Stroke Flashcards by Kerry Hendrie

List the three types of stroke

Haemorrhage (primary and secondary)
Sub-arachnoid haemorrhage
Infarct

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List the main differentials for stroke, or stroke mimics (9)

Seizure
Sepsis
Toxic/ metabolic (inc. hypoglycaemia)
SOL
Presyncope
Acute confusion/delirium
Vestibular dysfunction
Functional
Dementia

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Outline the elements of the Rosier scale, signs we would and would not look for in stroke

+: Asymmetric facial, arm or leg weakness
Speech disturbance
VF defect

-: Loss of consciousness
Syncope
Seizure

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What methods can be used to identify the type of stroke?

CT (within 1 week - blood reabsorbs)
MRI DWI (acute ischaemic hypodense lesions)
MRI T1/T2/FLAIR (after 1 week)

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An area of hypodensity on CT would suggest an infarct? True/ False

True

Hyperdensity would suggest haemorrhage

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What classification system is used to determine the size of the stroke?

Oxford

TACS, PACS, LACS, POCS

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What presenting features in a patient would suggest they have had a TACS?

MIDDLE AND ANTERIOR STROKE
All three of the following:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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What presenting features in a patient would suggest they have had a PACS?

ANTERIOR STROKE
Two of the following:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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What presenting features in a patient would suggest they have had a LACS?

One of the following:
Unilateral weakness of the face, arm and leg (or all 3)
Pure sensory loss
Ataxic hemiparesis

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What presenting features in a patient would suggest they have had a POCS?

POSTERIOR CIRCULATION
One of the following:
Cerebellar or brainstem syndromes (e.g. ataxia, nystagmus, vertigo)
Loss of consciousness
Isolated homonymous hemianopia
CN dysfunction

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In a lacunar stroke, there is loss of higher cerebral function. True/ False?

False

No higher cerebral dysfunction - no dysphasia, neglect

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Which classification of stroke is associated with the worst prognosis?

TACS

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Which arteries can be occluded in lacunar stroke?

Medial and lateral lenticulostriate arteries

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Lacunar strokes occur as a result of…

Small vessel disease

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Which classification of stroke is associated with cranial nerve palsies?

POCS

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In the majority of people, which side of the brain is dominant?

Left

What is the main function of the left side of the brain?

Language

What is the main function of the right side of the brain?

Spatial awareness

List the three main causes of infarcts in the brain

Atheroembolic
Cardioembolic
Small vessel disease

What is the pathogenisis of atheroembolic stroke?

Thrombus in carotid artery, breaks off and travels to cerebral artery in brain

What are some risk factors for cardioembolic stroke? What is the most common?

AF (MOST COMMON)
Ventricular thrombus
Prosthetic valves
Acute MI
Rheumatic heart disease

What are the six types of small vessel disease?

Arteriosclerotic (age/ RF related)
Sporadic and heridatory cerebral amyloid angiopathy
Genetic small vessel disease
Inflam and immunologically mediated (churg strauss, wegeners)
Venous collagenosis
Other SVD e.g. post radiation

List three signs on MRI of small vessel disease

White matter hyperintensities
Lacunes
Microbleeds

How does AF cause cardioembolic stroke?

Irregular beating of heart, churns and thickens blood, firing off clots to brain

What structural abnormality is a common cause of stroke in younger people?

Patent foramen ovale | Right to left blood flow allows venous clots to pass into the arterial system

What are the main causes of primary intracerebral haemorrhage?

``` Hypertension (more commonly deeper) Amyloid angiopathy (more commonly lobar) ```

What are the main causes of secondary intracerebral haemorrhage?

AV malformation Aneurysm Tumour

A haemorrhage within the brain does not grow. True/ False?

False | Early haematoma expansion, causes continued arterial bleeding and further oedema

Outline the acute management for stroke

``` Thrombolysis/ thrombectomy Imaging Swallow assessment Nutrition and hydration Anti-platelets Stroke unit care DVT prophylaxis ```

Which factors need to be considered when deciding whether to thrombolyse a patient

``` Age Time since onset History of ICH or infarct Atrophic changes BP DM ```

What is the maximum time that IV tPA can be given from onset of symptoms?

4.5 hours

Which investigations should be carried out, after imaging, to assess the stroke patient?

``` Full lipid profile BP Carotid scan ECG (consider 72 hour ECG) Consider ECHO ```

What surgical procedure can be performed if a carotid scan shows severe stenosis?

Carotid endarterectomy

What secondary preventative measures should be considered in the stroke patient?

Antithrombotic therapy (antiplatelet, anticoagulant) BP Cholesterol DM/ Don't smoke

What are the risk factors of stroke, outlined in the CHA2DS2VASc score?

``` CHF or vascular disease Hypertension Age >65 especially >75 DM History of stroke/ TIA/ thromboembolism Female sex ```

What is a watershed infarct?

A brain ischemia that is localized to the vulnerable border zones between the tissues supplied by the anterior, posterior and middle cerebral arteries.

What clinical sign on imaging would be suggestive of watershed infarct?

Bilateral ischaemia