Stroke Flashcards
1
Q
What is the definition of stroke?
A
- Neurological deficit of sudden onset lasting for more than 24 hours
- Vascular origin
2
Q
What does TIA stand for?
A
- Transient ischaemic attack
3
Q
What is a TIA?
A
- A stroke resulting in a neurological deficit of less than 24 hours
4
Q
What are the 4 subtypes of stroke?
A
- TACS
- PACS
- LACS
- POCS
5
Q
What does TACS stand for?
A
- Total anterior circulation stroke
6
Q
What percentage of strokes are TACS?
A
- 20%
7
Q
What is the mortality of TACS?
A
- The worst of the 4
8
Q
What does PACS stand for?
A
- Partial anterior circulation stroke
9
Q
What percentage of strokes are PACS?
A
- 35%
10
Q
What does LACS stand for?
A
- Lacunar stroke
11
Q
What percentage of strokes are LACS?
A
- 20%
12
Q
What does POCS stand for?
A
- Posterior circulation stroke
13
Q
What percentage of strokes are POCS?
A
- 25%
14
Q
What is special about POCS?
A
- Highest recurrence rate
15
Q
What do the symptoms of stroke depend on?
A
- The area of the brain affected
16
Q
What are the 5 things that can be lost due to a stroke?
A
- Power
- Sensation
- Speech
- Vision
- Coordination
17
Q
How can power be lost?
A
- Loss of motor control
- Clumsiness
- Weak limb
18
Q
How can sensation be lost?
A
- Loss of feeling in areas of the body
19
Q
What 2 ways can throat function be affected?
A
- Dysarthria (slurred speech)
- Dysphagia
20
Q
What ways can visual function be affected?
A
- Visuospatial problems
- One eye affected
- Hemianopia
- Gaze palsy
21
Q
What is hemianopia?
A
- Blindness over half the field of vision
22
Q
What is gaze palsy?
A
- Inability to move the eyes in the same direction of motion
23
Q
What 4 conditions can coordination be affected due to?
A
- Ataxia
- Vertigo
- Incoordination
- Nystagmus
24
Q
What is ataxia?
A
- Loss of voluntary function
25
What is nystagmus?
Constant uncontrolled eye movements
26
What modifiable risk factors are there for stroke?
- Hypertension
| - AF (loss of adequate blood flow to the brain)
27
What are the non modifiable risk factors for strokes?
- Age
- Race
- Family history
28
What is the cause of stroke?
- Damage to part of the brain due to blockage of a blood vessel by thrombus or embolism OR
- Haemorrhage from a ruptured blood vessel
29
What percentage of strokes are caused by infarction?
- 85%
30
What are the 5 ways that infarction can occur in vessels in the brain?
- Large artery atherosclerosis
- Cardioembolic stroke
- Small artery occlusion
- Undetermind/cryptogenic
- Rare causes
31
What percentage of infarcting strokes are caused by large artery atherosclerosis?
- 35%
32
What large artery is usually the one to cause an infarction due to it having atheromatous plaques and what do these plaques do to the artery?
- Carotid artery
| - Cause carotid stenosis which will be heard as a bruit on examination
33
What is a cardioembolic stroke a result of?
- AF
34
What percentage of infarcting strokes are cardioembolic strokes?
- 25%
35
What type of stroke is a result from small artery occlusion?
Lacunar
36
What percentage of infarcting strokes are from small artery occlusion?
- 25%
37
What percentage of infarcting strokes are from undetermined/cryptogenic causes?
- 10 - 15%
38
What rare causes may result in a stroke?
- Aortic dissection
| - Venous sinus thrombosis
39
What percentage of strokes are from haemorrhage?
- 15%
40
What is the main cause of haemorrhagic stroke?
- Primary intracerebral haemorrhage
41
What is a primary intracerebral haemorrhage?
- A bleed in the brain tissue
42
What pathologies can cause a primary intracerebral haemorrhage?
- Brain trauma
- Aneurysm
- Tumours
43
What type of haemorrhages account for the other 30% of haemorrhagic stroke?
- Subarachnoid
| - Arteriovenous malformations
44
What initial tests should be carried out on presentation of a suspected stroke?
- Blood tests
- ECG
- CT scan
- MRI
- Carotid doppler
- Echocardiogram
45
What blood tests should be carried out?
- FBC (platelets and RBC's)
- Lipid count
- ESR
46
What is the benefit of a CT scan?
- Quick
| - Shows the area of the infarct
47
What are the benefits of an MRI?
- Better for ischaemic stroke diagnosis
48
What are the detriments of MRI?
- Takes longer
| - Claustrophobic
49
Why is an echocardiogram used in stroke diagnosis?
- Look for clots in the heart
50
What unit should the patient be referred to after diagnosis?
- Stroke unit
51
What things should be done in the stroke unit?
- Mobility
| - Concentrate on simple things for the patient such as swallowing and positioning
52
What treatment should be performed in the stroke unit?
- Anti coagulation
53
What initial treatment should be done to reduce effects of a stroke?
- THROMBOLYSIS
| - Clot retrieval using minimally invasive surgery
54
What is the aim of thrombolysis?
- Restore perfusion before cell death occurs
55
What drugs are used in thrombolysis?
- Alteplase
- Reteplase
- Tenecteplase
56
What type of drug are all alteplase, reteplase and tenecteplase?
- Tissue plasminogen activators
57
What do tissue plasminogen activators do?
Convert plasminogen to plasmin to break down clot
58
At what time do risks of thrombolysis outweigh the benefits?
- Around 4.5 hours after event
59
How is minimally invasive clot retrieval surgery performed?
- Catherter with a retrieval device on the end
60
What is the typical history of presenting complaint of a stroke?
- Headache
- Vomiting
- Neck stiffness
- Photophobia
- Loss of consciousness
- Fit
- Incontinence
61
What does photophobia suggest?
- The stroke is haemorrhagic
62
What does post thrombolysis haemorrhage risk depend on?
- Infarct size
- Vessel occlusion
- Diabetes
- BP
- Age
