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CVS > Stroke > Flashcards

Stroke Flashcards

1
Q

Define stroke with three distinct characteristics

A
  • Acute onset
  • Focal neurological signs and symptoms
  • Caused by disruption of blood flow. Causes End organ complication, poor vascular health
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2
Q

What are the two types of stroke?

A
  • Ischaemic
  • Haemorrhagic
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3
Q

What are the causes haemorragic stroke? (3)

A
  • Hypertension
  • Endothelial wall damage due to- inflammation of vessel wall (vasculitis),

structural abnormalities Like aneurysm, arteriovenous malformation

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4
Q

What are three main types of Ischaemic stroke?

A
  1. Thrombotic
  2. Embolic
  3. Hypoperfusion
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5
Q

What is the Virchow’s triad for thrombosis?

A
  1. Endothelial injury 2. Stasis 3. Hyper-coagulability.
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6
Q

What is the pathological progression underlying athero-thrombotic stroke? (starts with atheroma/plaque)

A
  1. Poor risk factor control
  2. Atherogenesis/ plaque
  3. Vessel stenosis or vessel rupture
  4. Stenosis–> Lowers blood flow Rupture–> platelet aggregation and clot
  5. Thrombus/ low blood flow= Ischaemia.
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7
Q

What are some non-modifiable risk factors for stroke?

A
  • Age - Family history - Gender - Ethnicity - Previous stroke
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8
Q

What are the main modifiable stroke risk factors?

A
  • Hypertension (esp if previous history of TIA) - Hyperlipidaemia
  • Smoking

Others- diabetes, AF, congestive HF, alcohol, diet, inactivity.

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9
Q

Statins are used for what type of stroke?

A

Recommended in all patients with hyperlipidaemia and ischaemic stroke Not used for haemorrhagic stroke.

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10
Q

What are the links of high SBP and DBP and stroke? Reduction in which BP has a greater effect on stroke?

A

Both are risk factors for stroke.

Reducing SBP has greater reduction in risk

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11
Q

Some Uncommon reasons for stroke? (no need to memorise)

A
  • Protein S, C, Anti thrombin deficiency - Vasculitis - Genetic: factor V Lieden deficiency.
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12
Q

What are some conditions that present as stroke? (stroke mimics) (3)

A
  1. Seizure
  2. Hypoglycaemic attack
  3. Migraine
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13
Q

What are the things to look for in examination?

A
  1. AF
  2. neurological examination to identify type of stroke
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14
Q

What imaging types are useful in stroke?

A

Only way to distinguish between ischaemic and haemorrhagic

  1. CT
  2. Angiogram
  3. MRI
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15
Q

What tests would be carried out in Ischaemic stroke?

A

Aim- to identify where origin of thrombus/embolus

  1. Young ppl- glucose/lipids/thrombophillia screen
  2. Atheroembolism- CT of carotid, aortic arch angiogram
  3. Cardio-embolism- ECG- AF?, LVH (poorly controlled hypertension), ECHO, 24hr ECG test.
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16
Q

What is an athero and cardio embolism? How would you differentiate between the two in stroke?

A
  • Atheroembolism: Embolus from an atherosclerotic plaque travels to another vessel and dislodges it. Shows up as a single arterial region infarcted on a brain CT

Cardioembolism- Embolus from a thrombus in the heart causes occlusion in the brain. Multiple arteries in the brain infarcted on a brain CT.

17
Q

What do investigations show in haemorrhagic stroke in different ppl? (young old etc)

A

Imaging: - Hypertensive: deep bleeding, older patients -

Young: investiage aneurysm, AVM -

Multiple bleed: vasculitis

18
Q

What is a TIA?

A

Focal neurological symptoms that resolve within an hour. The blood clot formed is reversible and the body naturally degrades it.

Shown to be always followed by a stroke in the next few months. TIA- Medical emergency. Determine cause and good management plan to prevent stroke.

19
Q

What is thrombolysis?

A

Destroying a thrombus to open up a vessel. Thrombolytics- drugs. used only in Ischaemic stroke.

20
Q

What drugs are used in treating stroke?

A
  1. Anti- platelets- Aspirin, Clopidogrel, dipyramidole
  2. Anti- Coagulants- For AF. Rivaroxaban, apixaban dabigatran, heparin, warfarin,
  3. Statins- Atoravastatin, simvastatin
  4. Anti-hypertensives- ACE/ARB, Ca Blocker
21
Q

When is surgical intervention in stroke needed?

A
  • to remove haematomas - relief of raised intracranial pressure

CVS (21 decks)

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