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Neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the definition of stroke

A

Focal neurological deficit of ischaemic vascular origin, involving CNS or retina and lasting >24 hours if patient survives
Aka cerebrovascular disease

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2
Q

What is definition of Transient Ischaemic Attack

A

Transient disruption to blood supply causing similar presentation to stroke but resolving within 24 hours

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3
Q

What is stroke syndrome

A

Constellation of signs/symptoms due to disruption to blood supply to the Brain

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4
Q

What are the types of pathophysiology of stroke

How common are they

A

Ischaemic - 85%

Haemorrhagic - 15%

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5
Q

What are the causes of ischaemic stroke

A

Embolism: AF, Valve disease, Endocarditis, Carotid artery atherosclerosis

Atherosclerosis of cerebral arteries

Other - Sickle cell disease, cocaine, vasculitis

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6
Q

What are the causes of haemorrhagic stroke

How common are each of the types

A

Subarachnoid (5%):
Ruptured Berry aneurysm - PCKD, HTN

Intracerebral (10%):
Hypertension
Amyloid deposition in elderly

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7
Q

What are the features of ACA stroke syndrome

A

Contralateral paresis of LL
Contralateral sensory loss of all modalities of LL
Incontinence - loss of voluntary control of micturition
Split brain syndrome

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8
Q

What are the features of Proximal MCA stroke syndrome

A 
Coma: due to infarction/oedema + RICP 
Contralateral hemiparesis 
Contralateral hypaesthesia 
Contralateral homonymous hemianopia 
Global aphasia (Left) 
Contralateral Hemineglect (Right)
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9
Q

What are the features of MCA Division stroke syndrome

A

Superior:
Contralateral paresis of UL + Face
Contralateral hypaesthesia of UL + Face
Broca’s aphasia

Inferior:
Homonymous hemianopia
Wernicke aphasia

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10
Q

What are the features of MCA Cortical Branches stroke syndromes

A 
A. Brocas aphasia
B. Wernicke aphasia
C. Prefrontal Syndrome
D. Contralateral hemineglect
E. Contralateral paresis/hypaesthesia of UL + Face
F. Homonymous hemianopia
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11
Q

What are the features of PCA stroke syndrome

A

Stem:
Homonymous hemianopia with macular sparing

Branches:
Midbrain - ipsilateral CN III palsy + Contralateral hemiplagia
Thalamus - Contralateral hypaesthesia

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12
Q

What are the features of cerebellar arteries stroke syndrome

A

Distal:
Ipsilateral DANISH

Proximal:
Ipsilateral DANISH
Ipsilateral cranial nerve palsies
Contralateral hemiparesis

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13
Q

What are the features of basilar artery stroke syndrome

A

Distal:
Cortical blindness - bilateral PCA
Bilateral CN III palsies - midbrain
Bilateral hypaesthesia - bilateral thalamic

Proximal:
Locked in Syndrome - pons infarction
Coma - reticular formation infarction

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14
Q

What is lacunar stroke

How are they different from stroke

A

Occlusion of small perforating arteries supplying deep structures of the brain

It has sub-cortical features, not cortical

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15
Q

What are the vessels occluded in lacunar strokes

What structures do they supply

A

Lenticulostriate arteries - internal capsule

Thalamoperforating arteries - Thalamus (spinothalamic and DMNL tracts)

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16
Q

What are the types of lacunar stroke syndromes

A

Dysarthria: genu
Pure motor: posterior limb
Pure sensory: somatosensory tracts in Thalamus

17
Q

What are stroke mimics

A

Hypoglycaemia
Epilepsy
Migraines
Intracranial tumours/infections (insidious onset)

18
Q

What imaging modality is used to investigate stroke

Why is it used

A

CT

Rule out intracranial haemorrhage - eligibility for Thrombolysis

19
Q

What are possible findings on CT
Why does this occur
Why is this unreliable

A

Intracerebral hypodense region
Infarction causes oedema
CT is insensitive at showing ischaemic changes in acute phase

20
Q

What are the steps in management of stroke

A
  1. Assessment
  2. CT head - rule out haemorrhage
  3. Thrombolysis - if within 4.5hrs of onset + no CIs
  4. Stroke unit - MDT care: physio, OT, swallowing assessment
  5. Investigate underlying cause
21
Q

What medications are given for stroke

A

Alteplase

Aspirin - 2 weeks

22
Q

What are contraindications to Thrombolysis

A 
Haemorrhage on CT
Mild deficit 
Previous CNS damage
Recent surgery/trauma/puncture at incompressible site 
Stroke in last 3 months 
AVM/aneurysms 
Severe liver disease/varices
GI/urinary tract haemorrhage in last month 
Known clotting disorder 
Anticoagulants/INR >1.5

Neuro (18 decks)

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