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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Name the classification system that assess stroke severity.

A

NIHSS - national institutes of health stroke scale

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2
Q

Name the oxfordshire community stroke project classifications.

A

TACS - total anterior circulation syndrome
PACS - partial anterior circulation syndrome
POCS - posterior circulation syndrome
LACS - lacunar syndrome

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3
Q

What is total anterior circulation syndrome?

A

The symptoms of a patient who clinically appears to have suffered a total anterior circulation stroke, but hasn’t had a diagnostic test yet
The symptoms are
- higher cortical dysfunction (dysphasia, visuospatial disturbances and decreased level of consciousness)
- homonymous hemianopia
- hemiparesis

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4
Q

What is the most common cause of TACS?

A

Proximal middle cerebral artery or internal carotid artery occlusion

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5
Q

What is partial anterior circulation syndrome?

A 
The symptoms of a patient that suggests they have had a partial anterior circulation stroke.
The symptoms are
- isolated higher cortical dysfunction 
OR 2 OF
- hemiparesis
- higher cortical dysfunction
- hemianopia
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6
Q

What is the most common cause of PACS?

A

Occlusion of a branch of the middle cerebral artery

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7
Q

What is posterior circulation syndrome?

A 
The symptoms of a patient who clinically appears to have had a posterior circulation stroke
The symptoms are
- isolated hemianopia 
OR
- brainstem syndrome
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8
Q

What is the most common cause of POCS?

A

Disruption of the posterior cerebral or cerebellar arteries

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9
Q

What is lacunar syndrome?

A 
The symptoms of a patient who clinically appears to have had a lacunar stroke
The symptoms ONE OF
- pure motor stroke
- pure sensory stroke
- sensorimotor stroke
- ataxic hemiparesis
- clumsy hand-dysarthria
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10
Q

What is the most common cause of LACS?

A

Small vessel disease or a perforating artery in a small (<1.5cm) area of the brain

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11
Q

What are the two types of stroke?

A

Ischaemic stroke - blockage of blood vessels causing lack of blood flow to the affected area
Hemorrhagic stroke - rupture of blood vessels causing leakage of blood into the brain

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12
Q

Where is a normal place for a hemorrhagic stroke in hypertensive patients, and why?

A

In the perforating arteries branching directly off the middle cerebral artery

  • the sudden change from wide blood vessel to small blood vessel, coupled with the hypertension, leads to a very sudden increase in pressure, causing the vessels to burst
  • this is known as a hypertensive pattern of stroke
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13
Q

How are intracerebral haemorrhages treated?

A 
ABCs
Admit to the stroke unit
Prevent haematoma expansion
Neurosurgery (only when indicated)
Treat pyrexia
DVT prophylaxis - intermittent pneumatic compression stockings 
Nutrition and early rehab
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14
Q

How can haematoma expansion be prevented?

A 
Reverse anticoagulants 
- prothrombin complex concentrate is better than fresh frozen plasma
- reversal agent for dabigatran 
- vitamin K infusion for warfarin
Lower BP
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15
Q

In what circumstances should an intracerebral haemorrhage be treated with neurosurgery?

A

When the haematoma is less than 1cm from the cortical surface
It’s a clinically deteriorating posterior fossa haematoma
Surgery done too early may be harmful

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16
Q

What can cause an ischaemic stroke?

A

Embolism (not often a thrombus like in MI)
- cardiac origins include AF, MI or a patent foramen ovale
- an atheroma from the aorta
- arterial origins include atheroma and dissection
Thrombosis
- large vessel disease (atherosclerosis)
- small vessel disease (lipohyalinosis and atherosclerosis)

17
Q

Briefly describe the pathophysiology of an embolytic ischaemic stroke.

A

Blood clot forms and travels in the bloodstream up to the brain.
Once there it blocks an artery in the brain, preventing an area of the brain from being oxygenated, and thus causing ischaemia and tissue death
- cells burst and release calcium which activates lots of enzymes (cytotoxic storm)
- inflammatory response causes damage to the brain

18
Q

Draw and label the circle of Willis.

A

Supplied by the two carotids and the two vertebral arteries
- the carotids supply become the middle cerebral arteries
- the vertebrals become the basilar artery
PICTURE

19
Q

What is the ‘stunned’ area of brain that can be saved with fast reperfusion treatment?

A

Penumbra

- this area has slow blood flow, which allows it to be fully restored if blood flow is rectified

20
Q

How should an ischaemic stroke be treated?

A 
Thrombolysis
- alteplase can be used up to 4.5 hours
- 32% chance of benefit 
- small risk of brain haemorrhage 
Antiplatelets
- 1st line if presenting after 4.5 hours
- otherwise shouldn't be given before the 24 hour scan
21
Q

What is endovascular therapy?

A

A guidewire is passed through the groin and into the brain.

A stent remover on the end is used to pull out the clot

22
Q

What are the criteria for use of endovascular therapy in ischaemic strokes?

A

Availability
Received rtPA within 4.5 hours of the stroke
When the clot is in the internal carotid or middle cerebral artery
Patient is 18 or older
NIHSS >6
The brain scan shows a small core and good collateral (rescue) vessels
Onset to groin puncture is less than 6 hours

23
Q

When can alteplase/rtPA not be used?

A

The patient is already on antiplatelets or they have a coagulopathy
They have a systolic BP of more than 185mmHg

24
Q

What are the risk factors for an ischaemic stroke?

A 
Age
Hypertension 
Heart disease (including atrial fibrillation)
Smoking
Diabetes
Hypercholesterolaemia 
Previous stroke/TIA
Family history
25
Q

What are the risk factors of an intracerebral stroke?

A 
HYPERTENSION
Cerebral amyloid angiopathy (high risk of recurrence)
Anti-coagulants 
Anti-platelets 
Dementia
Age
Male sex
Alcohol
Smoking
Drugs (cocaine, amphetamines)
Hypocholesterolaemia 
Vascular lesions (aneurysms, AVMs, cavernomas)
26
Q

Once someone has been treated for a stroke and they are recovering, what further investigations should be done?

A

Cardiac
- BP
- ECGs
- 72 hour ECG and loop recorder (trying to find AF)
- Echo (in some patients, to look for carotid stenosis)
Vascular
- carotid assessment
- CT angiogram/MR angiogram/doppler ultrasound

27
Q

What prophylaxis treatments will people be put on after having an ischaemic stroke?

A

Antiplatelets
- reduces risk of secondary stroke by 22%
- clopidogrel = aspirin and dipyridamole (and is more effective than both)
- aspirin is more commonly used acutely is they arrive after 4 hours than as a discharge drug
Anti-hypertensives
Statins
Warfarin/NOACs
- used if the patient has AF
Carotid endarterectomy
- for carotid stenosis of more than 70%

28
Q

What are the typical discharge drugs after a person has had an ischaemic stroke?

A 
Clopidogrel or apixiban
Simvastatin 40mg
Perindopril 4mg (ACE inhibitor)
Bendrofluazide 2.5mg (thiazide diuretic) 
Smoking cessations tools

Neurology (13 decks)

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