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Cardiovascular system > Stroke > Flashcards

Stroke Flashcards

1
Q

What is stroke?

A

Sudden loss of neurological function that lasts more than 24 hours, it is of vascular origin and occurs suddenly

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2
Q

Was is transiet ischaemic attack TIA ?

A

Sudden loss of neurological function that lasts less than 24 hours, it resolves itself, sometimes it is called mini stroke

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3
Q

What are the symptoms of stroke ?

A

loss of power, sensation, speech, difficulty speaking, inability to comprehend language, loss of vision, coordination, headache, vertigo, various levels of consciousness

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4
Q

What are the signs of stroke on examination?

A

Motor weakness or clumsy lims, loss of sensory feelings, dysarthria, dysphasia, visuospatial problems, loss of vision, hemianopia, gaze, palsy, ataxia, incoordination, nystagmus

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5
Q

What is dysarthria ?

A

Speech disorder, inability to formulate the words, disturbance of muscular control

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6
Q

What is dysphasia/aphasia?

A

Inability to comprehend or formulate language

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7
Q

What is hemianopia?

A

It is loss of one half of visual field

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8
Q

What is nystagmus?

A

Uncontrolled and uncoordinated movement of eyes

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9
Q

What is ataxia?

A

Group of disorders that control coordination, speech and balance

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10
Q

What are the two mains types of stroke?

A

Ischaemic or haemorrhagic

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11
Q

What does cause ischaemic stroke?

A

Embolus or thrombus, large artery atherosclerosis, AF, cryptogenic, aortic dissection, venous sinus thrombosis

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12
Q

What does cause haemorrhagic stroke?

A

Rupture of blood vessel that can occur due to aneurysm, hypertension or congenitally weak vessels

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13
Q

What is the difference between ischaemic and haemorrhagic stroke on CT?

A

Ischaemic stroke looks dark, whereas haemorrhagic looks white

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14
Q

What is penumbra ?

A

Sleep area rather than dead, there is reduced delivery of O2, but not complete absence, it is still viable tissue and it can be saved

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15
Q

Describe the anterior circulation of the brain

A

Formed from common carotid artery that then forms internal artery, middle cerebral and anterior cerebral artery

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16
Q

Describe the posterior circulation of the brain

A

Formed from vertebral arteries that then form basil arteries, then posterior cerebral and cerebellar artery

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17
Q

Where does anterior and posterior circulations join?

A

At the Circle of Willis

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18
Q

Which two arteries does Circle of Willis join?

A

Posterior cerebral and middle cerebral arteries

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19
Q

What does the carotid system supply?

A

most of hemispheres, cortical deep white matter

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20
Q

What does the vertebro-basillar system supply?

A

brain stem, cerebellum, occipital lobe

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21
Q

Where is motor cortex?

A

In front of central sulcus, sends motor information

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22
Q

Where is sensory cortex?

A

Behind the central sulcus, receives sensory information, such as pain, heat, other sensations

23
Q

Where is frontal lobe and what is its role?

A

Frontal portion of the brain, it has Broca’s speech area, judgement, foresight, voluntary movement, smell

24
Q

Where is parietal lobe and what is its role?

A

Behind the sensory portion, it is responsible for comprehension of language

25
Q

Where is occipital lobe and what is its role?

A

At the back of the brain, its role is vision

26
Q

Where is temporal lobe and what is its role?

A

Middle portion of the brain, intellectual and emotional functions, there is also Wernicke’s area which has speech comprehension role

27
Q

What is the role of cerebellum?

A

Coordination

28
Q

What is the role of brainstem?

A

swallowing, breathing, other involuntary functions

29
Q

Which artery is the most likely affected if the parent can’t move their upper body but can move legs?

A

Middle cerebral artery

30
Q

What are the 4 main subtypes of stroke?

A

Total anterior circulation, partial anterior circulation, lacunar stroke, posterior circulation stroke

31
Q

What is unilateral loss of vision?

A

Full loss of vision in one eye, the lesion must be close to the eye, example is optic nerve compression

32
Q

What is bitemporal hemianopia?

A

Loss of the outer fields of vision in both eyes, the lesion is in chiasmata crossover

33
Q

What is homonymous hemianopia?

A

If the right or left field of vision is lost, due to right or left cerebrovascular event

34
Q

What is TACs and what are the signs?

A

Total anterior circulation stroke, the signs include weakness, sensory deficit, homonymous hemianopia, higher cerebral dysfunctions such as dysphasia, dyspraxia

35
Q

Where does the occlusion occurs on the TACs?

A

In the internal carotid, middle cerebral

36
Q

What is PACs and what are the sings?

A

Partial anterior circulation stroke, restricted motor/sensory deficit or higher cerebral dysfunctions

37
Q

Where does the occlusion occurs in PACs?

A

In the branches of middle cerebral artery

38
Q

What is LACs and what are the signs?

A

Lacunar stroke, pure motor weakness, complete or incomplete, on one side, involving whole 2 or 3 body areas, or pure sensory with the same distribution, or sensorimotor, combination of the two, ataxic hemiparesis

39
Q

Where does the occlusion occurs in LACs?

A

In the basal ganglia or pons

40
Q

What is ataxia and hemiparesis?

A

Ataxia -lack of voluntary coordination, hemiparesis - weakness of one side

41
Q

What is POCs and what are the signs?

A

Posterior circulation stroke, affects brainstem, cerebellum, occipital lobe, very variable and complex presentation, visual problems, disordered conjugate eye movements, coma, disordered breathing, vetigo, Horners syndrome, tinnitus

42
Q

Where does the occlusion occur in POCs?

A

In the posterior circulation

43
Q

What is tinnitus ?

A

Hearing voices from the inside

44
Q

What are the risk factors for stroke?

A

hypertension, AF, cocaine use, age, race, family history

45
Q

What investigations would be performed?

A

Bloods (fBC, lipids, ESR), ECG, CT or MRI, carotid dropler, ECHO possible later on

46
Q

Compare and contrast CT and MRI machine

A

CT shows blood better, whereas MRI shows better ischaemia, but MRI takes longer time

47
Q

What scale is used to asses severity of stroke and how many stages are there?

A

NIHSS, there are 0-42 stages

48
Q

Until what time thrombolysis is acceptable to be used ?

A

Within 4.5 hours from the onset of symptoms

49
Q

What fibrinolytic agent is used for fibrinolysis ?

A

Alteplase, IV

50
Q

What are the contraindications for use of fibrinolysis ?

A

Under 16 and over 80, major infarct, haemorrhage, recent birth, trauma, surgery, artery or venous puncture at incompressible site, past CNS bleeds, hypertension, aneurysm, liver disease, varicose, portal hypertension, INR >1.7

51
Q

What is the more invasive treatment option for ischaemic stroke?

A

endovascular clot retrieval

52
Q

What is the secondary prevention for ischaemic strokes?

A

aspirin or clopidogrel, statins, BP medication, carotid endarectomy

53
Q

What is the treatment of haemorrhages stroke?

A

Surgery

Cardiovascular system (18 decks)

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