Stroke Flashcards
Outline the aetiology of stroke
- 85% ischemic
- 15% haemorrhagic
What are the causal factors in intracerebral haemorrhage?
Anatomical factors: -small vessel disease; amyloid angiopathy, AVMs Haemodynamic factors: - hypertension Haemostatic factors: -anticoagulants; anti-platelets; thrombolytics Other factors: -Recreational drugs, vasculitis
What is amyloid angiopathy?
- Amyloid deposition in cortical artery muscle layers
- Typically causes: lobar intracerebral haemorrhage (ICH) and ICH at grey/white matter border
- prone to recurrence
Which patients require an URGENT brain scan?
- Unconscious
- deteriorating conscious level
- on anticoagulants
- presentation within thrombolysis window of opportunity
What are the different causes of ischemic stroke?
- AF
- Flow reducing carotid stenosis
- Penetrating artery disease
- Valve disease
- Left ventricular thrombi
- Cardiogenic emboli
- Carotid plaque with arteriogenic emboli
- Intracranial atherosclerosis
What do the cortical branches of the MCA supply?
What are the exceptions ?
- The cortical branches of the MCA supply the lateral surface of the hemisphere
- Except for the medial part of the frontal & parietal lobe ( anterior cerebral artery) and the inferior part of the temporal lobe&occipital lobe ( posterior cerebral artery)
What is the importance of Wernicke’s area in the brain?
comprehension of speech; language development; sensory area
What is the importance of Broca’s area in development?
controls motor function in the production of speech
What may be the presentation of a lesion in a large vessel- ACA territory
ACA= anterior cerebral artery
- Contralateral hemiparesis: leg more than arm/face
- Cortical signs: emotional changes; dysphasia( left anterior cerebral artery- Broca’s area)
What may a patient with a lesion in the MCA territory present with?
-Contralateral hemiparesis: arm/face more than leg
-Contralateral hemisensory loss
-Cortical signs:
Contralateral hemianopia
Contralateral hemineglect
Dysphasia (left MCA)
What may a patient with a lesion in the PCA territory present with?
- Contralateral hemianopia
- Contralateral hemineglect
What may a patient with a lesion in the Vertebrobasilar territory present with?
- Nausea & Vomiting
- Diplopia
- Vertigo & nystagmus
- Ataxia
- Hemi/quadriplegia
- Visual field defect
- Coma
What causes Lacunar stroke/ lacunar infacrt (LACI) ?
- It is the most common type of ischaemic stroke
- results from the occlusion of small penetrating arteries that provide blood to the brain’s deep structures.
- It is in n deep non-cortical white matter or the brainstem
What may someone with lacunar stroke present with?
- No cortical features
- Pure hemiparesis
- Pure hemisensory loss
- Sensorimotor stroke
- Ataxic hemiparesis
What are the characteristics of transient ischemic attacks?
TIAs are:
- Characterised by an acute loss of focal cerebral or monocular function
- Symptoms lasting less than 24 hours
- Due to inadequate cerebral/ocular blood supply
- Result of arterial thrombosis or embolism (artery, cardiac, haematological disease)
- Clinical diagnosis without specific diagnostic test
- Rely on constellation of clinical features
What are the causes of transient focal neurological attacks?
- Focal cerebral ischaemia ie TIA
- Migraine aura (with/without headache)
- Partial (focal) epilepsy
- Labyrinthine disturbances
- Meniere’s disease
- BPPV
- Benign recurrent vertigo
- Labyrinthitis/vestibular neuronitis
- Transient global amnesia (TGA)
- Multiple sclerosis
Outline the characteristics of an epileptic attack
-Focal sudden positive sensory or motor phenomena
-Spread quickly to adjacent body parts over ± 1
minute
-Versus TIA where tingling will arise in affect parts of
the body at the same time
-Migraine is over minutes
-May be focal jerking
-Altered awareness
What is a positive Babinski reflex
- aka extensor plantar reflex
- Normal response= flexor planar reflex
- This reflex happens upon stroking the sole of the foot
- May be indicative or nerve disease or damage
- May be accompanied by fanning (of the foot
What is the NIH Stroke Scale (NIHSS)
- Aka National Institutes of Health Stroke Scale
- A tool used by healthcare providers to objectively quantify the impairment caused by a stroke
What are intermittent pneumatic compression devices?
- IPC devices are used to help prevent DVT of the legs
- The devices use cuffs around the legs that fill with air& squeeze your legs
- This increases blood flow through the veins of your legs and prevents thrombosis.
Outline the treatment options for acute stroke
- TPA: ‘clot buster medicine’; dissolves clot
- THROMBECTOMY:minimally invasive for larger clots
How can medication be used to prevent stroke
- Aspirin to reduce chance of clotting
- Blood thinners for people with abnormal heart rhythms eg AF
How can we diagnose stroke
- CT scan(can show where blood flow is blocked)
- Flair MRI(can distinguish a new stroke injury from an old one)
