Stroke Flashcards
What is a stroke?
When the blood flow to part of the brain is cut off. All organs of the body need oxygen which is carried in the blood and every part of the brain needs a good blood supply in order to function.
Stroke has a rapid onset, causes a neurological deficit and is vascular in origin.
Abrupt loss of focal brain function lasting over 24hrs
Includes SAH
What are the main types of stroke? and which is more common?
Ischaemic (most common) - Blood supply is stopped by a blot clot and the arteries are often narrowed due to atherosclerosis
Haemorrhagic - weakened blood vessel bursts. Main cause is hypertension which weakens the artery walls
What are the risk factors for stroke?
Smoking High BP Obesity High cholesterol Diabetes Excessive alcohol use Atrial Fibrillation Age Gender Family History of Stroke
What is the treatment for stroke?
Warfarin - reduces chance of clot occurring again (affects synthesis of vitamin K dependent clotting factors - ii, vii, ix, x)
Antihypertensives to treat high BP
Statins to lower cholesterol
Thrombolysis - altepase, streptokinase –> dissolves blood clots and restores flow of blood to the brain
haemorrhagic stroke - surgery to repair ruptured blood vessels
What lifestyle advice can be given?
Eat a healthy diet, stop smoking and reduce alcohol
What are the causes for cerebral infarcts?
Large vessel atheroma/embolism
cardiac embolism
Small vessel disease
Blood disorders
What are the causes of a intracerebral haemorrhage?
Hypertensive microaneurysms Arteriovenous Malformations Amyloid angiopathy Haemostatic anticoagulant Cocaine Amphetamines Tumour Venous thrombosis
What is Brocas aphasia?
Comprehension fine
Struggle to speak
When stroke is in frontal lobe
What is wernickes aphasia?
Speaks very fast but is incomprehensible
cannot do 3 stage command
when there is damage to temporal lobe
What can a stroke in the cerebellum cause?
D - Dysdiadokinesia A - Ataxic gait N - nystagmus I - Intention tremor S - Slurred/Staccato speech H - Hypotonia
What is a TIA?
Transient Ischaemic Attack - sudden onset, focal disturbance of brain function (occasionally global)
What are some differential diagnoses for stroke?
Hypoglycaemia Migraine aura Epilepsy SOL MS - demylination
List some symptoms of stroke
one side of the body weakness facial droop on one side slurred speech dizziness confusion loss of consciousness
What additional symptoms may also be present?
Headache, seizures - suggest bleeding
Headache, vomiting, drowsiness - suggest raised ICP
Cardiac symptoms - suggests aetiology
Which part of the brain does the anterior cerebral artery supply?
the medial part of the frontal and parietal lobes
anterior portion of the corpus callosum, basal ganglia and internal capsule
Which part of the brain does the middle cerebral artery supply?
Lateral part of the cerebrum
lateral aspect of the frontal, parietal and occipital lobes
Most strokes occur in this territory
Which artery joins to the two anterior cerebral arteries?
the anterior communicating artery
Which artery does the vertebral artery arise from?
Subclavian arteries
Which branch is the largest branch of the Vertebral arteries?
Posterior inferior cerebellar artery (PICA)
Which part of the brain does the basilar artery supply?
Most of the brainstem
Overlies the pons
Stroke here has poor prognosis
Which part of the brain does the posterior cerebral artery supply?
Goes around the midbrain
Supplies midbrain, thalamus, temporal and occipital lobes
What does a normal early CT scan rule out if a patient presents with symptoms of a stroke?
Rules out bleeding
DOES NOT rule out infarct or ischaemic stroke
When should thrombolysis be given?
Within 3hr of documented event
CT must exclude bleeding and established infarct
No bleeding risk (i.e. not on warfarin)
