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CVS clinical conditions > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

Sudden onset of loss of function due to neurological deficit which is of vascular origin and lasts more than 24hrs

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2
Q

Whats the difference between ischamic attack and stroke?

A

TIA only lasts 24 hours

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3
Q

What are the symptomrs of stroke?

A 
Loss of function
Loss of vision
Loss of sensation
Loss of speech
Loss of co-ordination
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4
Q

What is the term for loss of speech?

A

Aphasia

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5
Q

What may a ptient experience before the stroke?

A 
Headache
Nausea/vomitting
Neck stiffness
Photophasia
Loss of incontenence
Fit
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6
Q

What is the term to describe pain in the eyes due to light?

A

Photophasia

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7
Q

Name some of the signs which can be associated with stroke patients on examination.

A 
Motor (loss of function)
Sensory (loss of feeling)
Speech - dysarthria, dysphasia
Neglect / visuospatial problems
Inco-ordination-  Ataxia, vertigo, nystagmus
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8
Q

What is ataxia?

A

Loss of co-ordination of muscle movements

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9
Q

What is vertigo?

A

Imbalance

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10
Q

What is nystagmus?

A

Reptitive uncontrolled eye movements

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11
Q

What is the difference between dysphasia and dysarthria?

A

Dysarthria is slurred speech due to loss of function of facial muscles
Dysphasia is languague disorder (can speek but dont make sense)

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12
Q

What is hemianopia

A

Loss of visual fields in one side of both eyes

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13
Q

What causes a stroke?

A

Damage to part of the brain due to blockage in a blood vessel by thrombus or embolus or due to haemorrhage from rupture of a blood vessel

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14
Q

The vertebral arteries join to form what artery?

A

The basilar artery

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15
Q

What artery system/ arteries the cerebellum, brain stem and occipital lobes?

A

Vertebro-basilar system

Vertebral arteries join to form the basilar artery which supplies the cerebellum, brain stem and occipital lobes

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16
Q

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

A

The carotid system (carotid arteries)

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17
Q

What is the parietal lobe responsible for?

A

Comprehension of language

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18
Q

What is the brainstem responsible for?

A

Involuntary movements such as swallowing, breathing, heartbeat etc

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19
Q

What is the occiptal lobe responsible for?

A

Vision

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20
Q

What is the temporal lobe responsible for?

A

Intellectual and emotional functions

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21
Q

Even a small stroke in which areas will cause major deficits?

A

brainstem (pons) and the white matter because this is where the fibres are all packed tightly
not: they may still have higher function such as speech as the stroke isn’t affecting the cortex.

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22
Q

what does the frontal lobe control?

A

foresight, judgement and voluntary movement

23
Q

what are major causes of strokes overall?

A

blockage of a blood vessel with throbs or clot
disease of vessel wall
disturbance of normal properties of blood (thicker/more viscous)
rupture of a vessel wall (causing haemorrhage stroke)

24
Q

what are the different categories of haemorrhage stroke?

A

primary intraceberal haemorrhage

secondary haemorrhage - subarachnoid haemorrhage , arteriovenous malformation

25
Q

name specific causes of ischaemic stroke.

A 
large artery atherosclerosis (e.g. in carotid)
cardioembolic (from atrial fibrillation)
small artery occlusion (lacunar)
arterial dissection
venous sinus thrombosis
or it may be undermines / cryptogenic
26
Q

where is lacunar stroke found in the brian?

A

the lacunar arteries branch off the middle cerebral artery

therefore a lacunar stroke is a small vessel stroke due to blockage in one of the lacunar vessels

27
Q

when there is a patient with a stroke, what do you have to consider in order to work out what part of the brain is affected?

A

consider whether:

  • is it the left or the right side?
  • is it the cortex or deep white matter?
  • is it the carotid territory or vertebrobasilar territory?
  • is it the cerebral hemispheres or brainstem?
28
Q

whats the name for a stroke which occurs int he deep white matter?

A

lacunar stroke

29
Q

what are the different strokes subtypes?

