Stroke Flashcards

1
Q

Define stroke

A

Rapidly progressive clinical symptoms and signs of focal and at times global loss of cerebral function lasting more than 24 hours

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2
Q

What are the 2 main types of stroke and how frequent are they?

A
  • haemorrhagic (20-30%)

- ischaemic (70-80%)

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3
Q

What is the primary cause of a haemorrhagic stroke?

A

Hypertension

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4
Q

What is the secondary cause of a haemorrhagic stroke?

A
Trauma
Tumour
AV Malformation
Venous thrombosis
Vasculitis
Coagulopathy
Drugs - cocaine
Haemorrhagic transformation of infarct
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5
Q

What are the complications of an intracellular haemorrhage?

A

Local damage
Local mass effect/herniation
Raised ICP
Hydrocephalus

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6
Q

How is an intracellular haemorrhage managed?

A

Establish cause - imaging/angiography/platelet function/clotting
Stop aspirin or warfarin
Treat complications - may need surgery/ICP management
Treat RF - blood pressure
Rehabilitation

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7
Q

What are the 2 types of ischaemic stroke?

A
  • large vessel -> can cause midline shift

- small vessel (lacunar) -> in deep brain structures, perforated vessels

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8
Q

What is the ischemic cascade?

A

Treatment aims to save the penumbra region inside the outer surviving cells where neurons are hypoxic and/or damaged but survival is still possible
- depends on how big/long penumbra is depending on various factors

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9
Q

What are the causes of ischemic stroke and how frequent/likely are they?

A
  • arteriolar sclerosis (25%)
  • atherosclerosis (50%)
  • cardiac AF (15%) - spaces of blood in the appendage
  • carotid dissection (5%)
  • vasculitis (1%)
  • haematological (1%)
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10
Q

What are he demographic risk factors for stroke?

A

Age, male, race, socioeconomic status

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11
Q

What are the lifestyle risk factors?

A

Smoking, weight, inactivity, alcohol

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12
Q

What are the medical RF?

A
Hypertension (biggest risk factor for all stroke -50%)
Hypercholesterolaemia
Diabetes
Vascular disease
Cardiac - AF, chamber dilatation
Rare associations
Genetic/Family History
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13
Q

How significant is a reduction in cholesterol in reducing stroke risk?

A

1mm/L decrease in LDL cholesterol = 15% decreased risk

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14
Q

What is the pathway of the pyramidal system? (CSP tract)

A

Primary motor cortex -> IC -> cerebral peduncles -> decussation of pyramids -> descending CSP tract

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15
Q

What does an ischemic stroke of the pyramidal system result in?

A

Ischemic stroke = motor deficits

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16
Q

Which strokes affect visual pathways?

A

PCA

MCA

17
Q

What would a stroke affecting the anterior circulation result in?

A

Unilateral motor deficit
Homonymous hemianopia
Higher cerebral function

(total anterior circulation infarct or partial)

18
Q

What would a stroke affecting the posterior circulation result in? (Posterior circulation infarct)

A

Pure hemianopia
Cerebellar signs
Bilateral/crossed sensorimotor signs
Diplopia and CN palsy

19
Q

What would a lacunar stroke result in? (Lacunar infarct)

A

Pure motor deficits
Pure sensory deficits
Ataxic hemiparesis

20
Q

How many patients are suitable for thrombolysis?

A

20%

21
Q

How many patients are suitable for thrombectomy?

A

5%

22
Q

Treatment for Stroke

A
  • thrombolysis
  • stroke unit
  • review antiplatelet therapy
  • address RF
  • treat complications
  • MDT rehab (for survivors)
  • advice and education