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neuro year 4 > stroke > Flashcards

stroke Flashcards

1
Q

how is stroke defined

A

rapid onset cerebral deficit lasting >24h or leading to death with no other cause apparent other than a vascular one

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2
Q

what is the definition of TIA

A

brief episode of neurological deficit temporary focal cerebral or retinal ischaemia without infarction. seconds to minutes with complete recovery

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3
Q

what are the types of stroke

A

ischaemic, haemorrhagic, other (dissection, venous, vasculitis)

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4
Q

what leads to ischaemic stroke

A

thrombotic, large artery stenosis, small vessel disease, cardioembolic, hypoperfusion

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5
Q

what causes haemorrhagic stroke

A

intracranial haemorrhage and subarach haem

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6
Q

what is the most modifiable risk factor for stroke

A

hypertension

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7
Q

features of TIA (anterior system)

A

amaurosis fugax, hemiparesis, aphasia, hemisensory loss, hemianopic visual loss

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8
Q

features of TIA (posterior system)

A

diplopia, vertigo, vomiting; ataxia, choking and dysarthria, hemisensory loss, visual loss, tetraparesis, LOC

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9
Q

what is amaurosis fugax

A

suddent transient visual loss in one eye- emboli in retinal artery. shows internal carotid stenosis

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10
Q

differential diagnosis TIA

A

hypoglycaemia, migraine with aura, focal epilepsy, hyperventilation, retinal bleeds

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11
Q

tests in TIA

A

FBC, ESR, U&Es, glucose, lipids, CXR, ECG, carotid doppler and angio, CT or MRI

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12
Q

which circulation carries a higher risk for stroke and MI

A

anterior circulation

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13
Q

what is the ABCD2 score used for

A

stratify risk of stroke in the first 2 days after TIA

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14
Q

what is the ABCD2

A

Age >60; BP >140 systolic and or >90 diastolic; Clinical features- unilateral weakness (2), isolated speech disturbance (1), other (0); duration of symptoms in mins >60 (2), 10-59 (1),

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15
Q

what is high risk on the ABCD2 score

A

6 high risk

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16
Q

treatment of TIA

A

control cardio risk factors; antiplatelets- clopidogrel, aspirin, dipyridamole; warfarin in cardiac emboli; carotid endarterectomy if >70% stenosis do surgery within 2 weeks. endovascular carotid stenting is an alternative

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17
Q

what is the ischaemic penumbra

A

swollen area around the infarcted region which doesnt function but is structurally intact and can regain function

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18
Q

what features are seen in stroke

A

contralateral hemiplegia or hemiparesis with facial weakness, weak limbs at first flaccid and areflexic, conciousness usually preserved

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19
Q

causes of stroke

A

small vessel occlusion, atherothromboembolism, CNS bleeds

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20
Q

other causes of stroke to consider especially in younger patients

A

sudden drop in bp >40mmHg boundary zone/watershed stroke eg in sepsis; dissection; vasculitis; SAH

21
Q

features of cerebral infarction

A

contralat sensory loss or hemiplegia, dysphasia, homonymous hemianopia

22
Q

features of brainstem infarction

A

quadriplegia, disturbances gaze and vision, locked in syndrome, coma, psuedobulbar palsy, lateral medullary syndrome

23
Q

what is lateral medullary syndrome

A

posterior inferior cerebellar artery (PICA) or one vertebral artery. Wallenberg syndrome. acute vertigo with cerebellar signs

24
Q

features of lacunar infarct

A

small infarcts seen on MRI often asymptomatic. minor strokes- ataxic hemiparesis, pure motor, pure sensory, sensorimotor, dysarthria/clumsy hand

25
Q

what is Webers syndrome

A

ipsilateral 3rd nerve palsy with contralat hemiparesis, unilateral infarct in the midbrain

26
Q

hemi/tetraparesis

A

corticospinal tracts

27
Q

sensory loss

A

medial lemniscus/spinothalamic tracts

28
Q

diplopia

A

oculomotor

29
Q

facial numbness

A

5th nerve

30
Q

facial weakness

A

7th nerve

31
Q

nystagmus/vertigo

A

vestibular connections

32
Q

coma/altered conciousness

A

reticular formation

33
Q

left MCA

A

right weakness, involve face arm > leg with dysphagia

34
Q

right MCA

A

left weakness face and arm > leg with visual and or sensory neglect

35
Q

lateral medulla- posterior inferior cerebral artery

A

ipsilateral horners syndrome, Xth palsy, facial sensory loss, limb ataxi

36
Q

posterior cerebral arery

A

homonymous hemianopia

37
Q

internal capsule

A

motor, sensory, sensorimotor loss. face=arm=leg. dysarthria

38
Q

carotid artery dissection

A

ipsilateral horners syndrome- compression of sympathetic plexus around the carotid artery

39
Q

stroke general management at first

A

airways, O2, monitor BP, look for source of emboli

40
Q

brain imaging in stroke

A

non contrast CT shows haemorrhage immediately so can be used to rule out; diffusion weighted MRI shows infarction straight away

41
Q

signs that it is likely to be a haemorrhagic stroke

A

decr GCS, signs incr ICP, severe headache, meningism, progressive symptoms

42
Q

if CT excludes haemorrhage

A

thrombolytic therapy immediately, if contraindicated then aspirin 300mg/day

43
Q

if CT shows haemorrhage

A

give no drugs that can interfere with clotting, neurosurgery

44
Q

when can thrombolysis be used

A
45
Q

what is the thrombolysis agent and dose

A

recombinant tissue plasminogen activator (tPA)- alteplase. 0.9mg/kg. 10% total dose in first minute bolus then remainder over 60 mins

46
Q

CI to thrombolysis

A

have to be >18. major infarct/haem; mild/non disabling deficit; recent birth, trauma, surgery, artery/venous puncture at uncompressible site; past CNS bleed; AVM/aneurysm; severe liver disease; anticoags or INR

47
Q

medication after stroke

A

clopidogrel monotherapy, aspirin or dipyridamole used if clopidogrel CI. warfarin 2 weeks after stroke if due to AF (antiplatelets until then)

48
Q

complications after stroke

A

aspiration pneumonia, pressure sores, contractures, constipation, depression

49
Q

signs lateral medullary syndrome

A

vertigo, vomiting, dysphagia, nystagmus, ipsilat ataxia, soft palate paralysis, ipsilat horners, crossed pattern sensory loss- analgesia to pin prick on ipsilateral face and contralateral trunk

neuro year 4 (19 decks)

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