Stroke Flashcards
What is the leading cause of long term disability?
stroke
What is a stroke?
sudden onset neurological deficit lasting greater than 24 hours
What is a TIA?
brief episode of neurological deficit caused by focal ischaemia lasting less than 24 hours (but typically much shorter) without evidence of acute infarction
What is the difference between haemorrhage and ischaemic stroke?
haemorrhage - blood leaks into brain tissue
ischaemic - clot stops blood supply to an area of the brain
What are some stroke mimics?
seizure sepsis SOL syncope vestibular dysfunction dementia
What factors are required to make a full diagnosis of stroke?
type
size
laterality
cause
How is size of stroke classified?
Oxford classification - TACS, PACS, LACS, POCS
What is involved in a TACS?
hemiplegia of at least two of arm, face and leg
homonymous hemianopia
cortical signs - dysphasia, neglect
What is involved in a PACS?
2 out of 3 features present in a TACS
isolated cortical dysfunction
What is a LACS?
small infarcts in the deeper parts of the brain - basal ganglia, thalamus and brain stem
what causes LACS?
caused by occlusion of a single deep penetrating artery - any two of face arm leg
What is seen in POCS?
cranial nerve palsies bilateral deficits isolated homonymous hemianopia cortical blindness ataxia
Which is the dominant hemisphere?
Left
What is important about strokes affecting the dominant hemisphere?
often affects language
non-dominant - neglect
What are some causes of primary intracerebral haemorrhage?
hypertension
amyloid angiopathy
What are some causes of secondary intracerebral haemorrhage?
AVM
aneurysm
tumour
What changes can be seen on hyperacute brain CT?
maybe none!
hyperdense MCA sign
What is a red thrombus?
fibrin containing cardioembolic thrombus
What is a white thrombus?
patelet dependent atherothrombolic thrombus
What investigations should be done in a stroke patient?
full lipid profile
blood pressure
carotid scan
ECG - 24hr
What is the ABCDD of medical stroke prevention?
antithrombotic therapy - antiplatelet/anticoagulant blood pressure cholesterol diabetes don't smoke
What is a potential serious outcome of a missed diagnosis of impaired swallow?
aspiration pneumonia
What is involved in the ABCD2 score?
age greater than 60 - 1 blood pressure - 1 clinical features -unilateral weakness - 2 -speech disturbance - 1 -other - 0 Duration - >60mins - 2 - 10-59 - 1 - <10-0 - 0 Diabetes - 1
Name some antiplatelet agents
clopidogrel
aspirin
dypiridamole
Which type of stroke is low cholesterol associated with?
haemorrhage stroke
What is a carotid endarterectomy?
opening of the carotid arteries and removing plaques to reduce arterial stenosis and stroke risk
What two factors are key in small vessel disease?
blood pressure blood sugar (diabetes)
what is AF?
supraventricular tachyarrhythmia characterised by uncoordinated atrial activation and reduced function
What does rivaroxaban inhibit?
direct factor 10a inhibitor
What does dabigatran inhibit?
direct thrombin inhibitor
