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ʏear 3 ɴeurological Core Conditions > Stroke > Flashcards

Stroke Flashcards

1
Q

What is strokeʔ

A

ʀapid, permanent neurological decline caused by a cerebrovascular event.
That lasts for more than 24hours.

(TɪA lasts for less than 24hours)

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2
Q

What the 2 types of strokeʔ

A

1) ischemic stroke
2) hemorrhagic
Strokes can be caused by an infarction (80%) or hemorrhage.

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3
Q

What are the causes of ischaemic strokeʔ

A

1) Thrombosis —> small vessel occlusion
2) Cardiac emboli (Afib, endocarditis, Mɪ)
3) hypotension (sepsis)

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4
Q

What are the causes of haemorrhagic strokeʔ

A

1) hypertension
2) trauma
3) aneurysm rupture (berry aneurysm in circle of willis)
4) anticoagulation
5) thrombolysis

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5
Q

What is the annual incidence of strokeʔ

A

2 in 1000

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6
Q

What are the presenting symptoms of a strokeʔ

A
  • sudden onset
  • weakness on one side of body
  • impaired consiousness
  • sensory,
  • blurred or loss of vision,
  • cognitive impairment (confusion, difficulty finding words)
  • sudden, severe headache
  • dizzy
  • loss of balance
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7
Q

What are the symptoms of an infarct of the area supplied by the anterior cerebral artery ʔ

A
  • lower limb weakness (motor cortex)

- confusion (frontal lobe)

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8
Q

What are the symptoms of an infarct of the area supplied by the middle cerebral arteryʔ

A
  • Facial weakness ( motor cortex)
  • hemiparesis (motor cortex)
  • hemisensory loss (somatosensory cortex)
  • apraxia (difficulty initiating speech) (parietal lobe)
  • ʀeceptive / expressive dysphasia (difficulty understanding words and difficulty finding the words to express themselves.
  • Quadrantanopia (loss of vision from one quadrant) (superior or inferior optic radiation)
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9
Q

Occlusion of which artery leads to hemianopia (loss of half of visual field)ʔ

A

Posterior cerebral

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10
Q

What are the modifiable risk factors of strokeʔ

A

Cardiacː

  • ischaemic heart disease
  • atrial fibrillation
  • heart valve disease

Vascularː

  • hypertension
  • periferal vascular disease
  • carotid bruit

ʟifestyleː

  • alcohol
  • smoking
  • hyperlipidaemia

Drugsː
-OCP

ɪnfectiousː
-syphilis

  • Diabetes
  • previous TɪA
  • increased clotting
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11
Q

What does a cerebral infarct lead toʔ

A
  • contrelateral sensory loss or hemiplegia (weakness of one side of body)
  • dysphasia (inability to express or understand speech)
  • homonymous hemianopia (same side of vision lost in both eyes)
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12
Q

ɪnfarct of what area of the brain leads to locked in syndromeʔ

A

Brainstem

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13
Q

What is the immediate response to a patient presenting with strokeʔ

A

1) protect airway
2) pulse, BP, ECɢ
3) Urgernt CT (haemorrhagicʔ)
4) Or urgent Mʀɪ (acute infarct)
5) Thrombolysis if vessel occlusion
6) ɴil by mouth (dysphagia —> choking risk)
7) Antiplatelets (only if haemorrhagic cause excluded)

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14
Q

Where is a subdural haematomaʔ and what does it look like on a CT scanʔ

A

Subdrual haematoma is a collection of blood in the subdural space. That is the space between the dura mater and the arachnoid mater.

ɪt looks like a banana on the CT scan.

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15
Q

What are the symptoms of a subdural haematomaʔ

A

Can be caused by a rupture of vein following a light head injury. The symptoms may only occur days to weeks after the injury.

symptoms includeː

  • headache
  • drowsiness
  • confusion
  • fluctuating consciousness
  • siezures

-raised ɪCP

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16
Q

Who is at risk of a subdural haematomaʔ

A

Elderly because atrophy of the brain makes veins more vulnerable

17
Q

sudden headache, followed by vomiting , collapse and coma is significant of….

