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Y3 NEUROLOGY > Stroke > Flashcards

Stroke Flashcards

1
Q

List the three types of stroke

A

Haemorrhage (primary and secondary)
Sub-arachnoid haemorrhage
Infarct

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2
Q

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

A 
Seizure
Sepsis
Toxic/ metabolic (inc. hypoglycaemia)
SOL
Presyncope
Acute confusion/delirium
Vestibular dysfunction
Functional
Dementia
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3
Q

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

A

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

-: Loss of consciousness
Syncope
Seizure

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4
Q

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

A

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

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5
Q

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

A

True

Hyperdensity would suggest haemorrhage

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6
Q

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

A

Oxford

TACS, PACS, LACS, POCS

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7
Q

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

A

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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8
Q

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

A

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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9
Q

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

A

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

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10
Q

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

A 
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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11
Q

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

A

False

No higher cerebral dysfunction - no dysphasia, neglect

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12
Q

Which classification of stroke is associated with the worst prognosis?

A

TACS

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13
Q

Which arteries can be occluded in lacunar stroke?

A

Medial and lateral lenticulostriate arteries

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14
Q

Lacunar strokes occur as a result of…

A

Small vessel disease

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15
Q

Which classification of stroke is associated with cranial nerve palsies?

A

POCS

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16
Q

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

A

Left

17
Q

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

A

Language

18
Q

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

A

Spatial awareness

19
Q

List the three main causes of infarcts in the brain

A

Atheroembolic
Cardioembolic
Small vessel disease

20
Q

What is the pathogenisis of atheroembolic stroke?

A

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

21
Q

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

A 
AF (MOST COMMON)
Ventricular thrombus
Prosthetic valves
Acute MI
Rheumatic heart disease
22
Q

What are the six types of small vessel disease?

A
  1. Arteriosclerotic (age/ RF related)
  2. Sporadic and heridatory cerebral amyloid angiopathy
  3. Genetic small vessel disease
  4. Inflam and immunologically mediated (churg strauss, wegeners)
  5. Venous collagenosis
  6. Other SVD e.g. post radiation
23
Q

List three signs on MRI of small vessel disease

A

White matter hyperintensities
Lacunes
Microbleeds

24
Q

How does AF cause cardioembolic stroke?

A

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

25
Q

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

A

Patent foramen ovale

Right to left blood flow allows venous clots to pass into the arterial system

26
Q

What are the main causes of primary intracerebral haemorrhage?

A 
Hypertension (more commonly deeper)
Amyloid angiopathy (more commonly lobar)
27
Q

What are the main causes of secondary intracerebral haemorrhage?

A

AV malformation
Aneurysm
Tumour

28
Q

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

A

False

Early haematoma expansion, causes continued arterial bleeding and further oedema

29
Q

Outline the acute management for stroke

A 
Thrombolysis/ thrombectomy
Imaging
Swallow assessment
Nutrition and hydration
Anti-platelets
Stroke unit care
DVT prophylaxis
30
Q

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

A 
Age
Time since onset
History of ICH or infarct
Atrophic changes
BP 
DM
31
Q

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

A

4.5 hours

32
Q

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

A 
Full lipid profile
BP
Carotid scan
ECG (consider 72 hour ECG)
Consider ECHO
33
Q

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

A

Carotid endarterectomy

34
Q

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

A

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

35
Q

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

A 
CHF or vascular disease
Hypertension
Age >65 especially >75
DM
History of stroke/ TIA/ thromboembolism
Female sex
36
Q

What is a watershed infarct?

A

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

37
Q

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

A

Bilateral ischaemia

Y3 NEUROLOGY (22 decks)

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