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Neurology SB > Stroke > Flashcards

Stroke Flashcards

1
Q

what are the 2 types of strokes

A

haemorrhagic (about 10%)

ischaemic (80%)

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2
Q

what are the features of a stroke

A

rapid onset (seconds-mins) of focal CNS signs and symptoms

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3
Q

what are the important stroke mimics

A

7 S

Seizures
Syncope
Sugar (hypo/hyperglycaemia)
SOL (tumours/brain abscess/SDH)
Severe migraine
Sepsis
Si-chological/psychology
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4
Q

what are causes of strokes

A
  • small vessel occlusions/cerebral microangiopathy
  • thrombosis in situ
  • cardiac emboli (AF, endocarditis, MI)
  • Atherothromboembolism
  • CNS bleeds (BP increase, trauma, aneurysm rupture, anticoagulation, thrombolysis)
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5
Q

how is the cerebral circulation split (anterior and posterior)

A

anterior - 80% of cerebral flow; middle and anterior cerebral artery

posterior - 20% of cerebral flow; vertebra-basilar system and posterior cerebral artery

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6
Q

Sx of acute stroke

A
  • sudden onset
  • focal language problems = aphasia/dysphasia/slurred speech
  • visual disturbances = hemianopia/diplopia
  • loss of coordination (particularly in loss of posterior circulation)
  • headache
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7
Q

what does the symptoms of a stroke depend on

A

location of the bleed

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8
Q

although unreliable, what signs/Sx point to a haemorrhagic or ischaemic stroke

A

bleed = meningism, severe headache, coma

ischaemic = carotid bruit, AF, past TIA, IHD

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9
Q

what are the main locations of an infarct in the brain

A

Cerebral infarct
Brainstem infarct
Lacunar infarct

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10
Q

what is a lacunar infarct

A

most common type of stroke

results from occlusion of small penetrating arteries

supplies basal ganglia, internal capsule, thalamus and pons

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11
Q

what are Sx suggestive of a cerebral infarct

A
  • contralateral sensory loss or hemiplegia
  • initially flaccid (floppy limbs)
  • dysphagia
  • homonymous hemianopia
  • visuo-spatial deficit
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12
Q

what are Sx suggestive of brainstem infarcts

A
  • quadriplegia
  • disturbance of gaze and vision
  • locked-in syndrome
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13
Q

what are Sx of lacunar infarcts

A
  • No visual field defect
  • No new higher cortical or brainstem dysfunction
  • Pure motor hemiparesis, or pure sensory deficit of one side of the body, or sensorimotor hemiparesis or ataxic hemiparesis
    (dysarthric clumsy hand syndrome or ipsilateral ataxia with crural hemiparesis)
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14
Q

what is intact in lacunar infarcts

A

cognition/consciousness

except in a thalamic stroke

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15
Q

what is a watershed stroke

A

watershed zone = between 2 vascular beds where supply is most tenuous

occur at the border between cerebral vascular territories

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16
Q

what is CADASIL

A

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarct & Leucoencephalopathy

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17
Q

why is CADASIL important and what gene is affected

A

most common genetic cause of stroke

NOTCH3 gene mutation

18
Q

how does CADASIL present

A

40 y/o with migraine, TIA, mood disorders, dementia +/- pseudo bulbar palsy

19
Q

what will a stroke in the dominant hemisphere cause

normally left hemisphere; think how most people are right handed

A

language problems

20
Q

what will a stroke in the non dominant hemisphere causes

A

spacial awareness problems

21
Q

what is the first line Ix for suspected stroke and why

A

Non contrast CT

MRI more detailed but takes too long

22
Q

what is an MRI useful for

A

identify old lesions and lesions of non-vascular origin
identify new ischemic lesions
identify bleeds and micro bleeds

23
Q

what is an early CT sign of a stroke (of the Middle Cerebral artery)

A

Loss of the insular ribbon sign

- loss of definition of the gray-white interface in the lateral margin of the insular cortex

24
Q

what are Sx of a POSTERIOR circulation stroke

A 
Cranial nerve palsy
Unilateral or bilateral motor or sensory deficit
Disorder of conjugate eye movements
Cerebellar dysfunction
Homonymous hemianopia
Cortical blindness
25
Q

in relation to lacunar strokes, how many areas are affected often

A
  • At least 2 of the 3 areas (face, arm, leg) should be involved in its entity
26
Q

what is the most commonly affected territory in cerebral infarctions

A

middle cerebral artery

27
Q

Sx of a middle cerebral artery infarctions

A

contralateral hemiparesis

contralateral hemisensory loss

hemianopia

aphasia: if the dominant hemisphere
neglect: non-dominant hemisphere

28
Q

what does an Anterior cerebral artery (ACA) infarct present with

A

dysarthria, aphasia

unilateral contralateral motor weakness (leg/shoulder > arm/hand/face)

minimal sensory changes (two-point discrimination - leg/shoulder > arm/hand/face)

left limb apraxia

urinary incontinence

29
Q

how does an Anterior inferior cerebellar artery (AICA) infarct present

A

vertigo
ataxia
peripheral facial palsy
hypoacusis

30
Q

how does a basilar artery occlusion present

A

sudden death/LOC

‘locked in syndrome’

31
Q

what is Weber Syndrome

A

midbrain stroke syndrome that involves the fascicles of the oculomotor nerve

32
Q

what are Sx of Weber Syndrome

A

ipsilateral CN III palsy and contralateral hemiplegia or hemiparesis.

33
Q

what arteries does Weber Syndrome affect

A

branches of the posterior cerebral artery that supply the midbrain

34
Q

what are Sx of occlusion of the retinal/ophthalmic artery

A

amaurosis fugax

35
Q

in regards to the Tx of stroke, what should be considered if the patient is seen within 4.5 hours

A

1 - intravenous or intra-arterial thrombolysis (e.g. streptokinase, rtPA)
= 0.9 mg/Kg for Thrombolysis

2 - mechanical thrombectomy

36
Q

what are absolute contraindications for thrombolysis

A
  • recent severe bleeding
  • Hx of intracranial bleeding
  • Sx suggestive of SAH
  • Known hemorrhagic problems
  • recent major surgery - 14 days
  • blood pressure more than 185/110 ever after treatment with beta blocker
37
Q

what are relative contraindications for thrombolysis

A
  • on warfarin (unless INR > 1.6)
  • any Hx of CNS damage (neoplasms etc)
  • recent traumatic external heart massage
  • seizure at onset of stroke
  • major surgery or significant trauma in past 3 months
38
Q

what is given if a patient presents after 4.5 hours or cannot have thrombolysis

A

aspirin = 300 mg orally once daily

39
Q

what cardiac arrhythmia is a big risk factor for stroke

A

AF

40
Q

what should be stopped in a hemorrhagic stroke

A

statins and anticoagulants

41
Q

what is the definition of a TIA

A

stroke symptoms and signs that resolve within 24 hours

most TIAs resolve fully within 30-60 minutes however

42
Q

what Ix should TIA patients get

A

Carotid doppler

Neurology SB (23 decks)

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