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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

A rapid onset of neurological deficit

Which is the result of a vascular lesion (haemorrhage or thrombus)

Causing infarction of central nervous tissue

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2
Q

What is a transient ischaemic attack?

A

A transient episode of neurologic dysfunction caused by ischaemia without infarction

The symptoms totally resolve within 24 hours

A mini stroke

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3
Q

What is a completed stroke?

A

When the neurological deficit has reached its maximum, usually within about 6 hours

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4
Q

Describe the pathophysiology of ischaemic strokes?

A

Either thrombus or embolism

Thrombus: atherosclerosis in a cerebral artery, this builds up and causes a thrombus which blocks the vessel

Embolus: a clot from another part of the body flows through the bloodstream and gets lodged in a cerebral vessel

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5
Q

Describe the pathophysiology of a haemorrhagic stroke?

A

An aneurysm ruptures, or something else happens that causes bleeding into the brain tissue damaging it (intracerebral)

Or a berry aneurysm causes a sub-arachnoid haemorrhage?

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6
Q

What are some uncommon causes of stroke?

A 
Venous infarct
Carotid / vertebral dissection
Fat / air embolism
Drugs
Migraine
Vegetation from endocarditis

Many more

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7
Q

What are the risk factors for a stroke?

A

Male
Age
Black African

Hypertension
Smoking, alcohol
Diabetes
Heart disease
Atrial fibrillation
Excess clotting
Aneurysm
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8
Q

Why does hypertension increase the risk of a stroke?

A

Damages arterial walls

Leading to increased risk of thrombus formation

And increased risk of haemorrhage

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9
Q

Why does smoking increase the risk of a stroke?

A

Increases BP so you have the risk associated with hypertension

Also it has direct effects on the arterial walls

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10
Q

Why does atrial fibrillation increase the risk of a stroke?

A

High chance of a thrombus forming in the heart, becoming an embolus and going to the brain

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11
Q

The brain is split into 3 regions in terms of blood supply, what are the regions?

And what blood vessels supply the regions?

A

Anterior: anterior cerebral arteries

Middle: middle cerebral arteries

Posterior: posterior cerebral arteries

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12
Q

Which stroke is worse:

  • anterior
  • middle
  • posterior? Why?
A

Middle, because many of the important parts of the brain are in the middle

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13
Q

What structures are damaged in an anterior cerebral artery stroke?

A

Frontal + parietal lobes
- Primary motor cortex

Basal ganglia
Anterior corpus callosum

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14
Q

Clinical features of anterior cerebral artery stroke?

A

Contra-lateral hemiparesis/plegia

No impetus to move, since primary motor cortex is damaged

Contra-lateral sensory disturbance

Gait apraxia

Incontinence

Drowsiness

Akinetic mutism: decrease in speech

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15
Q

What does a stroke appear like on a CT scan?

A

Dark lesions

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16
Q

What structures are damaged in a middle cerebral artery stroke?

A

Lateral frontal, temporal, parietal lobes

Corona radiata

Putamen
Caudate
Globus pallidus

17
Q

Clinical features of a middle cerebral artery stroke?

A

Contralateral hemiparesis/plegia

Contralateral sensory loss

Ataxia

Dysphasia / aphasia: Broca’s, Wernicke’s

18
Q

What happens if Broca’s area is damaged?

A

Expressive aphasia

Loss of ability to speak coherently

19
Q

What happens if Wernicke’s area is damaged?

A

Receptive aphasia

Loss of understanding of speech or written words

20
Q

What is hemiparesis?

A

Weakness down one side of the body

21
Q

What is hemiplegia?

A

Paralysis of one side of the body

22
Q

What structures are damaged in a posterior cerebral artery stroke?

A

Occipital and temporal lobe

Thalamus
Upper brainstem
Midbrain

23
Q

Clinical features of a posterior cerebral artery stroke?

A

Contralateral homonymous hemianopsia (loss of half visual field in one eye)

Cortical blindness (blindness caused by damage to occipital lobe)

Visual agnosia: can’t interpret visual info but can see

Dyslexia: problems with discrimination, colour naming

24
Q

Clinical features of brainstem infarcts?

A

Depends on exactly where the infarct is

Quadriplegia
Visual problems
Locked-in syndrome

25
Q

What is locked-in syndrome?

A

The person is aware of their surroundings

They are unable to move or respond or anything though

26
Q

What is a lacunar stroke?

A

Infarcts in the thalamus, basal ganglia, internal capsule, pons

Sometimes causes weakness/paralysis or sensory loss in just one arm or leg

27
Q

What are warning syndromes?

A

Stroke-like symptoms that appear and disappear over a few days

They are usually a sign that a proper stroke could occur imminently

28
Q

Investigation of stroke?

A

Brain CT or MRI shows up lesion

Blood tests

ECG: to look for MI or AF

29
Q

Acute management of stroke?

A

If in the first 4 hours you can give Actilyse - a thrombolyser

If not, or thrombolysis is contra-indicated:

  • aspirin, clopidogrel
  • manage risk factors
  • clot retrieval
  • interarterial thrombolysis

Supportive care

30
Q

What risk factors can you manage when treating a stroke?

A

Statins
Treatment for AF
Anti-hypertensives
Control diabetes

31
Q

What are the contra-indications of treating a stroke with thrombolysis medication?

A

Recent surgery or arterial puncture

Active malignancy

Evidence of brain aneurysms

Clotting disorders

32
Q

Long term management of stroke?

A

Rehabilitation: try to restore as much of the person as you can

Occupational therapy: help them remain independent

Consider residential care options if they can’t return home

Prevent further problems: modify lifestyle, medication

33
Q

How long does a TIA usually last?

A

Approx. 5-15 mins

34
Q

Clinical features of a TIA?

A

Depends on site of brain affected

Amaurosis fugax
Aphasia
Hemiparesis
Hemisensory loss

35
Q

What is amaurosis fugax?

A

Painless transient monocular blindness as a result of the passage of an emboli through the retinal arteries

36
Q

Investigations of TIA?

A

Blood:

  • ESR: to rule out vasculitis, eg. temporal arteritis
  • FBC: to rule out polycythaemia

Brain CT or MRI

Carotid artery imaging, uses US: look for atheroma, stenosis

37
Q

What is polycythaemia?

A

Increased concentration of haemoglobin in the blood, due to a neoplasm in the bone marrow that makes it produce too many RBCs

This makes the blood thicker and more likely to clot causing a stroke

38
Q

Management of a TIA?

A

Their symptoms reside by themselves

But give aspirin, followed by long term warfarin

Reduce risk factors, prevent recurrence or occurrence of a proper stroke

  • Statin
  • Control BP

Surgical: carotid endartectomy
- removal of inner layers or blockages of the carotid artery

Neurology (23 decks)

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