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Cardiovascular (Annie) > Stroke > Flashcards

Stroke Flashcards

1
Q

what is a stroke?

A

ACUTE onset of focal neurological symptoms and signs due to DISRUPTION OF BLOOD SUPPLY

= end organ complication of poor vascular health

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2
Q

what are the 2 types of stroke?

A

1) haemorrhagic

2) ischaemic

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3
Q

what happens haemorrhagic stroke?

A

= when bleeding occurs in inside or around brain tissue

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4
Q

what happens in ischaemic stroke?

A

= a clot blocks blood flow to an area of the brain

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5
Q

what type of blood pressure causes haemorrhagic shock?

A

raised high blood pressure

= HYPERTENSION

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6
Q

what does a haemorrhagic shock to the vessel walls?

A

= weakening and rupturing blood vessel walls

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7
Q

in haemorrhagic shock, what causes the weakened blood vessels?

A
  • structural abnormalities e.g. aneurysm, arteriovenous malformation (AVM) = abnormal and poorly formed blood vessels that have a higher rate of bleeding
  • inflammation of vessel wall
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8
Q

what 3 things happen in ischaemic stroke?

A

1) thrombotic
2) embolic
3) hypo perfusion

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9
Q

what is a thrombosis, in iscahemic stroke?

A

= clot blocking the artery AT SITE OF OCCLUSION

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10
Q

what is an embolic, in iscahemic stroke?

A

= clot blocking artery that has TRAVELLED to an artery to occlude from somewhere more proximal in the arteries of the heart

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11
Q

what causes hypo perfusion in ischaemic stroke?

A

= due to reduced flow of blood due to stenosed artery rather than occlusion of artery

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12
Q

what are the 3 components that encompass thrombosis?

A

1) endothelial injury
2) circulatory stasis
3) hyper-coagulable state

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13
Q

what is the mechanism of athero- thrombotic stroke?

A

1) atherogenesis
2) plaque
3) platelet aggregation
4) thrombosis
5) ischaemia

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14
Q

what 2 things can happen between plaque and platelet aggregation?

A

1) plaque rupture

2) vessel stenosis

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15
Q

what does vessel stenosis cause?

A

causes low blood flow

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16
Q

what are the non-modifiable risk factors for stroke?

A
  • age (incidence rises with age)
  • family history of stroke
  • gender
  • race
  • previous stroke
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17
Q

what are the modifiable risk factors for stroke?

A
  • hypertension
  • hyper-lipidaemia
  • smoking
  • alcohol excess
  • obesity
  • physical inactivity
  • poor socioeconomic status
  • prior history of transient ischaemic attack
  • atrial fibrillation
  • diabetes
  • congestive heart failure
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18
Q

how can improvement in hypertension improve stroke?

A

= a 10mm reduction in systolic BP reduces risk of CV events

- isolated systolic hypertension canincrease stroke risk

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19
Q

how can smoking affect stroke?

A

= doubles risk of ishaemic stroke

20
Q

when should statins be used?

A
  • statins recommended in all patients with iscahemic stroke

NOT RECOMENDED in haemorrhagic stroke

21
Q

what are the 3 essential questions to ask yourself when investigating a stroke?

A

1) is this a stroke?
2) what kind of stroke is it?
3) what has caused this?

22
Q

what is a stroke mimic?

A

= conditions that present acutely with focal neurological signs but aren’t due to interrupted blood flow

23
Q

give examples of what might be the causes of stroke mimics?

A
  • hypoglycaemia
  • seizures = postical states
  • migraine
  • other metabolic, hyperglycaemia, hyponatremia
  • space occupying lesions like brain tumours
  • functional hemiparesis (weakened one side of the body)
24
Q

what is the only way to differentiate between ischaemic and hemorrhagic stroke?

A

= imaging

25
Q

what are the possibilities of imaging that could be done?

A
  • CT brain +/- angiography
  • MRI with DWI (diffusion weighting imaging) +/- angiography
  • MRI with SWI (susceptibility weighing imaging) = looks for old haemosiderin deposits (old bleed)
26
Q

what is the imaging preference?

