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Neurology SOH > Stroke > Flashcards

Stroke Flashcards

1
Q

Definition - Sudden/Gradual disturbance of cerebral function of vascular origin that either causes ____ or symptoms last over ___ hours

A

Sudden
Death
Over 24 hours

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2
Q

What 4 things do you need to find out about the stroke

A

Type of stroke
Size of stroke
Laterality of stroke
Cause of stroke

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3
Q

Driving rules following stroke

A

Advise patient not to drive for a month after the stroke but no need to tell the DVLA

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4
Q

What are the 2 types of stroke

A

Haemorrhage

Ischaemia/infarct

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5
Q

Haemorrhagic stroke - definition

A

Bleeding from an artery due to a rupture/leak

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6
Q

Haemorrhagic stroke - causes

A

Structural abnormality - tumour
Hypertensive
Amyloid angiopathy
Subarachnoid haemorrhage

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7
Q

Whats the most common cause of a non-traumatic subarachnoid haemorrhage

A

PKD (berry aneurysm)

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8
Q

Infarct/ischaemia - more/less common than haemorrhage?

A

More common

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9
Q

Infarct/ischaemia - definition

A

Interruption of cerebral blood flow due to a thrombus or embolus

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10
Q

Infaract/ischaemia is more common in males/females?

A

Males

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11
Q

Infarct/ischaemia - thrombotic stroke - most commonly affects which artery?

A

Middle cerebral artery

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12
Q

Infarct/ischaemia - embolic stroke - most occlusions occur in the branches of which artery?

A

Middle cerebral artery

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13
Q

Red thrombus

A

Cardioembolic clot

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14
Q

White thrombus

A

Atheroembolic clot

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15
Q

What is the most severe type of stroke?

A

Total Anterior Circulation Syndrome (TACS)

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16
Q

A large/small area of brain is affected with a Total Anterior Circulation Syndrome (TACS)

A

Large area of brain affected

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17
Q

Total Anterior Circulation Syndrome (TACS) - clinical features

A 
Ipsilateral motor (hemiplegia) and/or sensory deficit involving at least 2 of: 
Face
Arm
Leg 
\+
Visual field defect: Homonymous hemianopia 
\+
Cortical dysfunction
- dysphasia 
- neglect
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18
Q

Partial Anterior Circulation Syndrome (PACS) - definition

A

Less severe than TACS as there is a smaller area of brain affected and therefore there are slightly less severe symptoms and signs

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19
Q

Partial Anterior Circulation Syndrome (PACS) - clinical features

A 
2 or 3 features present in TACS
- hemiplegia 
- visual field defect
- cortical dysfunction: dysphasia, dysphagia 
OR 
Isolated cortical dysfunction
- dysphasia 
- weakness 
- pure motor/sensory signs less severe than in lacunar syndromes
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20
Q

Lacunar Syndrome (LACS) - definition

A

Small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brainstem

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21
Q

Which type of stroke has the best prognosis?

A

Lacunar syndrome

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22
Q

Lacunar syndrome (LACS) - causes

A

Hypertension
Occlusion of a single deep penetrating artery
Blockage in the small branch of the arteries

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23
Q

Lacunar syndrome (LACS) - clinical features

A 
Pure motor hemiparesis OR  pure sensory deficit of one side of the body OR  
an ataxic hemiparesis 
Affects any 2 of the following 
- face 
- arm 
- leg

NO visual field defect
It is either PURE motor or PURE sensory

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24
Q

Posterior circulation syndrome (POCS) affects which 2 arteries

A

Vertebral arteries

Basilar arteries

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25
Q

Posterior circulation syndrome (POCS) - clinical features

A

Ipsilateral CN palsies with contralateral motor and/or sensory deficit

isolated homonymous hemianopia

cortical blindness

Cerebellar deficits without ipsilateral motor/sensory signs

Unilateral/bilateral motor and/or sensory deficits

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26
Q

Carotid artery disease - clinical features

A

Contralateral weakness or sensory loss

If dominant hemisphere is affected then there may be aphasia or apraxia

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27
Q

Middle cerebral artery occlusion - clinical features

A

Weakness predominantly in contralateral face and arm

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28
Q

Anterior cerebral artery occlusion - clinical features

A

Weakness and sensory loss in contralateral leg

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29
Q

In most people, the RIGHT side of the brain is the dominant hemisphere. True or false?

