at all costs
24
Q

What classification system is used for strokes?

A

Bamford classification of stroke (based on symptoms, gives prognosis)

  • TACS: Total anterior circulation stroke: Hemiplegia, homonymous hemianopia, higher cortical dysfunction. Worse prognosis
  • PACS: Partial anterior circulation. 2/3rds of the above
  • LACS: Lacunar infarct. Pure hemi-motor or sensory loss. Best prognosis

Neurology (29 decks)

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