Stroke Flashcards
Define TIA (transient ischaemic attack)
Brief episode of neurological dysfunction
Symptoms last typically <1 hour and definitely <24 hours
Describe the 3 different types of ischaemic stroke
Atheroembolic infarcts (clots from the carotids)
Cardioembolic infarct (clot from the heart)
Small vessel disease (arteriosclerosis elsewhere causes emboli)
What are some of the causes of haemorrhagic strokes?
Amyloid angiopathy
AVM
Aneurysm
Tumours
What are the 4 main stroke syndromes?
Total anterior circulation syndrome (TACS)
Partial anterior circulation syndrome (PACS)
Posterior circulation syndrome (POCS)
Lacunar syndrome (LACS)
What are the functions of the RIGHT side of the brain which may be affected by a stroke?
Creativity
Spatial orientation
Control of the left side of the body
What are the functions of the LEFT side of the brain which may be affected by a stroke?
Language
Number skills
Reasoning
Control of the right side of the body
Which side of the brain is usually the dominant hemisphere?
LEFT
How many strokes are due to atrial fibrillation?
1 in 6
due to stasis of blood leading to clot formation
Why does a patent foramen oval increase the risk of strokes?
Blood crosses from the RA to the LA of the heart through the patent foramen ovale.
Therefore clots from DVTs reach the heart and instead of going to the lungs to cause a PE, they go to the brain to cause a stroke.
What investigations should be done for a suspected stroke?
CT (very good at identifying haemorrhage acutely)
MRI (better than CT for identifying infarcts and haemorrhage if a week has passed)
Bloods
Carotid scan, ECHO, ECG angiogram
How should an ischaemic stroke be managed acutely?
Thrombolysis (tissue plasminogen activator IV TPA)
+ aspirin 24 hours later
If <4.5 hours from onset
Aspirin only if >4.5 hours from onset
What secondary prevention should be done post stroke?
Anticoagulants (cardioembolic infarcts and AF)
Antiplatelts (infarcts)
Statins
Antihypertensives
Lifestyle advice
What are some of the risk factors for stroke?
Hypertension
Diabetes
Smoking/ diet/ obesity
Carotid disease
Posterior circulation syndrome storkes involve which vessels?
Vertebral artery or basilar artery and their branches
Lacunar syndrome stokes involve vessels in which parts of the brain?
Deep parts of the brain; basal ganglia, thalamus, white matter and brainstem
How would a total anterior circulation stroke (TACS) present?
Hemiplegia and/ or hemisensory loss (2+ of face/arm/leg)
Homonoymous hemianopia
Higher cortical dysfunction
How would a partial anterior circulation stroke (PACS) present?
2/3 of the criteria for TACS
How would lacunar syndrome present?
Pure motor or sensory storke
Motor + sensory deficits
Ataxia
How would a posterior circulation stoke (POCS) present?
BILATERAL motor and/or sensory deficit
Cranial nerve dysfunction
Isolated homonymous hemianopia
Cortical blindness
How should a haemorrhagic stroke be managed acutely?
Antihypertensives
Surgery; craniotomy or aspiration
Neglect syndrome is most likely to be due to a stroke on which side of the brain?
Right side of the brain
What is the hyper dense middle cerebral aftery sign an indicator for?
Thrombolysis
What is meant by higher cortical dysfunction? Which strokes does this occur with? Which sides of the brain are affected with which symptoms?
Higher cortical function refers to language problems or neglect depending on the side of the brain affected
It occurs with TACS/ PACS
Language problems (LEFT) neglect (RIGHT)
What are the causes of cardioembolic strokes?
Arrhythmias
Valvular heart disease
Prosthetic valves
Post MI
Congenital defects
Which drug is given after aspirin for ischaemic strokes for lifelong prevention?
Aspirin is given for 2 weeks and then…
Clopidogrel lifelong
OR warfarin if the stroke was caused by a cardioembolic infarct
Polycystic kidney disease increases the risk of which type of stroke?
Subarachnoid haemorrhage
due to the presence of berry aneurysm
Ataxic hemiparesis occurs with which stroke syndrome?
Lacunary syndrome
What is amarousis fugax?
Type of TIA involving the retinal artery
- rapid painless loss of vision in one eye
Why are ‘watershed’ areas of the brain more sensitive to hypoxia?
They are at the periphery of vascular territories and so are less well supplied and most distant from the heart
Which sex immediately gains a score of 1 on the CHA2DS2VASx scoring system?
Female sex
What treatment is given for cardioembolic strokes?
Same as for other ischaemic strokes - but after the 2 weeks of aspirin, warfarin is given rather than clopidogrel for life long prevention
What is the rosier scoring system used for?
To assess the likelihood of stroke being the cause for current symptoms
Which artery is the most likely to be affected in thromboembolic disease?
Middle cerebellar artery
This is due to its alignment from the internal carotid artery
Which stroke syndrome is the only one which would cause BILATERAL sensory/ motor loss?
POCS
The rest all cause UNILATERAL sensory or motor loss
Which imaging test must also be done other than CT if a haemorrhagic stroke is suspected?
Cerebral angiography
