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BB2 > Stroke > Flashcards

Stroke Flashcards

1
Q

What is stroke?

A

Condition characterised by rapidly progressive clinical symptoms and signs of focal, and at times global, loss of cerebral function lasting more than 24hrs or leading to death with no apparent cause other than that
of vascular origin.

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2
Q

What are the two types of stroke? Which is most common?

A

Ischaemic (70-80%)

Haemorrhagic (20-30%)

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3
Q

How many people have strokes per year in the UK?

A

152,000

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4
Q

What are the mechanisms of intracerebral haemorrhage?

A

Charcot Bouchard microaneurysms
Microbleeds
Haemorrhagic transformation of infarcts
Vasculitis

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5
Q

What are the causes of ICH?

A 
Hypertension
Trauma
Tumour
AV Malformation
Venous thrombosis
Vasculitis
Coagulopathy
Anticoagulation/TPA 
Drugs e.g. coccaine
Haemorrhagic transformation of infarct
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6
Q

What are the complications of ICH?

A

Local damage
Local mass effect/herniation
Raised ICP
Hydrocephalus

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7
Q

How is ICH managed?

A 
Imaging/angiography
Clotting/platelet function
Stop Aspirin/Warfain
ICP Management
Surgery / EVD
Treat risk factors
Rehabilitation
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8
Q

What are the two areas around a thrombus called?

A

Core and penumbra

penumbra has metabolically sensitive neurons

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9
Q

What causes 50% of ischaemic strokes?

A

Atherosclerosis (10% is carotid)

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10
Q

What causes 25% of ischaemic strokes?

A

Arteriolarsclerosis

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11
Q

What causes 15% of ischaemic strokes?

A

Atrial fibrillation and other cardiac emboli

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12
Q

What causes 5% of ischaemic strokes?

A

Carotid dissection

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13
Q

What are the demographic/non-modifiable risk factors for stroke? (5)

A 
Age
Sex (male x1.25)
Race (non-white x2)
Socioeconomic status (poor)
Family history
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14
Q

What are the lifestyle risk factors for stroke? (4)

A

Smoking (x2)
Overweight (x1.64)
Inactivity (x1.5)
Alcohol (x3)

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15
Q

What are the medical risk factors for stroke? (5)

A 
Hypertension
Hypercholesterolaemia
Diabetes (x2)
Vascular disease (PVD, IHD & CVD)
Cardiac (e.g. AF x5, left to right shunts, chamber dilatation)
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16
Q

What are the rare associations with stroke? (5)

A 
Homocysteinaemia
Fabrys disease
Vasculitis
Mitochondrial disease
Thromobophilia etc.
17
Q

Why are statins given for the secondary prevention of stroke?

A

A decrease of 1mm/L in LDL Cholesterol = 15% risk reduction in ischaemic stroke

18
Q

Hypertension is a risk factor for stroke. Is this for both systolic and diastolic? What else has been found to make a difference?

A

Yes for both

Variability on visits to the doctor/hospital (more variation then more risk)

19
Q

How is stroke classified? (3)

A

By vascular anatomy (MRI/CT)
By clinical picture (The Oxford Bamford Classification)
By aetiology (the TOAST Classification)

20
Q

According to the Oxford Bamford Classification, what does a stroke of the anterior circulation present with? (3)

A

Unilateral motor deficit
Homonymous hemianopia
Higher cerebral dysfunction (e.g. dysphasia, neglect)

21
Q

According to the Oxford Bamford Classification, what does a stroke of the posterior circulation present with? (4)

A

Pure hemianopia
Cerebellar signs
Diplopia & CN palsy
Bilateral/crossed sensory-motor signs

22
Q

According to the Oxford Bamford Classification, what does a lacunar stroke present with? (4)

A 
Pure motor (50%)
Sensorimotor stroke (35%) 
Ataxic hemiparesis (10%)
Pure sensory (5%)
23
Q

What vessels does a lacunar stroke affect?

A

Small vessels

24
Q

What tests are done if a patient presents with a possible stroke?

A 
Brain Imaging - CT/MR
FBC, and other bloods:
ESR, fasting glucose, cholesterol, and VDRL
Carotid Doppler
ECG +/- 24hr ECG
ECHO
25
Q

What additional tests are done if a patient UNDER 50 presents with a possible stroke?

A 
Vasculitis Screen
HIV Test
Drug screen
Thrombophilia Screen
Lumbar Puncture
TOE/cECHO
Catheter Angiography
26
Q

What are the first three steps of stroke management?

A

Consider Thrombolysis
Transfer to Stroke Unit
Review antiplatelet therapy

27
Q

What are the next two steps of stroke management? (Step 4 and 5)

A

Address risk factors (diabetes, hypertension, cholesterol, cardiac disease etc)

Treat Complications (nutrition, depression, seizures, DVT, infection, cerebral oedema, pressure sores etc)

28
Q

What are step 6 and 7 of stroke management?

A

MDT Rehabilitation (nursing, speech and language, occupational therapy, physio)

Advice & Education (driving, work, weight loss, exercise, smoking, benefits, contraception)

29
Q

For every 6 patients that receive thrombolysis, 1 benefits.
What is this figure for treatment with aspirin?
What about for acute stroke units?

A

100

20

30
Q

What is the % risk of haemorrhage with thrombolysis?

A

7-8%

31
Q

What are the current guidelines for antiplatelet therapy?

A

Aspirin 300mg for 2/52 then Clopidogrel 75mg monotherapy
OR
Aspirin 75mg + Dipyridamole 200mg

32
Q

What is a TIA?

A

An acute loss of focal cerebral or monocular function
with symptoms lasting less than 24h and which, after adequate investigation, is presumed to be due to
embolic or thrombotic vascular disease.

OR (new definition):
A transient episode of neurological dysfunction
caused by focal brain, spinal cord, or retinal
ischemia, without acute infarction.

33
Q

How many stroke patients are suitable for thrombolysis?

A

20%

34
Q

How are TIAs managed in A&E?

A

CT
Doppler/CTA
ECG
Start Antiplatelets

Patients area admitted if…
AF
Carotid stenosis (for surgery)
>2 TIAs in 1 week

35
Q

With TIA patients, there risk is calculated using the ABCD(2) system. What are the criteria?

A

Age > 60 = 1 point
BP > 140/90 = 1 point
Clinical features - hemiparesis 2 points, speech 1 point
Duration (10-59 mins 1 point, >1 is 2 points)
Diabetes = 1 point

If their score is >4 they are admitted.

BB2 (32 decks)

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