A

CT scan - NOT MRI

27
Q

in investigating iscahemic stroke, what are you trying to find?

A
  • cause of thrombosis

- cause of embolism

28
Q

what tests would you perform in investigating iscahemic stroke?

A

Blood tests;

  • glucose
  • lipids
  • thrombophilia screen in young patients
  • assess for hypertension
29
Q

what is athero-embolism?

A

= embolism from a thrombus forming on an atherosclerosis plaque = platelet rich clots

  • infarcts in same side as affected carotid artery
30
Q

what is a cardioembolism?

A

= embolism forms a clot formed in heart (usually left atrium) = clothing factor rich clots

  • infarcts in more than one arteries territory, bilateral
31
Q

if query atheroembolism, what investigations would you do?

A
  • carotid scanninng

- CT/MR angiography of aortic arch

32
Q

if query cardioembolism, what investigations would you do?

A
  • ECG
    = AF
    = old iscahemic changes (mural thrombus)
    = LVH (suggests uncontrolled hypertension = commonest cause of AF)
  • echocardiogram (transthoracic, transeosphageal, bubble contrast study to look for intertribal connection)

= 24hour, 5 day ECG monitor tests

33
Q

what are you trying to investigate in haemorrhagic stroke?

A

the cause of bleeding

34
Q

when and where is hypertension often seen?

A
  • older patients

- deeper in the brian

35
Q

if theres a young person, who is not hypersensitive & has lobar (superficial) haemorrhage, what are you investigating for?

A
  • aneurysm

- AVM

36
Q

what 2 things can you do to reverse iscahemic stroke?

A

1) thrombolysis
= upto 4.5hours from onset of symptoms

2) thrombectomy
= upto 6hours from symptoms onset, usually after having started thrombolysis

= both are trim dependent treatments as brain tissue dies rapidly with any delay

37
Q

what does thrombolysis help with?

A

= tPA helps DISSOLVE BLOOD CLOT if given IV

38
Q

what is thrombectomy?

A

= REMOVES BLOOD CLOT

= pass a catheter up vessel and integrate into blood clot and taken into catheter and removed

39
Q

what drugs should you give to prevent next stroke?

- if atheroembolic or thrombus has caused it?

A 
- Ant-iplatelets
= (Aspirin 75 mg + Dipyridamole MR 200 mg twice daily/Clopidogrel 75 mg daily)
- Statins to treat high lipids
- Diabetes management
- Hypertension management
- Lifestyle advice
40
Q

what drugs should be given to prevent next stroke if stroke is due to atrial fibrillation?

A

= warfarin (Vit K antagonists)

= direct acting oral anticoagulants (act by inhibiting clotting factors directly like factor X and thrombin)

  • rivaroxaban
  • dabigatran
  • apixaban
  • edoxaban
41
Q

what do anti-hypertensives do?

when are anti-hypersensitive most important?

A

= control hypertension

  • mort important in coronary heart disease & peripheral heart disease
42
Q

what combination of drugs could reduce recurrent of stroke?

A

perindopril + indapamide

43
Q

what surgical management techniques could be done?

A

1) Haematoma evacuation
2) Relief of raised intracranial pressure
- Obstructive hydrocephalus
- Large total MCA infarctions

3) Carotid endarterectomy
>70% stenosis in same sided internal carotid artery(as affected side of brain)

44
Q

what is transient ischaemic attacks (TIA)?

A

= temporary neurological symptoms due to occlusion of artery stopping flow of blood.
- temporary b’cos arteries capable of dissolving small clots

45
Q

in a TIA, when do focal neurological symptoms resolve?

A

within 24houurs

46
Q

what are the chances of having a stroke after having had a TIA?

A

quite high

47
Q

what are some rarer causes of stroke?

A
  • homocysteinemia
  • protein S, C antithrombin III deficiency
  • vasculitis
  • paradoxical embolism

Cardiovascular (Annie) (36 decks)

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