A

subarachnoid haemorrhage
(thunderclap headache)

Differentialsː
Cerebellar haemorrhage - headache followed by stupr/coma, ocular palsies, nystagmus

18
Q

What haemorrage could cause acute hydrocephalusʔ

A

Cerebellar haemorrhage.

symptomsː(brainstem/ cerebellar involvement) stupor/coma, ocular palsies, nystagmus

19
Q

ʀupture of what type of aneurysm could cause an intracerebral haemorrhageʔ

A

Charcot - bouchard aneurysm

20
Q

Following what type of haemorrhage could there be neck stiffness , +ve kernig’s sign and papilloedemaʔ

A

major Subarachnoid haemorrhage can show signs of meningism.

21
Q

What invx should be done in a pt presenting with strokeʔ

A

1) Bloods ː FBC, U+E’s, Clotting profile, lipids
2) ECɢ (Atrial fibʔ)
3) Echocardiogram (valvular endocarditisʔ - cardiac source of emboli)
4) Carotid doppler USS (carotid artery disease)
5) CT head (detect haemorrhage)
6) Mʀɪ (identify infarction)
7) CT-cerebral angiogram to identify occlusion or intracranial stenosis.

22
Q

What is the treatment of a non haemorrhagic stroke, if less than 4.5 hours from onset of symptomsʔ

A

ɪntravenous thrombolysis

23
Q

When is heparin anticoagulation in a stroke patient consideredʔ

A

ʜeparin may be given in a non-haemorrhagic stroke if there is a high risk of embolu recurrence or stroke progression e.g. carotid dissection, carotid stenosis ect.)

24
Q

Why would a formal swallow assesment be essential in a stroke patientʔ

A

Stroke can cause dysphagia so there is choking risk.

Swallow assment needed to decide whether ɴɢ tube necessary.

25
Q

What is a TIA?

A

Sudden onset of CNS decline that lasts less than 24h.

26
Q

What is the usual pathogenesis of TIA?

A

emboli in the small vessels of brain causing small infarct (lacunar infarct)

  • Atherothromboembolism from carotid
  • cardioembolism (Afib, mural thrombus, post MI)
  • hyperviscosity (e.g. polycythemia or sickle cell)
27
Q

What are the signs of a TIA?

A

Mimics stroke

  • facial weakness
  • aphasia
  • amaurosis fugax (progressive vision loss in one eye due to emboli in retinal artery)
28
Q

Frontal sparing is a sign of:

a) Stroke (umn lesion)
b) facial nerve palsy (LMN lesion)

A

Frontal sparing is a sign of stroke.

29
Q

What is the sign of a carotid source of emboli in TIA?

A

carotid bruit

30
Q

When examining a TIA pt what signs should you look out for that could indicate the cause of the event?

A
  • carotid bruit
  • increased Blood pressure
  • heart murmur (from valve disease)
  • atrial fibrillation
  • fundoscopy may show retinal artery embolism
31
Q

What are the differential diagnoses for TIA?

A
  • hypoglycaemia
  • migraine aura
  • focal epilepsy
  • hyperventilation
  • retinal bleed
32
Q

What invx are done for TIA?

A

The Invx aim to find a cause for the TIA and assess vascular risk:

1) Bloods (FBC, ESR, U+Es, Glucose, lipids)
2) CXR (afib?)
3) Carotid doppler +/- angiography (carotid stenosis)
4) CT / MRI to identify infarct

33
Q

What treatment should be given to a pt with TIA?

A

1) control cardiovascular risk factors:
- Blood pressure,
- hyperlipidemia,
- stop smoking,

2) Antiplatelet drugs:
- clopidogrel
- aspirin 300mg/d for 2wks, then 75mg/d

3) Warfarin if cardiac emboli
4) Carotid endartectomy if more than 70% stenosis

34
Q

When should TIA lead to prompt referral?

ABCD2 criteria

A

ABCD2 if score 6+ then high stroke risk within next week. If score 4+ then must be assessed within 24hrs.

A- Age 60+ (1 point)
B - blood pressure more than 140/90 (1 point)
C - clinical features - unilateral weakness (2 points), speech disturbance without weakness (1 point)
D - duration of symptoms - 1hr+ (2 points), 10-59 mins (1 point)
D - diabetes

ʏear 3 ɴeurological Core Conditions (10 decks)

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