Stroke Flashcards
What is stroke?
The experience of persisting neurological complications of CVD
What is a TIA?
A TIA is a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction
What does acute cerebrovascular syndrome cover?
With or without evidence of cerebral infarction
Source of embolus (threat)?
With or without evidence of cerebral haemorrhage
What are some stroke mimics?
Seizure Sepsis Toxic/metabolic SOL Pre (syncope) Acute confusion Vestibular dysfunction Functional Dementia
What score should be used to get the stroke diagnosis correct?
Rosier scoe
How is the type of stroke found?
CT
What classification is used to assess the size of stroke?
Oxford Classifcation
Total Anterior Circulation Syndrome (TACS)
Partial Anterior Circulation Syndrome (PACS)
Lacunar Syndrome (LACS)
Posterior Circulation Syndrome (POCS)
Describe TACS
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss
Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)
Most severe (5% alive and independent at 1y)
Describe PACS
2 out of 3 features present in a TACS or;
Isolated Cortical Dysfunction such as dysphasia or;
Pure motor/sensory signs less severe than in lacunar syndromes
(eg monoparesis).
55% of patients alive and independent at 1y
Describe LACS
Lacunar infarcts are small infarcts in the deeper parts of the brain (basal
ganglia, thalamus, white matter) and in the brain stem.
Caused by occlusion of a single deep penetrating artery. Affect 2 any two
of face arm and leg
60% alive and independent at 1y
Describe POCS
Cranial nerve palsies Bilateral motor and/or sensory deficits Conjugate eye movement disorders Isolated homonymous hemianopia Cortical blindness Cerebellar deficits without ipsilateral motor/sensory signs (in contrast to Ataxic Hemiparetic lacunar syndrome) 60% alive and independent at 1y
Why is laterality important in prognosis/management?
Dominant hemisphere (left) cortical events often affect language (major implications for rehab) Non dominant hemisphere (right) cortical events affect spatial awareness (neglect)
What are the components of the full diagnosis of stroke?
Type
Size
Laterality
Cause
What are some causes of ischaemic cerebrovascular disease?
Atherothromboembolism
Intracranial small-vessel disease
Cardiac source of embolism
Rare causes
What is type 1 small vessel disease?
Ateriosclerotic (age/RF related)
- Fibrinoid necrosis
- Lipohyalinosis
- Microatheroma
- Microaneurysm
What is type 2 small vessel disease?
Sporadic and hereditary cerebral amyloid angiopathy
What is type 3 small vessel disease?
Genetic small vessel disease distinct from cerebral amyloid angiopathy
e.g. CADASIL
What is type 4 small vessel disease?
Inflammatory and immunologically mediated
e.g. Churg-Strauss syndrome, Wegener’s granulomatosis
What is type 5 small vessel disease?
Venous collagenosis
What is type 6 small vessel disease?
Other small vessel disease
e.g. post radiation angiopathy
What are the causes for primary intracerebral haemorrhagic stroke?
Hypertension
Amyloid angiopathy
What are the causes for second intracerebral haemorrhagic stroke?
Arteriovenous malformation
Aneurysm
Tumour etc
What are lobar and deep haemorrhages more likely to be related to?
Lobar: cerebral amyloid angiopathy
Deep: blood pressure
What different types of stroke effect treatment?
Cardioembolic • Fibrin dependent “red thrombus” – Atheroembolic • Platelet dependent “white thrombus”: Cf Acute Coronary Syndrome – Small vessel disease • Arteriosclerosis • Microatheroma of the ostium, • Embolism (athero and cardioembolism) • changes in hemorrheology • etc
What investigations should be carried out?
Full lipid profile BP Carotid scan ECG Consider: 24hr ECG, Echo
What is the ABCD of medical stroke prevention?
Antithrombotic therapy (antiplatelet/coagulant) Blood pressure Cholesterol DM Don't smoke
What is the ABCD(2) of stroke risk prediction in patients with transient neuro symptoms?
Age >=60 =1 BP >=140/90 =1 Clinical features -Unilateral weakness=2 -Speech disturbance without weakness=1 -Other=0 Duration ->=60=2 -10-59=1 =5 is considered at serious risk
What antiplatelet therapy should be used in stroke prevention?
Aspirin
Clopidogrel
Dipyridamole
What level of reduction of recurrent stroke at 2 years does carotid endarterectomy show?
65%
