Stroke Flashcards
Describe the common pathology of small vessel disease?
Small Artery Lipohyalinosis
Hypertension causes thickening of small artery walls leading to luminal narrowing
What are borderzone anatomoses? [1]
Anastomoses between peripheral branches of cerebral arteries
Too small to compensate for blocked major arteries
What neglect syndromes result from infarct of non-dominant hemisphere?
- Visual Agnosia (Cant process left side vision)
- Sensory Agnosia
- Anosagnosia (Denial/unawareness of hemiplegia or stroke as a whole)
- Prosopagnosia (Failure to recognise faces)
Which cerebral artery supplies the basal ganglia? [2]
Middle cerebral -> Lenticulostriate arteries
What does the basilar artery supply? [3]
Brainstem, Cerebellum, thalamus
Where does the post cerebral circulation supply? [5]
Brainstem. Cerebellum and thalamus
+ Occipital and medial temporal lobes
What symptoms occur if the brainstem is ischemic? (Such as in post circulation infarcts) [6]
- Coma
- Ataxia, Vertigo, N&V
- Cranial nerve palsies
- Hemiparesis or hemisensory loss
- Crossed sensori/motor deficits (Means ipsilateral cranial nerve signs and contralateral motor/sensory signs)
- Visual field deficits
How do you classify strokes? [4]
Total Anterior Circulation Stroke (TACS)
Partial Anterior Circulation Stroke (PACS)
Lacunar Stroke (LACS)
Posterior Circulation Stroke (POCS)
Order the classes of stroke by prognosis? [4] (Death or dependance at 6m) Difference between (terminology) TACI and TACS?
Death or dependance at 6 months:
- TACS 96%
- PACS 45%
- LACS 39%
- POCS 38%
They are refferred to as **S instead of **I, meaning stroke syndrome instead of infarct prior to imaging as we cant yet be sure it is a stroke and not some other condition causing a stroke like syndrome.
Aims of treatment in stroke [3]
Restores supply
ABCDE
Prevents ischemia & extension
Protect brain tissue
Stroke treatments [4]
- Oyxgen >95%
- NBM until swallow screen, so give IV fluids
- NCCT
Refer to Stroke On-Call - Within 4.5 hour window consider thrombolysis
- Within 6 hour window consider imaging for thrombectomy
- BM 5-15
- Treat hypertension if >185 >110
- Start statins within 48h
Criteria for TPA use [4]
it is administered within 4.5 hours of onset of stroke symptoms (unless as part of a clinical trial)
haemorrhage has been definitively excluded (i.e. Imaging has been performed)
Contraindicaitons for thrombolysis
Relative [5]
Absolute [11]
What sort of treatments can reduce stroke risk after a TIA? [4]
Antiplatelets
Antihypertensives
Statins
Endarterectomy if atheroma
Whats involved in stroke secondary prevention? [4]
- Anti-HTN
- Anti-platelets: 75mg clopidogrel or aspirin + dypiridamole (if contraindicated/not tolerated) lifelong
- Atorvastatin 80mg
- Endarterectomy (mainly carotid)
Differentiating between different classes of stroke: LACS [4]
Where are the infarcts? [4]
At least one of:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke.
- ataxic hemiparesis
Lacunar strokes are small in infarct in basal ganglia, internal capsule or thalamus and pons
Differentiating between different classes of stroke:
PACS [4]
Source: Oxford stroke classification/Bamford classification
Partial anterior circulation stroke
At least 2 of:
1. Unilateral hemiparesis and/or hemisensory loss of face, arm or leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction (dysphasia)
Differentiating between different classes of stroke: TACS [4]
Source: Oxford stroke classification/Bamford classification
All 3 of:
- Unilateral hemiparesis and/or hemisensory loss of face, arm or leg
- Homonymous hemianopia
- Higher cognitive dysfunction (dysphasia)
Differentiating between different classes of stroke: POCS [4]
Source: Oxford stroke classification/Bamford classification
Posterior circulation syndrome Any of motor, sensory, cerebral deficits [1] \+ 1. cerebellar or brainstem syndromes 2. loss of consciousness 3. isolated homonymous hemianopia
Stroke by anatomy:
Basilar artery infarct
Locked-in syndrome
Stroke by anatomy:
ACA [2]
Contralateral hemiparesis + sensory loss
Lower extremity > upper
Stroke by anatomy:
MCA [4]
Contralateral hemiparesis + sensory loss
Upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Stroke by anatomy:
PCA [3]
Contralateral homonymous hemianopia with macular sparing [2]
Visual agnosia
Define stroke [3]
A neurological deficit [1] of sudden onset [1] lasting >24 hours of vascular origin [1]
When is the main risk period for further strokes/TIAs following one?
The first two weeks, this is why its mportant to give DAPT
Hemorrhagic stroke mx [5]
Reverse anticoagulation
Systolic BP between 130-139 mmHg within one hour
Hydrocephalus should consider extraventricular drain
Acute drop in GCS necessitates neurosurgical opinion for consideration of decompressive craniectomy
TIA initial mx [3]
Ix [6]
Immediate anti-platelet therapy Aspirin 300mg
clopidogrel (initial dose 300 mg followed by 75 mg od) + aspirin (initial dose 300 mg followed by 75 mg od for 21 days) followed by monotherapy with clopidogrel 75 mg od
ticagrelor + clopidogrel is an alternative
Ix:
- Bloods
- CXR
- ECG
- ECHO
- Carotid doppler
- Brain imaging
TIA subsequent management [4]
o Further anti-platelet: CLOPIDOGREL
o Anti-coagulant: if in AF
o Modifiable cardiac RFs: BP control, statin, DM, stop smoking
o Carotid endarectomy: >70% stenosis