Stroke Flashcards
Define a stroke?
- Rapidly developing clinical symptoms and/or signs of focal, and at times global, loss of brain function,
- Symptoms lasting more than 24 hours
- Or leading to death with no apparent cause other than that of vascular origin
name the different types of stroke (3) + subgroups
Haemorrhage
- structural abnormality
- hypertensive
- Amyloid angiopathy
subarachnoid haemorrhage
Infarct (most common)
- Cardioembolic
- Small vessel
- Atheroembolic (carotid artery origin)
- Other (clotting disease or inflammatory process)
Underlying cause in:
- Cardioembolic stroke?
- Atheroembolic stroke?
- small vessel disease?
- fibrin dependant, red thrombus
- platelet dependant, white thrombus
-Arteriosclerosis
Microatheroma of the ostium,
Embolisms
changes in hemorrheology (blood flow)
stroke classification
- name the 4 classifications
- name the features of each
POCI- posterior circulation infarct
CN deficit with contralateral hemiparesis/ sensory deficit/ bilateral stroke/ disorders of conjugate eye movement/ isolated cerebellar stroke/ isolated homonymous hemianopia
LACI- Lacunar infarct
pure motor or pure sensory deficit affecting 2+ of face,arm,leg/ sensorimotor stroke/ ataxic hemiparesis/ dysarthria + clumsy hand/acute onset movement disorders
TACI- Total anterior circulation infarct
- new higher cerebral function dysfunction: dysphasia/dyscalculia/ apraxia/ neglect/ visuospatial problems +
- homonomous visual field defect + 3 of ipsilateral motor and/or sensory deficit of 2+ face/arm/leg
PACI- Partial anterior circulation infarct
2 of the 3 components of TACI/ isolated dysphagia or other cortical dysfunction/ motor/sensory loss more limited than for a LACI
Frontal lobe:
- functions? (3)
- lesions here cause? (7)
- personality, emotional response, social behaviour
- disinhibition, lack of initiative, antisocial behaviour, impaired memory, incontinence, grasp reflexes, anosmia
Parietal lobe:
- functions on dominant side? (4)
- lesions here cause? (6)
- functions on non-don side (2)
- lesions here cause? (5)
-calculation, language, planned movement
appreciation of size, shape, weight & texture
- dyscalculia, dysphasia, dyslexia, apraxia, agnosia, homonymous hemianopia
- spatial orientation, constructional skills
- neglect of non dom side, spatial disorientation, constructional apraxia, dressing apraxia, homonymous hemianopia
Occipital lobe
- function? (1)
- lesions here cause? (5)
- analysis of vision
- homonymous hemianopia, hemianopia scotomas, visual agnosia, prosopagnosia, visual hallucinations
Temporal lobe
- functions of dominant side? (4)
- lesions here cause? (5)
- functions of non dom side? (4)
- lesions here cause? (4)
- auditory perception, speech, language, verbal memory, smell
- dysphasia, dyslexia, poor memory, complex hallucinations, homonymous hemianopia
- auditory perception, music, tone sequences, non verbal memory, smell
- poor non verbal memory, loss of musical skills, complex hallucinations, homonymous hemianopia
presentation of stroke?
important aspects of hx to ask?
-sudden onset neurological symptoms use FAST outside hospital (face, arms, speech)
-time of onset
what were/are symptoms
how did they progress
Investigations in suspected stroke and why they are performed?
-To identify the presence of the infarct or haemorrhage
CT,
MRI with diffusion weighted imaging/ gradient echo/ susceptibility weighted imaging
-Aetiology of stroke
carotid scan, angiogram, ECG, 24 hour tape, echo, bubble TCD, bubble echo
-risk factors for 2nd stroke
lipid profile, BP, BG, smoking
Management of stroke
- acute (5)
- secondary prevention (3)
- thrombolysis/thrombectomy, imaging, swallow assessment (risk of pneumonia), antiplatelets, stroke unit care
- medication, lifestyle, carotid surgery
REHAB
state the factors considered when deciding to thrombolyse (7)
treatment used for thrombolysis? (2)
-age time since onset Prev intracerebral haemorrhage or infarct Atrophic changes BP DM Amount gained by thrombolysis
-IV tPA
endovascular therapy
Secondary prevention medication? (5)
anticoagulants if cardioembolic/AF (warfarin)
anti platelets if not cardioembolic (clopidogrel 1st line)
smoking cessation
statins
manage BP
CHA2DS2VASc score, state the risk factors (8)
mas score?
management of results?
congestive heart failure/ LV dysfunction hypertension age >75 DM stroke/TIA/thrombo-embolism vascular disease age 65-74 sex =9
if >2 then OAC
if 1 then 75-325mg aspirin
if ) then nothing
how to asses bleeding risk?
use the HAS-BLED score Hypertension Abnormal renal/liver function Stroke Bleeding Labile INRs Elderly Drugs/alcohol max 9 points
