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Block 3 > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke is….

A

Sudden onset

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2
Q

What are the most likely causes of cerebral ischemia due to perfusion failure?

A

Severe stenosis of carotid and basilar artery

Microstenosis of small deep arteries

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3
Q

Describe the presentation of a ‘watershed’ infarction

A

The effects of perfusion failure are felt first at the distal territories before proximal ones

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4
Q

What are the most likely causes of embolism of brain of cardiac or aortic origin?

A

AF

Recent acute MI

Subacute bacterial endocarditis

Valvular disorders

Cardiac tumors

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5
Q

What are the most likely causes of intracerebral haemorrhage?

A

HTN

Warfarin use

Head trauma

Ruptured cerebral aneurysm

Arteriovenous malformation

Cocaine or meth use

Bleeding tumors

Bleeding disorders (haemophilia)

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6
Q

A patient presents with sudden onset leg weakness. Which vessel is most likely compromised in this patient?

A

ACA

Homunculus

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7
Q

What are the 4 categories in the Oxford/Bamford stroke classification?

A

TACS

PACS

LACS

POCS

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8
Q

What does TACS stand for?

A

Total anterior circulation stroke

Larger MCA or ACA stroke

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9
Q

What does PACS stand for?

A

Partial anterior circulation stroke

Cortical MCA or ACA stroke

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10
Q

What does LACS stand for?

A

Lacunar syndrome

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11
Q

What does POCS stand for?

A

Posterior circulation stroke

Brainstem/cerebellar arteries

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12
Q

What 3 symptoms MUST a patient present with to consider a TACS?

A

Unilateral weakness
- +/- sensory changes

Homonymous hemianopia

Higher cortical dysfunction

  • speech
  • visuospatial problems
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13
Q

Name 3 symptoms a patient COULD present with in a PACS stroke

(Need 2 out of 3 to be PACS stroke)

A

Unilateral weakness
- +/- sensory changes

Homonymous hemianopia

Higher cortical dysfunction

  • speech
  • visuospatial problems
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14
Q

Name 3 symptoms a patient COULD present with in a LACS stroke

(Need 1 of the following)

A

Unilateral weakness
- +/- sensory changes

Pure sensory or pure motor

Ataxic hemiparesis

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15
Q

Name 4 symptoms a patient COULD present with in POCS stroke

Need 1 of the following

A

Bilateral motor or sensory deficit

Cerebellar/brainstem signs

Isolated homonymous hemianopia

Cranial nerve palsy and contralateral motor/sensory deficit

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16
Q

What are cerebellar signs?

A

Dysdiadokinesia & Dysmetria

Ataxia

Nystagmus

Intention tremor

Slurred speech

Hypotonia

17
Q

How would cerebellar symptoms present?

A

D - past pointing, inability to perform and sustain a series of rapidly alternating muscle movements (typically flipping one hand rapidly in the palm of the other

A- gross incoordination of muscle movements

N- nystagmus

I - low, coarse, low frequency tremor that gets worse towards the termination of the action

S - slurred speech

H- low muscle tone

18
Q

Describe a watershed infarct

A

Result from systemic hypotension causing infarcts in areas of overlap and supply

19
Q

Which arteries are most likely to have been affected in watershed infarcts?

A

ACA-MCA infarct caused by occlusion of carotid artery

20
Q

How will a patient present with a watershed infarct?

A

Man in a barrel

-loss of trunk sensation/motor function and aphasia

21
Q

How would a patient with an MCA-PCA present?

A

Affects visual processing

22
Q

Which nuclei/tracts are damaged in lateral medullary syndrome?

A

Vestibular nuclei

Inferior cerebellar peduncle

Central tegmental tract

Lateral spinothalamic tract

Spinal trigeminal nucleus and tract

Nucleus ambiguous

Descending sympathetic fibres

23
Q

What symptoms may a patient present with in lateral medullary syndrome?

A

Vestibular: vomiting vertigo, nystagmus

Ipsilateral cerebellar signs: ataxia, dysmetria, dysdiadochokinesia

Palatal myoclonus

Contralateral pain and temperature loss from body

Ipsilateral pain and temperature loss from face

Ipsilateral dysphagia, hoarseness, absent gag reflex (ambiguous)

Ipsilateral Horner’s syndrome

24
Q

Name some general symptoms of stroke

A

Weakness/Paralysis or numbness on contralateral side

Vertigo/dizziness

Headache

Visual loss/blurred vision

Faintness

Confusion

Speech problems

Difficulty swallowing

Cognitive problems

Memory problems

Consciousness alterations

25
Q

What drug is given as a clot buster in A+E?

A

Alteplase

26
Q

What tool is used to assess someone’s likelihood of a stroke after a TIA?

A

ABCD2

27
Q

Describe the acute management of stroke

A

Imaging

Ischaemic/haemorrhagic

Aspirin

Pyrexia, glucose

TEDS

NBM/SALT

Thrombolysis/other agents

BP

28
Q

How soon should alteplase be given?

A

Within 4.5 hours

The quicker the better

29
Q

What complications need to be considered after acute management of stroke?

A

Swallow

DVT prophylaxis

Pressure areas

Continence

Speech

Infections (chest, UTI, skin)

Contractures

Pain

Depression

30
Q

What needs to be considered in secondary prevention of stroke?

A

IHD

DM

?AF - anticoagulation

Anterior circulation

Smoking cessation

Aspirin/clopidogrel, statin, BP control

Block 3 (14 decks)

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