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Cardiovascular system 16/17 > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the commonest cause of long term disability?

A

Stroke

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2
Q

What is a stroke?

A

Neurological loss of function of sudden onset lasting over 24 hours of vascular origin

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3
Q

What is a transient ischaemic attack?

A

Neurological loss of function lasting less than 24 hours

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4
Q

What are the symptoms of stroke?

A 
Loss of power
Loss of sensation
Loss of speech
Loss of vision
Loss of coordination
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5
Q

What might some patients experience during a stroke?

A 
Headache
Vomiting
Neck stiffness
Photophobia
Loss of consciousness
Fit 
Incontinence
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6
Q

What is dysarthria and dysphasia?

A

Dysarthria - Poor articulation in speech

Dysphasia - inability to formulate language

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7
Q

What is nystagmus?

A

Involuntary eye movement

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8
Q

What causes a stroke?

A

Damage to part of the brain due to either:
- occlusion of a vessel by an emboli
- haemorrhage at ruptured vessel
Both result in ischaemia of brain tissue

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9
Q

What is the tissue surrounding an ischaemic event that is low in oxygen but not infarcted called?

A

Penumbra, still viable for several hours after event so can be saved if treated fast enough

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10
Q

What blood vessels make up the anterior circulation to the face and neck?

A

External carotid arteries

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11
Q

What blood vessels make up the posterior circulation to the brain?

A

Internal carotid arteries

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12
Q

What blood vessels make up the circle of willis in the brain?

A

Where both the external and internal carotid arteries anastomoses in the brain

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13
Q

How can you quickly identify the responsible artery for a stroke?

A

Compare symptoms to area of brain it is linked to and its associated blood vessel

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14
Q

What vascular system supplies the brain stem, cerebellum and occipital lobes of the brain?

A

The vertebra-basilar system

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15
Q

What vascular system supplies most of the hemispheres and the cortical deep white matter of the brain?

A

The carotid system

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16
Q

What part of the brain is linked to speech?

A

Broca’s area

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17
Q

What part of the brain is linked to movement?

A

Motor cortex

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18
Q

What part of the brain is linked to sensation?

A

Sensory cortex

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19
Q

What part of the brain is linked to swallowing, breathing, heart rate, wakefulness etc?

A

Brainstem

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20
Q

What part of the brain is linked to smell?

A

Frontal lobe

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21
Q

What part of the brain is linked to vision?

A

Occipital lobe

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22
Q

What part of the brain is linked to hearing?

A

Temporal lobe

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23
Q

What part of the brain is linked to comprehension of language?

A

Parietal lobe

Wernickes area

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24
Q

What part of the brain is linked to judgement, foresight and voluntary movement?

