Stroke Flashcards
what conditions can mimic a stroke?
seizure sepsis metabolic eg DKA SOL syncope delirium
outline the components of the rosier score
loss of consciousness/syncope
seizure activity
acute onset: weakness, disturbance in vision/speech
when does a CT become ineffective at looking at blood and why?
1 week
blood reabsorbs so you cant see the white anymore
best imaging for blood after a week?
MRI
name the 4 different areas in which a stroke can occur?
posterior circulaion infarct
lacumar
total anterior circulation
partial anterior circulation
what does TACS mean in terms of stroke
total anterior circulation syndrome
how is a stroke named?
area it is PLUS whether it is a:
syndrome (s)
haemorrhage (h
infarct (i)
TACS presents with…
hemiplegia involving 2 of face, arm, leg
homonymous hemianopia
cortical signs
most severe type of stroke?
TACS
where are lacunar infarcts?
deep parts of the brain eg basal ganglia, white matter, thalamus. brain stem
what is a lacunar syndrome caused by
occlusion of a single deep penetrating artery
lacunar syndrome will affect what parts of the body?
face arm leg
what stroke has the best prognosis?
lacunar
how does the presentation of PACS differ from TACS?
has only a few of the features of TACS
motor/sensory signs
isolated cortical dysfunction
POCS wll present with…
cranial nerve palsyies
BILATERAL motor/sensory defects
homonymous hemianopia
blindness
a __ sided stroke will give you more disability after
left
what stroke type presents with bilateral motor and sensory signs
POCS
LHS brain is responsible for what functions
reasoning
spoken and written language
number skills
what side of the brain is responsible for creativity, music, spacial orientation and artistic awareness?
RHS
most common cause of stroke
atheroembolism usually from carotid
a thrombus finally lodges in the ___ to cause an ischaemic stroke
cerebral
Ix of stroke
angiogram
doppler USS carotid
what autoimmune conditions can cause strokes?
vasculitis eg GPA, eGPA due to small vessel damage
if a stroke patient has no risk factors and has a stroke, what could be the cause?
hereditary cerebral amyloid angiography
patent foramen ovale
what does small vessel disease look like on MRI?
looks smudgy
most common cardioembolic cause of stroke?
AF
patient with recent MI who gets a stroke could have what cardioembolic causes?
ventricular thrombus
stasis from scar tissue
what congenital defect can cause stroke and why?
patent foramen ovale
blood moves from R to L overloading the arterial side thus forming clots
Tx of arterial dissection
anticoagulation and antiplatelets
what is a carotid arterial dissection?
tear in the innermost lining of the carotid artery
primary intracerebral haemotthage is caused by…
hypertension
amyloid angiography
a secondary intracerebral haemorrhage is caused by…
patent foramen ovale
aneurysm
tumour
a lobar primary intracerebral haemorrhage suggests what cause?
cerebral amyloid angiopathy
hypertension is more likely to cause a haemorrhage where?
deep in the brain
acute Tx of stroke
thrombolysis/thrombectomy imaging swallow assessment nutrition/hydration antiplatelets DVT prophylaxis
thrombolysis only works if given before __ hours
4.5
what problems would make thrombolysis less effective?
diabetic patient hypertensive patient previous stroke time since stroke onset age
outline the FAST mnemonic for stroke symptoms
facial weakness - can they smile? drooping?
arm weakness- can they raise both arms?
speech problems- can they speak and understand you?
test all 3
if blood is not present on the CT due to hyperacuteness, how else could you diagnose a stroke using imaging?
look for a hyper-dense middle cerebral artery
how does thrombectomy work?
put a wire into the area of the clot and catch it using a stent, pull it out
name the 3 main subtypes of stroke causes
cardioembolic
atheroembolic
small vessel disease
Ix for stroke
lipid profile BP carotid scan ECG ECHO if cardioembolic
ABCD of stroke prevention?
antithrombotics blood pressure cholesterol diabetes dont smoke
main carotid surgery performed on stroke patients?
carotid endarterectomy
