Stroke Flashcards
Stroke is….
Sudden onset
What are the most likely causes of cerebral ischemia due to perfusion failure?
Severe stenosis of carotid and basilar artery
Microstenosis of small deep arteries
Describe the presentation of a ‘watershed’ infarction
The effects of perfusion failure are felt first at the distal territories before proximal ones
What are the most likely causes of embolism of brain of cardiac or aortic origin?
AF
Recent acute MI
Subacute bacterial endocarditis
Valvular disorders
Cardiac tumors
What are the most likely causes of intracerebral haemorrhage?
HTN
Warfarin use
Head trauma
Ruptured cerebral aneurysm
Arteriovenous malformation
Cocaine or meth use
Bleeding tumors
Bleeding disorders (haemophilia)
A patient presents with sudden onset leg weakness. Which vessel is most likely compromised in this patient?
ACA
Homunculus
What are the 4 categories in the Oxford/Bamford stroke classification?
TACS
PACS
LACS
POCS
What does TACS stand for?
Total anterior circulation stroke
Larger MCA or ACA stroke
What does PACS stand for?
Partial anterior circulation stroke
Cortical MCA or ACA stroke
What does LACS stand for?
Lacunar syndrome
What does POCS stand for?
Posterior circulation stroke
Brainstem/cerebellar arteries
What 3 symptoms MUST a patient present with to consider a TACS?
Unilateral weakness
- +/- sensory changes
Homonymous hemianopia
Higher cortical dysfunction
- speech
- visuospatial problems
Name 3 symptoms a patient COULD present with in a PACS stroke
(Need 2 out of 3 to be PACS stroke)
Unilateral weakness
- +/- sensory changes
Homonymous hemianopia
Higher cortical dysfunction
- speech
- visuospatial problems
Name 3 symptoms a patient COULD present with in a LACS stroke
(Need 1 of the following)
Unilateral weakness
- +/- sensory changes
Pure sensory or pure motor
Ataxic hemiparesis
Name 4 symptoms a patient COULD present with in POCS stroke
Need 1 of the following
Bilateral motor or sensory deficit
Cerebellar/brainstem signs
Isolated homonymous hemianopia
Cranial nerve palsy and contralateral motor/sensory deficit
What are cerebellar signs?
Dysdiadokinesia & Dysmetria
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
How would cerebellar symptoms present?
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
Describe a watershed infarct
Result from systemic hypotension causing infarcts in areas of overlap and supply
Which arteries are most likely to have been affected in watershed infarcts?
ACA-MCA infarct caused by occlusion of carotid artery
How will a patient present with a watershed infarct?
Man in a barrel
-loss of trunk sensation/motor function and aphasia
How would a patient with an MCA-PCA present?
Affects visual processing
Which nuclei/tracts are damaged in lateral medullary syndrome?
Vestibular nuclei
Inferior cerebellar peduncle
Central tegmental tract
Lateral spinothalamic tract
Spinal trigeminal nucleus and tract
Nucleus ambiguous
Descending sympathetic fibres
What symptoms may a patient present with in lateral medullary syndrome?
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
Name some general symptoms of stroke
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
What drug is given as a clot buster in A+E?
Alteplase
What tool is used to assess someone’s likelihood of a stroke after a TIA?
ABCD2
Describe the acute management of stroke
Imaging
Ischaemic/haemorrhagic
Aspirin
Pyrexia, glucose
TEDS
NBM/SALT
Thrombolysis/other agents
BP
How soon should alteplase be given?
Within 4.5 hours
The quicker the better
What complications need to be considered after acute management of stroke?
Swallow
DVT prophylaxis
Pressure areas
Continence
Speech
Infections (chest, UTI, skin)
Contractures
Pain
Depression
What needs to be considered in secondary prevention of stroke?
IHD
DM
?AF - anticoagulation
Anterior circulation
Smoking cessation
Aspirin/clopidogrel, statin, BP control