A

TACS - total anterior circulation stroke
PACS - posterior anterior circulation stroke
LACS - lacunar stroke
POCS - posterior circulation stroke

30
Q

what are the different visual field defects?

A

unilateral field loss
bitemporal hemianopia
homonymous hemianopia

31
Q

if there is unilateral field loss what is the likely lesion?

A

optic nerve compression

32
Q

if there is bitemporal hemianopia, what is the likely lesion?

A

chiasmal compression

33
Q

if there is homonymous hemianopia what is the likely lesion?

A

cerebrovascular event

34
Q

What defects does a TACS cause?

A

Sensory deficit - weakness
homonymous hemianopia
higher cerebral dysfunction i.e. dysphasia / dyspraxia

35
Q

what defects does a PACS cause?

A

2/3 of TACS criteria

i.e. one limb, face and hands, or higher cerebral dysfunction alone

36
Q

what are the different subtypes of LAC strokes?

A

pure motor
pure sensory
sensorimotor
ataxic hemiparesis

37
Q

in a LAC stroke, what does an ataxic hemiparesis cause?

A

hemiapresis and ipsilateral cerebellar ataxia (lack of co-ordination)
small infarcts in basal ganglia or pons

38
Q

State some of the deficits that a POC stroke can cause.

A 
bilateral motor/ sensory deficit
disordered conjugate eye movement
isolated homonymous hemianopia
ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
coma
tinnitus (hearing of sound when there is no external sound)
vertigo (imbalance)
horners syndrome
disordered breathing
39
Q

what type of stroke has the highest recurrence rate after one year?

A

POC stroke with 20% recurrence

40
Q

what type of stroke has the highest mortality at 1 year?

A

TACS with 60% mortality at 1 year

41
Q

What symptom of stroke suggests a haemorrhage stroke?

A

Photophobia

42
Q

What type of stroke causes Horners syndrome?

A

Posterior circulatory stroke

43
Q

What type of stroke causes ataxia hemiapresis and what does it mean?

A

Ataxia hemiapresis is weakness and lack of co ordination

It is one of the major symptoms of a lacunar stroke

44
Q

What investigations are carried out to diagnose a stroke/ progression of a patient who has had a stroke?

A

Full blood count
ECG
CT, MRI and carotid Doppler
May do an ECHO to look for emboli in heart

45
Q

What are the risk factors for a stroke?

A

Modifiable; blood pressure and atrial fibrillation

Non-modifiable; age, race, family history

46
Q

What is the aetiology of stroke?

A

cerebral ischaemia; MI, atrial fibrillation, atherosclerosis plaque rupture or thrombus, carotid artery dissection, drug abuse, haematological disease i.e. sickle cell
intra-cerebral haemorrhage
sub-arachnoid haemorrhage

47
Q

when is prophylactic carotid endarterectomy surgery considered?

A

when there is >70% stenosis of the carotid artery
or in men with stenosis 50-69%
(ECST criteria)

48
Q

what is the most risky period for a further event following a stroke/TIA?

A

2 weeks

49
Q

when is prophylactic surgery not offered in patients?

A

when the stenosis is <70% ECST (<50% in NASCET criteria) or there is complete occlusion

50
Q

if there is complete occlusion of the carotid artery, what is the embolic risk?

A

there is no risk because there is no blood flow
(risk of embolism increases with increasing turbulent blood flow)
blood flow is maintained to the brain due to the circle of willis

51
Q

what is the BMT for a patient who has had a stroke/TIA?

A 
smoking cessation
diabetic control
anti platelet
statin
anti-hypertensive's
52
Q

what is the treatment if someone has had a TIA and carotid ultra sound shows 50% stenosis?

A

BMT

53
Q

what is the treatment of someone has a TIA and carotid ultrasound shows 80% stenosis?

A

carotid endarterectomy + BMT

54
Q

what symptoms post stroke are suggestive that the stroke was caused by a carotid artery dissection?

A

horners syndrome

cranial nerve palsy

CVS clinical conditions (29 decks)

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