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Aging and Complex medicine > Stroke > Flashcards

Stroke Flashcards

1
Q

stroke is

A

a clinical syndrome where blood supply to part of the brain is restricted with by a) blockage b) haemorrhage

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2
Q

causes of ischaemic stroke

A

embolus and thrombus

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3
Q

Most common cause of embolus formation

A

Plaque formation in the carotid arteries –> ruptures –> clot formation

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4
Q

Rarer sources of an embolus

A
  • atrial myxoma

- paradoxical emboli from patent ductus arteriosus

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5
Q

Causes of haemorrhagic strokes? (6)

A
  • Hypertension
  • Amyloid angiopathy
  • Aneurysms
  • Cerebral arteriovenous malformations
  • Blood vessels in tumours
  • Taking warfarin medx
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6
Q

What ions build up within neurones in the ischaemic cascade?

A

Calcium + sodium

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7
Q

What does raised intracellular Calcium result in?

A

release of glutamate (excitatory neurotransmitter)
+
protease release

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8
Q

What does raised intracellular Sodium result in?

A

swelling of the neurone = cytotoxic oedema

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9
Q

vascular risk factors for ischaemic stroke? (6)

A
  • diabetes
  • hypertension
  • ischaemic heart disease
  • peripheral vascular disease
  • smoking
  • carotid stenosis
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10
Q

thrombotic risk factors for ischaemic stroke? (4)

A
  • AF
  • Combines OCP
  • Polycythaemia
  • Clotting disorders
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11
Q

aim of the FAST compaign

A

aims to increase the recognition of symptoms of TIA + stroke

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12
Q

What stroke scale is used in assessment?

A

NIHSS

National institute of Health Stroke Scale

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13
Q

what is the NIHSS used for?

A

a tool used by healthcare professionals to quantify the impairment caused by a stroke, to assess the severity of it; consists of 11 items

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14
Q

NIHSS score 0

A

no stroke symptoms

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15
Q

NIHSS score 1-4

A

minor stroke

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16
Q

NIHSS score 5-15

A

moderate stroke

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17
Q

NIHSS score 16-20

A

moderate to severe stroke

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18
Q

NIHSS score 21-42

A

severe stroke

19
Q

hyperacute findings - CT ischaemic stroke

A

visualisation of clot seen immediately

20
Q

sign on non-contrast CT of ischaemic stroke representing direct visualisation of clot within lumen

A

hyperdense artery

21
Q

name 4 stroke mimics

A
  • seizures
  • hypoglycaemia
  • sepsis
  • syncope
22
Q

contraindications for thrombolysis treatment for ischaemic stroke relating to recent surgery + bleeding

A

Recent surgery
- major head surgery or non head trauma in last 2 weeks

Bleeding
- history of any intracranial haemorrhage, AVM or cerebral aneurysm

23
Q

contraindication for thrombolysis treatment relating to anticoagulant use?

A

Contraindicated if Heparin or NOAC within last 48 hours OR

INR > 1.4 on Warfarin

24
Q

If haemorrhagic stroke has been excluded what should be given straight away?

A

300mg Aspirin

25
Q

When should thrombolysis be given?

A

within 4.5 hours of the onset of stroke symptoms

26
Q

what thrombolysis is recommended?

A

Alteplase

0.9 mg/kg via IV infusion

27
Q

what is alteplase

A

recombinant tissue plasminogen activator

28
Q

name 4 coagulopathies that can cause a stroke

A
  • Thrombocythemia
  • Polycythaemia
  • Hyperviscosity states
  • Haemophilia
29
Q

2 complications of thrombolysis treatment

A

angioedema + haemorrhage

30
Q

4 investigations required on following up patients post ischaemic stroke for secondary prevention

A
  • Carotid doppler
  • Blood pressure
  • Total cholesterol
  • 5 day ambulatory ECG
31
Q

at what level should a statin be started post stroke?

A

3.5 mmol/L

32
Q

treatment for carotid stenosis 50-99%

A

Referral within 1 week for carotid endarterectomy, with treatment within 2 weeks

33
Q

Treatment of carotid stenosis < 50%

A

no surgery, just medical management

34
Q

2 subtypes of haemorrhagic stroke

A

intracranial haemorrhage + subarachnoid haemorrhage

35
Q

management of haemorrhagic stroke

A
  • neurosurgical consultation for surgical assessment
  • lower BP acutely
  • reversal of anticoagulation
  • stop antithrombotic (clopidogrel) + anticoagulant (warfarin) medx
36
Q

Disorder of language =

A

Dysphasia

37
Q

Disorder of speech =

A

Dysarthria

38
Q

Receptive dysphasia =

A

difficulty understanding language being spoken

39
Q

Expressive dysphasia =

A

difficulty putting words together to be spoken

40
Q

Dysarthria =

A

difficulty articulating words + pronounciation

41
Q

Cerebellar lesions produce what type of language deficit

A

slurred, scanning, sticcato speech

42
Q

Wernicke’s aphasia =

A

good fluency + poor comprehension

receptive dysphasia

43
Q

Broca’s aphasia =

A

good comprehension + poor fluency

expressive dysphasia

Aging and Complex medicine (9 decks)

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