A

Frontal lobe

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25
What part of the brain is linked to intellectual and emotional functions?
Temporal lobes
26
What part of the brain is linked to coordination?
Cerebellum
27
What is the homunculus, and what is its relevance for stroke?
Distorted scale model of a human representing the relative space human body parts occupy on the somatosensory cortex and the motor cortex Can link symptoms to part of the brain fast
28
At what two points in the deep white matter cause significant damage in the event of a stroke?
Internal capsule and pons Fibres are packed very close together here
29
What % of strokes are caused by infarction?
85%
30
What % of strokes are caused by haemorrhage?
15%
31
List some causes of ischaemic stroke due to infarction
``` Large artery atherosclerosis Cardioembolic - AF most common cause Small artery occlusion - hypertension Undetermined/cryptogenic Arterial dissection Venous sinus thrombosis ```
32
List some causes of haemorrhagic stroke
Primary intracerebral haemorrhage Secondary haemorrhage - subarachnoid haemorrhage - arteriovenous malformation
33
What is the most common cause of cardioembolic strokes?
Atrial fibrillation
34
What is associated with small artery occlusion (lacunar) strokes?
Hypertension Blockage of small arteries feeding the deep white matter (internal capsule and pons)
35
What can cause the rare carotid dissection?
Trauma Idiopathic Exertion e.g. rowing, heavy lifting
36
How does artery dissection cause stroke?
Tear in artery wall leads to the formation of a clot at the site of the injury, which can later embolise and block an artery and cause a stroke
37
What is the importance of localisation of a stroke?
``` Confirms diagnosis of stroke Allows better imaging selection Gives indication of cause Gives indication of prognosis Gives indication of treatment needed ```
38
What are the 4 stroke subtype?
TACS - total anterior circulation stroke PACS - partial anterior circulation stroke LACS - lacunar stroke POCS - posterior circulation stroke
39
Describe unilateral field loss of vision
Vision in whole of one eye, due to compression of nerve supplying that eye Compression of nerve after chiasma
40
Describe bitemporal hemianopia vision loss
Loss of vision in both the internal portions of each eye (cant see directly in the middle between your eyes) Compression at chiasma
41
Describe homonymous hemianopia vision loss
Loss of vision on either the left or right portions of both eyes Damage of nerve in occipital lobe
42
What % of strokes are total anterior circulation strokes?
20%
43
What are the usual symptoms of TACS?
Weakness Sensory deficit Homonymous hemianopia Higher cerebral dysfunction Usually due to occlusion of proximal MCA or ICA
44
What are the usual symptoms of PACS?
Restricted motor/sensory deficit e.g. one limb, hand, high cerebral dysfunction alone Like TACS but 2/3 of TACS criteria Due to occlusion of branches of MCA, more restricted cortical infarcts
45
What % of strokes are partial anterior circulation strokes?
35%
46
What % of strokes are lacunar strokes?
20%
47
What are the usual symptoms of LACS?
Pure motor commonest Pure sensory Sensorimotor Ataxic hemiparesis Due to intrinsic disease of single basal perforating arteries (end arteries)
48
What % of strokes are posterior circulation strokes?
25%
49
What are the usual symptoms of POCS?
Variable, bilateral motos/sensory deficit - disordered eye movement - coma - disordered breathing - tinnitus - vertigo - Horners syndrome - ipsilateral cranial nerve palsy - visual deficit
50
Which stroke subtype has the greatest mortality rate after 1 year?
TACS
51
Which stroke subtype has the greatest recurrence rate at 1 year?
POCS
52
List some risk factors for stroke
``` Hypertension Atrial fibrillation Cocaine use Age Sex - females protected until menopause Race - increased risk in far eastern pop Family history ```
53
Describe the investigations used for stroke
``` Blood tests ECG Imaging - CT - MRI - Carotid doppler - ECHO - clots in heart (AF) ```
54
What are the benefits of CT vs MRI for each type of stroke?
``` CT - quick - shows up blood (useful in haemorrhagic) MRI - takes 30 mins - claustrophobic and noisy - shows ischaemic stroke better than CT ```
55
What imaging is best for haemorrhagic stroke?
CT
56
What imaging is best for ischaemic stroke?
MRI
57
How can you further harm someone with a stroke?
Alteplase (fibrinolytic agent) in wrong patient Can cause further damage or restoring blood flow to already dead tissue will have no effect
58
What are the SIGN guidelines for stroke treatment?
``` Ambulance priority (blue light) Rapid triage Immediate access to stroke specialists Rapid brain imaging Rapid specialist assessment ```
59
Describe FAST and strokes
Facial weakness Arm weakness Speech problems Time to call 999
60
When are patients suitable for thrombolysis?
Patients with neurological deficit due to a ischaemic stroke if they are scanned within 4.5 hours of symptom onset
61
What are some contraindications for thrombolysis?
Age - not in patients <16yo or >80yo | Recent MI, bleeding or very high BP
62
What is a hemicraniectomy?
Decompression surgery following stroke with massive cerebral oedema, only offered within 48hrs of stroke onset
63
What treatments are offered to stroke patients?
Stroke unit(?) Thrombolytics within 4 hrs Aspirin for 2 days Hemicraniectomy within 2 days if needed
64
What % of patients experience trouble swallowing after strokes?
50%
65
What is the relative % risk of an early recurrent stroke within 3 months of a previous TIA or stroke?
14%
66
What secondary prevention treatment is given to prevent second strokes/TIAs?
Clopidogrel or aspirin, dipyrimadole Statin Hypertension drugs Anticoagulants when needed
67
What surgery is performed for carotid stenosis?
Carotid endarterectomy - targets anterior circulation if external carotids are >70% occluded

Cardiovascular system 16/17 (40 decks)

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