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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

The experience of persisting neurological
complications of cardiovascular disease

NOT A DIAGNOSIS

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2
Q

What are the 3 main categories of a stroke?

A

Haemorrhagic
Subarachnoid haemorrhage
Infarct

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3
Q

What are the 3 main types/causes of haemorrhage strokes?

A
  • Structural abnormality
  • Hypertensive
  • Amyloid angiopathy
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4
Q

Name the 3 main types of strokes that come under the heading of infarcts.

A
  • Atheroembolic
  • Small vessel
  • Cardioembolic
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5
Q

A TIA is more common than a stroke

A

FALSE - a stroke is more common that a TIA

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6
Q

Cerebrovascular strokes are more common than coronary vascular strokes

A

TRUE

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7
Q

1/3rd of all stroke presentations are stroke mimics. List some things that can mimic a stroke.

A
  • Seizure
  • Sepsis
  • Toxic/metabolic
  • SOL
  • Syncope
  • Delirium
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8
Q

Describe functional brain disease. What can it mimic?

A

There is no brain disease but there is signs that the brain is malfunctioning
There will be no signs on a scan
Mimics a STROKE

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9
Q

What score is used to diagnose strokes?

A

THE ROSIER SCORE

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10
Q

Indicate what different ROSIER results show.

A

Score >0 Stroke is likely. Scores of =0 have low possibility of stroke but not completely excluded

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11
Q

What two things cause you to lose a point in the ROSIER system?

A
  • Loss of consciousness or syncope

* Seizure activity

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12
Q

What 5 things cause you to gain a point in the ROSIER system?

A
  • Asymmetric face weakness
  • Asymmetric arm weakness
  • Asymmetric leg weakness
  • Speech disturbance
  • Visual field defect
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13
Q

What 4 things are needed to diagnose a stroke?

A
  • Type
  • Size
  • Laterality
  • Cause
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14
Q

What scan is good for seeing ‘new’ haemorrhagic stroke?

A

CT

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15
Q

What scan is good for seeing an haemorrhagic stroke after 2 weeks?

A

MRI

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16
Q

What scan is good for seeing an infarct stroke?

A

MRI

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17
Q

What colour does blood appear on a CT?

A

WHITE

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18
Q

What colour does an infarct appear on a CT? Why?

A

BLACK - due to oedema and fluid

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19
Q

A CT is not sensitive to blood after __ week?

A

1

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20
Q

What type of scan should be used to see blood after 1 week?

A

MRI

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21
Q

PACI

A

Posterior anterior circulatory infarct

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22
Q

TACI

A

Total anterior circulatory infarct

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23
Q

LACI

A

Lateral anterior circulatory infarct

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24
Q

POCI

A

Posterior circulatory infarct

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25
Q

What scan is always done first?

A

CT

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26
Q

Describe TACS.

A

Contraleral motor/sensory loss (i.e hemiplegia involving 2 of: face, arm leg +/- hemisensory loss)
Homonymous hemianopia
Dysphagia, neglect

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27
Q

What is the most severe type of stroke?

A

TACS

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28
Q

What is ‘neglect’?

A

Body loses awareness of the world

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29
Q

Describe PACS.

A

2 of the 3 components of TACS OR

  • Isolated cortical dysfunction e.g dysphagia OR
  • Poor motor/sensory signs
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30
Q

Describe LACS.

A

Lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem

31
Q

What causes LACS?

A

Caused by occlusion of a single deep penetrating artery

Affect 2 any two of face arm and leg

32
Q

What type of stroke has the best prognosis?

A

LACS

33
Q

Describe POCS.

A
  • Cranial nerve palsies
  • Bilateral motor and/or sensory deficits
  • Conjugate eye movement disorders
  • Isolated homonymous hemianopia

ANY 1 of:

  • Isolated homonymous hemianopia
  • Brain stem signs
  • Cerebellar ataxia
34
Q

95% of the population have a dominant ___ hemisphere?

A

LEFT

35
Q

What may a stroke affecting the left side of the brain cause?

A

Language problems

Often needs rehab

36
Q

What may a stroke affecting the right side of the brain cause?

A

Cortical events affecting spatial awareness

e.g neglect

37
Q

In order of most to least common, list causes of Ischaemic Cerebrovascular Disease.

A
  • Atheroembolism
  • Small vessel occlusion
  • Cardiac sources of embolism
  • Rarer ones
38
Q

Outline the series of events (briefly) that lead to a cerebrovascular stroke.

A
  1. Normal carotids
  2. Diseased carotids with plaque
  3. Thrombus occurs in carotid
  4. Thrombus dislodges and travels to cerebral artery in the brain
  5. Thrombus lodges in cerebral artery of the brain
  6. STROKE
39
Q

What kind of imaging is good for seeing stenosis/clots in the carotid arteries?