A

False

- Left side is most dominant in 95% of people

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30
Q

Functions of the dominant hemisphere

A

Speech and language
Reasoning
Written language
Numeracy skills

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31
Q

Functions of the non-dominant hemisphere

A

Creativity
Music
Artistic awareness
Spacial orientation

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32
Q

If someone has a stroke affecting the RIGHT/LEFT side of the brain, they tend to have more disability from it

A

Left side = more disability

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33
Q

If someone has a stroke affecting the left side of the brain, it will affect the left side of the body. True or false?

A

False

- affects right side of the body

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34
Q

Name 3 possible causes of stroke

A

Arteriosclerotic
Hypertension
Atrial fibrillation

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35
Q

What is the most common cause of stroke

A

AF

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36
Q

TIA - definition

A

Transient obstruction of blood flow causing a sudden onset of symptoms that typically last for an hour but not more than 24 hours

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37
Q

TIA - there is evidence of an acute infarction. True or false?

A

False

38
Q

Stroke like features but episode lasts less than 24 hours. What is the likely diagnosis?

A

TIA

39
Q

TIA is treated the same as a stroke. True or false?

A

True

40
Q

TIA - clinical features

A

Lasts less than 24 hours
Cortical symptoms: facial or limb weakness, sensory disturbance
Speech abnormalities: dysphasia, dysarthria
Visual disturbance
CN involvement
Memory disturbance

41
Q

What are the benefits of the rapid access neurovascular clinic (TIA) ?

A

Drastically reduces the incidence of a subsequent TIA or stroke

42
Q

TIA - medical interventions

A

Statin

Anti platelet drug (aspirin, clopidogrel)

43
Q

Which scoring system is used to identify whether patients with a TIA are at low or high risk of developing subsequent cerebrovascular injuries?

A

ABCD2 score

44
Q

Which scoring system weighs up how likely it is to have a stroke?

A

Rosier score

45
Q

Stroke - clinical features vary between patients. Why is this?

A

Clinical features depend on the area of brain affected

46
Q

Stroke - clinical features develop rapidly/slowly?

A

Rapidly

47
Q

Stroke - clinical features

A 
Speech disturbance 
Vision disturbance 
Facial weakness
Contralateral limb weakness or sensory loss 
Cerebellar signs
48
Q

Stroke - clinical features - speech disturbance

A

Dysarthria
- unclear articulation of speech that is otherwise linguistically normal

Dysphasia

  • receptive (wernickes)
  • expressive (brocas)
49
Q

Stroke - clinical features - vision disturbance

A

Visual field defect

Visual inattention

50
Q

What is the most common visual field defect in a patient with a stroke?

A

Contralateral homonymous hemianopia

51
Q

Stroke - clinical features - facial weakness - a stroke can affect the UMN/LMN of which CN ?

A

UMN of CN VII

52
Q

Since a stroke affects the UMN of CNVII, on the affected side the patient will be unable to smile and raise eyebrows. True or false?

A

False

  • will be unable to smile
  • ability to raise eyebrows are preserved
53
Q

what are these features suggestive of:

  • sudden onset thunderclap headache
  • N+V
  • photophobia
  • neck stiffness
A

Subarachnoid haemorrhage

54
Q

Stroke - what differentiates between haemorrhage vs infarct type of stroke?

A

Imaging

- Brain CT

55
Q

Stroke - investigations - urgent imaging - what is the first line imaging investigation

A

Brain CT

56
Q

Stroke - CT scan - haemorrhage

A

ACUTE blood shows up as white blobs on CT scan

57
Q

Stroke - CT scan - infarct

A 
darker changes (hypoattenuation) 
- what you are actually seeing is increased water on the CT scan due to oedema from brain tissue injury
58
Q

Stroke - CT scan - no bleed detected - what do you treat it as

A

Infarct

59
Q

Stroke - if there are no abnormalities seen on CT scan then what investigation do you try?

A

MRI scan

60
Q

If a patient presents around 1 week post stroke instead of acutely, it is better to do a CT scan / MRI scan?

A

MRI scan

61
Q

What is the first line investigation to determine the aetiology of the stroke?

A

Carotid US scan

- look for atherosclerosis

62
Q

If there is an abnormality found on the carotid US scan, which investigation is carried out?

A

Angiogram

- to identify location of vascular abnormality

63
Q

A patients swallow may be affected due to their stroke. What is the risk they are at?

