Stroke Flashcards
Define stroke
Rapidly progressive clinical symptoms and signs of focal and at times global loss of cerebral function lasting more than 24 hours
What are the 2 main types of stroke and how frequent are they?
- haemorrhagic (20-30%)
- ischaemic (70-80%)
What is the primary cause of a haemorrhagic stroke?
Hypertension
What is the secondary cause of a haemorrhagic stroke?
Trauma Tumour AV Malformation Venous thrombosis Vasculitis Coagulopathy Drugs - cocaine Haemorrhagic transformation of infarct
What are the complications of an intracellular haemorrhage?
Local damage
Local mass effect/herniation
Raised ICP
Hydrocephalus
How is an intracellular haemorrhage managed?
Establish cause - imaging/angiography/platelet function/clotting
Stop aspirin or warfarin
Treat complications - may need surgery/ICP management
Treat RF - blood pressure
Rehabilitation
What are the 2 types of ischaemic stroke?
- large vessel -> can cause midline shift
- small vessel (lacunar) -> in deep brain structures, perforated vessels
What is the ischemic cascade?
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
What are the causes of ischemic stroke and how frequent/likely are they?
- arteriolar sclerosis (25%)
- atherosclerosis (50%)
- cardiac AF (15%) - spaces of blood in the appendage
- carotid dissection (5%)
- vasculitis (1%)
- haematological (1%)
What are he demographic risk factors for stroke?
Age, male, race, socioeconomic status
What are the lifestyle risk factors?
Smoking, weight, inactivity, alcohol
What are the medical RF?
Hypertension (biggest risk factor for all stroke -50%) Hypercholesterolaemia Diabetes Vascular disease Cardiac - AF, chamber dilatation Rare associations Genetic/Family History
How significant is a reduction in cholesterol in reducing stroke risk?
1mm/L decrease in LDL cholesterol = 15% decreased risk
What is the pathway of the pyramidal system? (CSP tract)
Primary motor cortex -> IC -> cerebral peduncles -> decussation of pyramids -> descending CSP tract
What does an ischemic stroke of the pyramidal system result in?
Ischemic stroke = motor deficits
