Stroke Flashcards
Define stroke with three distinct characteristics
- Acute onset
- Focal neurological signs and symptoms
- Caused by disruption of blood flow. Causes End organ complication, poor vascular health
What are the two types of stroke?
- Ischaemic
- Haemorrhagic
What are the causes haemorragic stroke? (3)
- Hypertension
- Endothelial wall damage due to- inflammation of vessel wall (vasculitis),
structural abnormalities Like aneurysm, arteriovenous malformation
What are three main types of Ischaemic stroke?
- Thrombotic
- Embolic
- Hypoperfusion
What is the Virchow’s triad for thrombosis?
- Endothelial injury 2. Stasis 3. Hyper-coagulability.
What is the pathological progression underlying athero-thrombotic stroke? (starts with atheroma/plaque)
- Poor risk factor control
- Atherogenesis/ plaque
- Vessel stenosis or vessel rupture
- Stenosis–> Lowers blood flow Rupture–> platelet aggregation and clot
- Thrombus/ low blood flow= Ischaemia.
What are some non-modifiable risk factors for stroke?
- Age - Family history - Gender - Ethnicity - Previous stroke
What are the main modifiable stroke risk factors?
- Hypertension (esp if previous history of TIA) - Hyperlipidaemia
- Smoking
Others- diabetes, AF, congestive HF, alcohol, diet, inactivity.
Statins are used for what type of stroke?
Recommended in all patients with hyperlipidaemia and ischaemic stroke Not used for haemorrhagic stroke.
What are the links of high SBP and DBP and stroke? Reduction in which BP has a greater effect on stroke?
Both are risk factors for stroke.
Reducing SBP has greater reduction in risk
Some Uncommon reasons for stroke? (no need to memorise)
- Protein S, C, Anti thrombin deficiency - Vasculitis - Genetic: factor V Lieden deficiency.
What are some conditions that present as stroke? (stroke mimics) (3)
- Seizure
- Hypoglycaemic attack
- Migraine
What are the things to look for in examination?
- AF
- neurological examination to identify type of stroke
What imaging types are useful in stroke?
Only way to distinguish between ischaemic and haemorrhagic
- CT
- Angiogram
- MRI
What tests would be carried out in Ischaemic stroke?
Aim- to identify where origin of thrombus/embolus
- Young ppl- glucose/lipids/thrombophillia screen
- Atheroembolism- CT of carotid, aortic arch angiogram
- Cardio-embolism- ECG- AF?, LVH (poorly controlled hypertension), ECHO, 24hr ECG test.
What is an athero and cardio embolism? How would you differentiate between the two in stroke?
- 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.
What do investigations show in haemorrhagic stroke in different ppl? (young old etc)
Imaging: - Hypertensive: deep bleeding, older patients -
Young: investiage aneurysm, AVM -
Multiple bleed: vasculitis
What is a TIA?
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.
What is thrombolysis?
Destroying a thrombus to open up a vessel. Thrombolytics- drugs. used only in Ischaemic stroke.
What drugs are used in treating stroke?
- Anti- platelets- Aspirin, Clopidogrel, dipyramidole
- Anti- Coagulants- For AF. Rivaroxaban, apixaban dabigatran, heparin, warfarin,
- Statins- Atoravastatin, simvastatin
- Anti-hypertensives- ACE/ARB, Ca Blocker
When is surgical intervention in stroke needed?
- to remove haematomas - relief of raised intracranial pressure