A

Risk of aspiration

64
Q

If swallow screen results are abnormal, who is the patient referred to?

A

Speech and language therapist

65
Q

Acute management of stroke

A

Thrombolysis

Antiplatelets

66
Q

Acute management of stroke - thrombolysis - examples

A

Anteplase

tissue plasminogen activator (IV)

67
Q

Acute management of stroke - thrombolysis - what is the time limit

A

Must be given less than 4.5 hours from onset of symptoms

68
Q

It is safe to thrombolyse someone who has had a bleed.. True or false?

A

False

69
Q

Acute management of stroke - anti platelets

A

300mg aspirin given after stroke (infarct)

70
Q

Acute management of stroke - anti platelets are given in both infarct and haemorrhages?

A

False

- just infarcts

71
Q

Acute management of stroke - anti platelets - CT must be done first to exclude a haemorrhage. True or false?

A

True

72
Q

Acute management of stroke - anti platelet - best route of administration?

A

Orally

73
Q

Acute management of stroke - thrombolysis - post thromolysis, patients should be given anti platelets immediately. True or false?

A

False

- given anti platelets after 24 hours

74
Q

Why is there a risk of getting a DVT and subsequently PE from a stroke ?

A

Due to immobility

75
Q

Heparin is useful post stroke for DVT prevention. True or false?

A

False

- there is a risk of haemorrhage with heparin

76
Q

Secondary prevention management of stroke - medications

A

BP management
Cholesterol management
Diabetes control
Anti-thrombotic therapy

77
Q

Secondary prevention management of stroke - medications - anti-thrombotic therapy

A

Anti-coagulants

  • give if cardioembolic/ if patient has AF
  • re-introduced after 2 weeks following a major stroke

Antiplatelets

  • if not cardioembolic
  • use clopidogrel
78
Q

Statin cannot be used in cardioembolic / non-cardioembolic disease?

A

cardioembolic

79
Q

What is the commonest cause of ischaemic stroke?

A

AF

80
Q

Which scoring system is used for patients with AF to determine their risk of having a stroke?

A

CHADSVASc score

81
Q

Score of 0 - is any intervention required?

A

NO

82
Q

Score above 0 - is any intervention required?

A

Oral anti-coagulants

83
Q

A man presents with a weak, numb left arm and leg. It is decided that this is due to an occlusion. Which vessel is likely occluded?

A

Right anterior cerebral artery

  • The anterior cerebral artery supplies the frontal and medial part of the cerebrum. Occlusion causes a weak/numb contralateral left with arm symptoms. The face is spared
84
Q

A women presents following a stroke with a movement loss on her left side, there is also sensory loss. It affects her left arm and face. On examination she appears to have lost vision in both eyes on the left upper and lower quadrants. What is the likely occluded vessel?

A

Right middle cerebral artery

  • The middle cerebral artery supplies the lateral hemisphere. This causes contralateral hemiparesis, hemisensory loss, contralateral homonymous hemianopia due to the involvement of the optic radiations If the dominant hemisphere is affect it can cause dysphasia If the less domains hemisphere is affect it can cause visuospatial disturbance
85
Q

Occlusion of which artery would present with contralateral homonymous hemianopia with macula sparing?

A

Posterior cerebral artery

86
Q

A women presents with a history of persistent headaches, seizures, weakness of all movements of her left foot. The tone is reduced however has an increase in her reflexes. It is thought this is a lesion, where is the likely lesion?

A

Right cortex

  • The cerebral cortex is the outer layer of neural tissues. Cortical lesions can cause weakness in hands of feet that may present with normal or reduced tone. It however does have increased reflex (upper motor neurone sign).
    Cortical lesions affect the contralateral side
87
Q

Contralateral hemiparesis is caused by a lesion where?

A

Internal capsule lesions cause contralateral hemiparesis

88
Q

A man presents with a left hemiplegia with his right eye depressed and pointing outwards. Where is the likely location of this lesion?

A

Right brainstem lesion.

  • CN palsy (III - XII) implies the brain stem is affected on the side of the palsy
89
Q 
Which of the following drugs is given to the majority of patients ASAP after an ishcaemic stroke and continued for 2 weeks?
Aspirin
Clopidogrel
Atorvastatin
Warfarin 
LMWH
A

Aspirin 300mg

90
Q

How long (hours) after stroke onset can thrombolysis be administered?

A

Within 4.5 hours of stroke onset

Neurology SOH (31 decks)

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