Stroke Flashcards
What are the 2 main types of stroke?
Ischaemic
Haemorrhagic
What is ischaemic stroke caused by? (5)
HINT: there are two main categories.
Give examples of each process.
EMBOLISM: Cardiac, e.g. -AF -MI -Patent foramen ovale Aortic, e.g. -Atheroma Arterial, e.g. -Atheroma -Dissection
THROMBOSIS: Large vessel disease, e.g. -Atherosclerosis Small vessel disease, e.g. -Lipohyalinosis -Atherosclerosis
Describe the pathophysiology of ischaemic stroke. (5)
- Blockage of cranial arteries causes ischaemia
- Anaerobic respiration produces less ATP
a. Therefore ATP depletion - Loss of Na+/K+ ATPase
a. Na+ builds up in cell
b. This causes cytotoxic oedema - Loss of Na+/Ca2+ ATPase
a. Ca2+ builds up in cell
b. This causes excitotoxicity
c. Also causes activation of proteases/lipases
d. Also causes ROS and free radical production - This causes tissue death (infarction)
What is the ischaemic penumbra?
Area of ischaemic tissue around a core of infarction in ischaemic stroke
Can be saved if blood supply is restored!
List 8 risk factors for ischaemic stroke.
Age Hypertension Heart disease (e.g. AF) Smoking Diabetes Hypercholesterolaemia Previous stroke/TIA Family history
What is haemorrhagic stroke caused by? (2)
Intracerebral haemorrhage
Anti-coagulation drugs
List 12 risk factors for haemorrhagic stroke.
Hypertension Cerebral amyloid angiopathy Anti-coagulants Anti-platelets Dementia Age Gender (males > females) Alcohol Smoking Drugs HypOcholesterolaemia Vascular lesions (e.g. aneurysms)
How do you differentiate between ischaemic and haemorrhagic stroke?
CT scan
Haemorrhagic - white area
Ischaemic - grey area BUT may look normal!!
What investigations would you do for stroke? (12)
CT scan
Bloods:
- FBC
- Troponin
- Glucose
- Coagulation assays
- Other standard tests
Cardiac investigations:
- BP
- ECGs
- Echocardiogram
Vascular investigations:
- CT angiogram
- MR angiogram
- Doppler ultrasound
How would you manage ischaemic stroke? (4)
Thrombolysis (alteplase, ONLY if <4.5 hours since onset)
Anti-platelet drugs (aspirin, AFTER 24 hour scan)
Endovascular procedures (ICA/proximal MCA occlusion)
Secondary prevention
What would you do for secondary prevention of ischaemic stroke? (5)
Aspirin/clopidogrel BP control Statins Warfarin/DOACs (in AF) Carotid endarterctomy
When would you do a carotid endarterectomy for secondary stroke prevention?
Carotid artery stenosis 70+%
Describe the typical discharge drugs after ischaemic stroke. (5)
Clopidogrel (or apixaban) Simvastatin Perindopril Bendrofluazide Smoking cessation tools
What advice about driving would you give patients after suffering a stroke? (2)
If no/minimal neuro deficit: wait 30 days
If significant deficit: do NOT drive until further assessment is carried out
How would you manage haemorrhagic stroke? (8)
ABCDs
Admission to stroke unit
Prevent haematoma expansion:
- Prothrombin complex concentrate
- Reverse anticoagulants
- Fresh frozen plasma
Neurosurgery
Treat fever
DVT prophylaxis:
-Compression stockings
Nutrition
Rehabilitation
How would you prevent haematoma expansion in haemorrhagic stroke? (3)
Prothrombin complex concentrate
Fresh frozen plasma
Reversal agents for anticoagulant drugs
When would you do neurosurgery for a haemorrhagic stroke? (3)
Haematoma is <1cm from cortical surface
Posterior fossa haematoma
Patient is rapidly deteriorating
Describe the clinical features of stroke.
CEREBRAL STROKE: Contralateral sensory loss/hemiplegia Dysphasia Homonymous hemianopia Visuospatial deficit
BRAINSTEM STROKE:
Quadriplegia
Locked-in syndrome
CEREBELLAR STROKE:
Cerebellar ataxia
Dysdochodiakinesis
List 3 clinical features of stroke which might suggest haemorrhagic stroke.
NOTE: this is very unreliable; don’t use it to actually diagnose one!
Meningism
Severe headache
Coma
List 3 clinical features of stroke which might suggest ischaemic stroke.
Carotid bruit
AF
Previous TIA
Ischaemic heart disease
How would you classify stroke? (4)
Total anterior circulation syndrome (TACS)
Partial anterior circulation syndrome (PACS)
Posterior circulation syndrome (POCS)
Lacunar syndrome (LACS)
Describe the features of a TACS stroke. (3)
What can cause a TACS stroke? (2)
CLINICAL FEATURES:
Hemiparesis
Higher cortical dysfunction
Hemianopia
CAUSED BY:
MCA occlusion
Internal carotid a. occlusion
Describe the clinical features of a PACS stroke. (4)
Isolated higher cortical dysfunction
OR
Any 2 of:
- Hemiparesis
- Higher cortical dysfunction
- Hemianopia
Describe the clinical features of a POCS stroke. (7)
Isolated hemianopia
OR
Cranial nerve abnormalities Brainstem syndrome: -Nystagmus -Past-pointing -Dysdiadochokinesis -Ataxia
