Stroke Flashcards
What is “stroke”?
Experiencing persisting neurological complications of CV disease.
Name the three subcategories of stroke.
- Haemorrhage.
- Subarachnoid haemorrhage.
- Infarct.
What percent of all stroke presentations are stroke mimics?
1/3.
What scoring system is used to calculate likelihood of stroke?
ROSIER.
CT is not sensitive for bleeding/blood after how long?
One week.
What is TACS - Total Anterior Circulation Syndrome?
- Hemiplagia involving at least two of: face, arm and leg +/- hemisensory loss.
- Homonymous hemianopia.
- Cortical signs (dysphasia, negletc etc.).
What is the most severe type of stroke?
TACS - total anterior circulation syndrome.
How many patients are alive and independent after one year following TACS?
5%.
What is PACS - Partial Anterior Circulation Syndrome?
2 out of 3 features present in TACS (hemiplagia, homonymous hemianopia, cortical signs).
OR
Isolated cortical dysfunction e.g. dysphasia.
OR
Pure motor/sensory signs less severe than in lacunar syndromes e.g. monoparesis.
How many patients are alive and independent after one year following PACS?
55%.
What are lacunar infarcts?
Small infarcts in the deep parts of the brain e.g. basal ganglia, thalamus, white matter and in the brain stem.
What causes lacunar syndrome?
Occlusion of a single deep penetrating artery in deep parts of the brain or brainstem.
Lacunar syndrome affects what?
Any two of:
- Face.
- Arm.
- Leg.
Which stroke has best prognosis?
Lacunar syndrome.
How many patients are alive and independent after one year following LACS?
60%.
What causes POCS - posterior circulation syndrome?
Cerebral infarct interrupts blood supply to unilateral posterior brain.
Symptoms and signs suggestive of POCS?
- CN palsies.
- Bilateral motor and/or sensory deficits.
- Conjugate eye movement disorders.
- Isolated homonymous hemianopia.
- Cortical blindness.
- Cerebellar deficits without ipsilateral motor/sensory signs.
How many patients are alive and independent after one year following POCS?
roughly 60%.
A stroke affecting the right side of the brain will affect what?
- The left side of the body.
- Creativity.
- Music.
- Spatial orientation.
- Artistic awareness.
A stroke affecting the left side of the brain will affect what?
- Right side of the body.
- Reasoning.
- Spoken language.
- Number skills.
- Written language.
Dominant (left) hemisphere cortical events often affect?
Language - major implications for rehab.
Non-dominant (right) hemisphere cortical event affect?
Spatial awareness - neglect.
Causes of ischaemic cerebrovascular disease?
- Cardiac embolism source.
- Intracranial small-vessel disease.
- Rare causes.
- Atherothromboembolism (50%).
Type 1 Small Vessel Disease Classification?
Arteriosclerotic (age/risk factor related.
Type 2 Small Vessel Disease Classification?
Sporadic and hereditary cerebral amyloid angiopathy.
Type 3 Small Vessel Disease Classification?
Genetic small vessel disease distinct from cerebral amyloid angiopathy.
Given an example of a genetic small vessel disease distinct from cerebral amyloid angiopathy.
CADASIL.
Type 4 Small Vessel Disease Classification?
Inflammatory and immunologically mediated.
- e.g. Churg-Strauss, Wegener’s granulomatosis.
Type 5 Small Vessel Disease Classification?
Venous collagenosis.
Type 6 Small Vessel Disease Classification?
Other small vessel disease e.g. post radiation angiopathy.
Atrial fibrillation is associated with what increase in risk of stroke?
5 fold.
how many stroke are due to AF?
one in six.
What may cause Primary intracerebral haemorrhage?
Hypertension.
- Amyloid angiopathy.
What may cause secondary intracerebral haemorrhage?
- Arteriovenous malformation.
- Aneurysm.
- Tumour.
Primary intracerebral haemorrhage in the lobar region is likely to be related to?
Cerebral amyloid angiopathy.
A deep primary intracerebral haemorrhage is likely to be related to?
Effects of BP.
Pathophysiology of intracranial hypertension in early haematoma expansion?
- Continued arterial bleeding.
- Secondary bleeding into perilesional tissue.
- Subsequent perilesional oedema.
Acute management of CVA?
- Thrombolysis/thrombectomy.
- Imaging.
- Swallow assessment.
- Nutrition and hydration.
- Antiplatelets.
- Stroke unit care.
- DVT prophylaxis.
Secondary prevention of CVA?
Medication, lifestyle and carotid surgery.
Rehab and recovery.
What should be considered when deciding to thrombolyse or not?
- Age.
- Time since onset.
- Previous intracerebral haemorrhage or infarct.
- Atrophic changes.
- BP.
- Diabetes.
- Benefit?
What sign may show on CT in CVA?
Hyperdense middle cerebral artery sign.
Describe IV tPA.
- Adiministration limited to <4.5 hour from symptom onset.
- Large and proximal clots less likely to re-canalise.
- Overall recanalisation rates 40-50%.
Describe cardioembolic strokes.
Fibrin dependent - “red thrombus”.
Describe atheroembolic strokes.
Platelet dependent “white thrombus” - Acute Coronary syndrome.
Stroke investigations?
- Full lipid profile.
- BP.
- Carotid scan.
- ECG.
- Consider: 72 hour ECG or echocardiogram.
ABCD of medical stroke prevention?
A: antithrombotic therapy - antiplatelet + anticoagulant.
B: BP.
C: cholesterol.
D: diabetes and DONT smoke.
Low cholesterol is associated with increased risk of which stroke?
Haemorrhagic.
What is carotid endarterectomy?
Surgical removal of plaque build up that causes narrowing in the carotid arteries.
Carotid endarterectomy reduces recurrent stroke at 2 years by what percent?
65% reduction in recurrent stroke at 2 years.