A

MRI Angiogram

Doppler US

40
Q

What is done for micro bleeds?

A

Try reduce BP

MRI shows them

41
Q

What is Leukoaraiosis?

A

White matter disease

42
Q

What is the most common cause of clots forming in the heart?

A

AF

43
Q

What type of stroke does AF cause?

A

Cardioembolic

44
Q

Name 4 other problems that cause clots in the heart.

A
  • Ventricular thrombus
  • MI
  • Rheumatic heart disease
  • Prosthetic valves
45
Q

What does AF cause?

A

5 fold increase in the risk of strokes

46
Q

How is AF investigated?

A

ECHO

47
Q

Describe PFO (patent foramen ovale).

A

In the womb there is connection between atriums, after you are born the FO closes, in some people it remains open (PFO)

48
Q

What can PFO cause?

A

Strokes

49
Q

What should people with PFO be on long term? Why?

A

Aspirin

To prevent clot formation

50
Q

What can happen due to arterial dissection?

A

Arteries tearing can result in a thrombus and produce a clot

51
Q

What can primary intracerebral haemorrhage (stroke) be due to?

A
  • Hypertension

* Amyloid angiopathy

52
Q

What can secondary intracerebral haemorrhage (stroke)be due to?

A
  • Arteriovenous malformation
  • Aneurysm
  • Tumour
53
Q

What can happen as a result of a haematoma?

A

The bleeding is continuous and expands, causing secondary haematoma due to oedema

54
Q

Give an example of a full stroke diagnosis.

A

“Its a Right Hemispheric,
Cardioembolic, Partial Anterior Circulation
Infarction”

55
Q

How is an ACUTE stroke managed?

A 
Thrombolysis/thrombectomy
Imaging
Swallow assessment
Nutrition and hydration
Antiplatelets
Stroke unit care
DVT prophylaxis
56
Q

Outline secondary prevention for a stroke?

A

Medication
Lifestyle
Carotid surgery
REHAB + RECOVERY

57
Q

When is the biggest benefit of thrombolysis?

A

The sooner it is given

58
Q

What are the 4 most common symptoms of a stroke (FAST)?

A
  • Facial weakness
  • Arm weakness
  • Speech problems
  • Test all three symptoms
59
Q

DO NOT THROMBOLISE SOMEONE WHO HAS HAD A BLEED

A

TRUE

60
Q

What should always be done before thrombolysing someone? Why?

A

CT

- to exclude a bleed

61
Q

In the hyper-acute setting, a brain CT may be normal?

A

TRUE

62
Q

What is done if someone has a clot that is too big for thrombolysis?

A

THROMBECTOMY

63
Q

What investigations should be done for someone with a stroke?

A 
Full Lipid Profile
Blood Pressure
Carotid Scan
ECG
Consider - 72 Hour ECG (or longer) and ECHO
64
Q

What is given in a stroke caused by an INFARCT?

A

ANTI - PLATELET

e.g Aspirin 300mg

65
Q

How long should you wait before giving 300mg Aspirin in someone who has been thrombolysed?

A

24 hours

66
Q

Who should never get Aspirin?

A

A patient with a bleed

67
Q

What is the secondary prevention for someone with a stroke caused by an infarct? For how long?

A

1st line: clopidogrel
2nd line: aspirin + dipyridamole

LIFE LONG

68
Q

What is the ABC approach to stroke management?

A 
Antithrombotic Therapy
Antiplatelet Therapy
Anticoagulant therapy
Blood Pressure
Cholesterol
Diabetes
Don’t Smoke
69
Q

How is dysphagia managed?

A
  • Initial swallow screen
70
Q

What is done if initial swallow screen is abnormal?

A

Patient is referred to speech and language therapist

71
Q

What may a patient need if swallow is abnormal?

A

May need NG tube placement or textured diet and thickened fluids depending on swallow

72
Q

Outline the treatment of an ISCHAEMIC stroke.

A
  1. Aspirin 300mg
  2. Thrombolysis - tPA

Secondary Prevention:

  1. Cardioembolic / AF = Warfarin
  2. Non-cardioembolic = Clopidogrel
73
Q

Outline the treatment of a HAEMORRHAGIC stroke.

A
  • Anti-hypertensives (prevent compensatory inc. BP)
  • Fresh frozen plasma (reverse blood thinners)
  • Elevate back rest (reduce ICP to prevent mass effect)
74
Q

What type of drug is aspirin?

A

NSAID and anti-platelet

Neurology (42 decks)

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