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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What does ABCD2 stand for?

A

Age >60………………………………….1
BP >90 diastole ……………………..1
Clinical features:
Unilateral weakness……………….2
Speech Imped no weakness …1
Duration (mins)
>60…………………………………………..2
0-59…………………………………………1
<10 =0
Diabetes………………………………….1

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2
Q

What are the relevant scores in ABCD2? & what are the indications?

A

<4 = minimal risk of stroke
<6= high risk of stroke - start aspirin & see specialist in 24 hours. (clopidogrel/dipyridone)
MRI/CT/Doppler

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3
Q

What does ABCD2 score?

A

Risk of stroke after TIA

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4
Q

What % strokes are preceeeded by TIA?

A

15

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5
Q

How long off driving after 1 TIA or multiple?

A

1 month for 1 TIA, 3 months for multiple

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6
Q

In AF following TIA what is given?

A

300mg Aspirin or Warfarin

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7
Q

When is an endarcectomy indicated?

A

> 70% stenosis

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8
Q

What are the causes of ischaemic stroke?

A 
Atherothromboembolism
Cardioembolism
small vessel disease (lacunar)
Arterial dissection (in young people)
Hypoperfusion of watershed areas due to hypotension.
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9
Q

What differentiates haemorragic and ischaemic strokes symptoms?

A

Haem- painful, vomit, drowsiness

Isch- painless

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10
Q

How fast do TIAs resolve?

A

within 24 hours

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11
Q

What aneurysms contribute to intracerebral bleeds & what does it affect?

A

Charcot Bouchard- Basal Ganglia

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12
Q

What bloods are done in suspected stroke?

A 
FBC
ESR 
Ca++
U&amp;E
Cr
LFT
Glucose
Thyroid
Cholesterol
Clotting Screen
Thrombophilias
Blood Cultures
Lactate
Homocysteine
Cardiac Enzymes
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13
Q

What investigations in stroke?

A 
CT (T2 weighted) (if doesnt show) MRI
ECG
Bloods
Carotid Doppler
Echo
TOE
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14
Q

Symptoms of an anterior circulation stroke

A 
Amaurosis fugax (transient monocular vision loss) 
Hemiparesis
Hemisensory loss
Hemianopia
Aphasia/dysphasia
Facial droop 
Brocca's area (motor defect)
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15
Q

Symptoms of a posterior circulation stroke

A 
Ataxia
Cranial Nerves (Diplopia, facial sensory defecit, LMN facial palsy)
Dysphasia &amp; Dysarthria
Contralateral Hemiparesis
Hemisensory loss
Vertigo
Contralateral homonymous hemianopia
Cortical blindness
Tertraplegia
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16
Q

Where does the posterior circulation supply & what is the main vessel?

A

Vertebrobasilar

Supplies brainstem

17
Q

Symptoms of Lacunar Strokes

A 
Pure motor
Pure sensory (thalamus)
Ataxic hemiparesis (Pontine)
18
Q

Holistic management of a stroke includes:

A 
SALT (NG/PEG)
BP/O2/glucose
Oral candidiasis management 
Physio &amp; OT
Specialist nursing
Family support groups
SSRI (depression)
Compression stockings
Keep head at 30 degree tilt
19
Q

Pontine stroke

A

Tetraplegia
Small pupils
Coma

20
Q

Capsular stroke

A

Hemiplegia & decreased conciousness

21
Q

Cerebellar Stroke

A

Ipsilateral ataxia

22
Q

Acute management of Ischaemic Stroke

A
  1. CT to exclude haemorrhage
  2. If withing 4.5 hour window (90 min particularly) THROMBOLYSE (Alteplase) & delay aspirin 24 horus
  3. If not thrombolysed 300mg Aspirin (or Clopidogrel if intolerant)
  4. 75 mg Aspirin daily
  5. If AF start LMWH.
23
Q

Contraindications for thrombolysis

A 
On anticoagulants
Liver disease
Recent arterial puncture
Recent LP
Clotting disorder
Cancer
Stroke in last 3 months
INR <1.7
24
Q

Primary prevention of Ischaemic stroke

A 
Risk factors:
Cholesterol
Smoking
Diabetes
BP
AF
25
Q

Secondary Prevention of Ischaemic Stroke

A

Lifestyle: Smoking, weight, alcohol, excercise
BP: ACEi & CCB - aim for 130/80
Simvastatin 40mg
Antiplatelet: Aspirin (& PPI if needed) / Clopidogrel
Warfarin
If AF- anticoagulate to INR 2-3

26
Q

What are the surgical options for haemorrhagic stroke

A

Thrombectomy

Craniotomy to remove blood

27
Q

If there is loss of consciousness is it a stroke?

A

No

28
Q

How long should you wait to anticoagulate after a stroke?

A

2 weeks

29
Q

What diseases/malformations increase the risk of strokes?

A 
ASD
PDA
Cerebral Vasculitis
Temporal Arteritis
Drug Usage (causes vasospasm
30
Q

What do you need to do following strokes?

A

24 hr ECG

31
Q

What is DAPT?

A

Double therapy aspirin and clopidogrel

32
Q

What are the 4 categories on the Bamford Stroke Classification?

A

TACS
PACS
POCS
LACS

33
Q

What are the feature of a TACS stroke

A

ALL 3

  1. Homonymous Hemianopia
  2. Unilateral motor defect in face, arm, leg and/or sensory deficit
  3. Higher cerebral dysfuntion (visuospacial, dysphasia)
34
Q

What are the features of a PACS stoke

A

2 OF

  1. Homonymous Hemianopia
  2. Unilateral motor and/or sensory deficit face, arm, leg
  3. Higher cortical dysfunction
35
Q

What are features of a POCS stroke

A

ONE OF

  1. CN palsy and contralateral motor/sensory loss
  2. Bilateral motor/sensory deficit
  3. Conjugate eye movement disorder (horizontal gaze palsy
  4. Cerebellar dysfunction (vertigo/ nystagmus/ ataxia)
  5. Isolated homonymous hemianopia
36
Q

Features of a LACS stroke

A

ONE of:

  1. Pure Sensory
  2. Pure Motor
  3. Sensorimotor stroke
  4. Ataxic hemiparesis

Neurology (25 decks)

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