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Cardiovascular Diseases > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the definition of a stroke?

A

Acute onset of focal neurological symptoms and signs due to disruption of blood supply

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2
Q

What are the two types of stroke, their definitions and their chances?

A
  • Haemorrhagic - bleeding occurs inside or outside brain tissue (15-20%)
  • Ischaemic - a clot blocks blood flow to an area of the brain (80-85%)
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3
Q

What is haemorrhagic stroke usually due to?

A
  • Raised BP
  • Weakened vessel wall due to:
    • Structural abnormalities e.g. aneurysm, arteriovenous malformation (AVM)
    • Vasculitis
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4
Q

What are the three usual causes of ischaemic stroke?

A
  • Thrombotic - clot blocking artery at site of occlusion
  • Emboli - clot blocking artery has travelled to artery from somewhere more proximal in the arteries or heart
  • Hypoperfusion - due to reduced blood flow because of stenoses (rather than occluded) artery
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5
Q

What are the 5 non modifiable risk factors for stroke?

A
  • Age (>55 risk doubles/decade)
  • Family history
  • Gender (higher in younger men, overall more common in women (as live longer))
  • Race (AA 2x as likely)
  • Previous stroke
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6
Q
A
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7
Q

What are the 6 important questions when dealing with a stroke?

A
  • Is this a stroke?
  • What kind of stroke is this?
  • What caused this stroke/TIA?
  • Have I tried my best to answer question 3?
  • Is the patient on the appropriate secondary prevention following investigations?
  • Have I answered any questions the patient has?
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8
Q

What do strokes mimic?

A

Conditions that present acutely with focal neurological signs but are not due to interrupted blood flow

  • Hypoglycaemia
  • Seizue
  • Migrane
  • Space occupying lesions like brain tumours
  • Functional hemiparesis
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9
Q

What are the three parts of identifying the type of stroke?

A
  1. History
  2. Exam - General (AF) and Neurological (disability)
  3. Brain imaging - only way to differentiate between ischaemic and haemorrhagic stroke - CT/MRI with or without contrast
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10
Q

If the stroke is identified to be ischaemic, what investigations should be done and why?

A

Investigations to try and find the cause

  • Bloods - glucose, lipids, thrombophilia screen in young patients
  • Assess for hypertension
  • Any other potential causes
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11
Q

What is an artheroembolism?

A
  • Embolism from thrombus forming on atherosclerotic plaque
  • Platelet rich clot
  • Infarcts in same side as affected carotid artery
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12
Q

What is a cardioembolism?

A
  • Embolism from clot formed in heart
  • Usually LA
  • Clotting factor rich clot
  • Infarct in more than one arterial territory, bilateral
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13
Q

If it is a large vessel/embolic stroke, what are you thinking and what are you doing?

A
  • ?Atheroembolism - Carotid scanning, CT/MR angiography of aortic arch
  • ?Cardioembolism - ECG (AF?, old ischaemic changes?, LVH?), echo, 24hr-5day ECG (Paroxysmal AF?)
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14
Q

What can cause haemorrhagic shock (deep, superficial and multiple)?

A
  • Hypertension (usually deep in brain, older patients)
  • If young, not hypertensive and lobar (superficial) haemorrhage, investigate for underlying aneurysm, AVM
  • If multiple - ?vasculitis, ?Moya Moya disease, ?cerebral amyloid angioplasty
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15
Q

What can be done to reverse the disability caused by ischaemic stroke?

A
  • Thrombolysis - up to 4.5hrs after symptom onset
  • Thrombectomy - up to 6hrs after symptom onset, usually after having started thrombolysis
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16
Q

What drug and route is used for thrombolysis in ischaemic stroke?

A

t-PA - tissue plasminogen activator (IV injection)

17
Q

What is the preventative treatment post artheroembolic or thrombotic stroke?

A
  • Antiplatelets (Aspirin 75 mg + Dipyridamole MR 200 mg twice daily/Clopidogrel 75 mg daily)
  • Statins to treat high lipids
  • Diabetes management
  • Hypertension management
  • Lifestyle advice
18
Q

When do you anticoagulate post stroke? How?

A

If due to AF

  • Warfarin (Vitamin K antagonist)
  • Direct acting oral anticoagulants (act by inhibiting clotting factors directly like factor X and thrombin) Rivaroxaban, Dabigatran, Apixaban, Edoxaban
19
Q
A
20
Q

What is a TIA?

A

Transient Ischaemic Attack

  • Temporary neurological symptoms due to occlusion of artery to brain (temporary as arteries can dissolve small clots)
21
Q

When does a TIA show on an ECG?

A

If symptoms last over 1hr

22
Q

What should be done if you suspect someone had a TIA?

A
  • HIGH RISK OF STROKES - Asprin and further tests within 24 hrs
  • LOW RISK OF STROKES - Asprin and further tests within 1 week
23
Q

What should be done if someone is high;y symptomatic of carotid stenosis by criteria?

A

Carotid endarterectomy

Cardiovascular Diseases (9 decks)

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