Stroke Flashcards
What is stroke?
Rapidly developing clinical symptoms and/or focal signs, and at times global loss of brain function, with symptoms lasting more than 24h leading to death with no apparent cause other than vascular origin
STROKE is a diagnosis TRUE/FALSE
FALSE
It is not a diagnosis, it is the experience of persisting neurological complications of cardiovascular disease
Which score helps to diagnose strokes?
Rosier Score
What fraction of all stroke presentations are stroke mimics e.g. seizures?
1/3
A TIA as compared to a stroke is benign TRUE/FALSE
FALSE
It is not benign
What time frame do symtoms have to last for for it to be classed as a TIA rather than a stroke?
Less than 24h
Define TIA
A brief episode of neurological dysfunction caused by ischaemia with clinical symptoms typically lasting less then 1h and without evidence of acute infarction
Which age group is stroke most common in?
More common in elderly, peak incidence >70 but can occur in other age groups
Strokes are more common in females T/F
False
Stroke more common in males
What 4 things is the extent of damage determined by?
Arterial territory of the affected artery
Timescale of the occlusion
Extent of the circulatory relief
System perfusion pressure
Before how many hours is there very little to observe on microscopy/microscopy after a stroke?
Less than 12h
How many days post stroke does the brain become gelatinous and febrile?
2-14 days
How long post stroke does it take for microglia to become the predominant cell type?
2-14 days
How early does reactive gliosis begin?
As early as wk 1
A CT is excellent and always picks up bleeds in the brain TRUE/FALSE
It is rather excellent however if hyperacute it may be essentially normal and it is not sensitive to bleeds over 1 week old
MRI is good with stroke at identifying…
Old lesions
Those of non-vascular origin
What is the time limit on using IV tissue plasminogen activator?
<4.5h
Do not treat cardioembolic stroke with aspirin TRUE/FALSE
TRUE
Aspirin can be used after thrombolysis TRUE/FALSE
TRUE but wait 24h
ABCDE of prevention of stroke
A-Antithrombotic therapy B-BP C-Cholesterole D-Diabetes E-Especially don't smoke
What fraction of strokes are due to AF?
1/6
For the majority of strokes antithrombotic therapy is started?
Aspirin 300mg for 2wks
What are the three types of ischaemic stroke?
Cardioembolic
Atheroembolic
Small vessel disease
Describe Cardioembolic stroke
Fibrin dependent “red thrombus” e.g. endocarditis
Describe atheroembolic stroke
Platelet dependent “white thrombus” e.g. from carotids
Where is the most likely place to get a thrombus?
Middle cerebral artery ( as it is aligned with the internal carotid artery)
CNS bleeds are the cause of what percentage of strokes?
10%
What are the two main reasons for haemorrhage stroke?
BBB disrupted
Damaged vessels
What are the four types of stroke?
TACS
PACS
LACS
POCS
What is the most severe type of stroke?
Total Anterior Circulation Syndrome (TACS)- only 5% of patients alive at 1 year
What are the 3 characteristics of total anterior circulation syndrome?
Hemiplegia involving 2/3 of face, arm,leg
Homonymous hemianopia
Cortical signs
With PACS how many of the patients are alive and independent at 1 year?
50%
With PACS they must have 2 of…
Hemiplegia involving 2/3 of face, arm,leg
Homonymous hemianopia
Cortical signs
What are lacunar infarcts?
Small infarcts in the deeper parts of the brain
What has the best prognosis of stroke?
LACS
What is LACS caused by?
Occlusion of a single deep penetrating artery
POCS can lead to multiple presentations, which are some of the most common
CN palsies Bilateral motor and/or sensory defecits Conjugate eye movement disorders Isolated homonymous hemianopia Cortical blindness Cerebellar deficits w/o
What is the right side of the brain responsible for?
Creativity, music, spatial orientation and artistic awareness
What is the left side of the brain responsible for?
Spoken language, reasoning, number skills and written language
With the small disease classification what type is churg-strauss?
Type 4
What is type 1 small vessel disease classification?
Arteriosclerosis
Causes of intracerebral haemorrhage
Hypertension Amyloid angiopathy AVM aneurysm Tumour
What are the two scoring tools to determine the risk of bleeding?
CHA2DS2VASc and HAS-BLED
Where would the weakness present if the lesion was in the middle v anterior cerebral artery
If middle- contralateral face and arm
If anterior- contralateral leg
TRUE/FALSE
Bleeding risk with aspirin is just as big as with warfarin
true
What does a cardio protective diet look like?
5+ portions of fruit/veg per day from a variety of sources
Two portions of oily fish per wk
Replace saturated fasts with polyunsaturated/monounsaturated fats
Reduce salt intake
Limit alcohol to 14u/week
If overweight/obese then lose weight
