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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Define stroke:

A

An experience of persisting neurological complications of a cardiovascular event.
It is an abrupt onset lasting more than 24 hours

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2
Q

List the different types of stroke form most to least common:

A

Ischaemic - 85%
Haemorrhagic - 10%
Subarachnoid - 5%

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3
Q

What is the difference between a TIA and a stroke?

A

A TIA will never have deficits lasting more than 24 hours, whereas in a stroke, the deficits will persist.

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4
Q

How many stroke like presentations tend to be stroke mimics?

A

1/3rd

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5
Q

What are some causes of stroke mimics?

A 
Seizures
Sepsis
Metabolic
Toxic
Pre-syncope
Delirium
Dementia
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6
Q

What scoring system can be used to differentiate between a stroke and a stroke mimic?

A

Rosier’s Score
>0 = stroke likely
= 0 means stroke less likely

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7
Q

What scoring system is used to assess risk of ischemic stroke?

A

CHADS-VASc

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8
Q

List some causes of ischaemic stroke:

A

Cardioembolic
Atheroembolic
Atrial Fibrillation
Small vessel occlusion

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9
Q

List some risk factors for ischaemic stroke:

A 
High Cholesterol
Smoking
Obesity
A. fib
Asian
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10
Q

List the main causes of haemorrhagic stroke:

A

Aneurysms
Amyloid angiopathy
Hypertension
Structural Abnormality

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11
Q

What is the main cause of a subarachnoid haemorrhage/stroke?

A

Berry aneurysm

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12
Q

What are some symptoms that would be suggestive of a subarachnoid haemorrhage?

A 
Sudden:
(Occipital) Headache
Neck stiffness
Kernig's Sign
Vomiting
Loss of consciousness - (drowsiness may last a few days)
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13
Q

What is the process of hemorrhagic to ischaemic stroke in a subarachnoid stroke?

A

Haemorrhage leads to irritation causing vasospasm which causes an ischaemic attack

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14
Q

What artery does the anterior circulation branch off?

A

Internal carotid

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15
Q

Which of the anterior vessels is larger?

A

Middle cerebral artery

80% of the blood flows through here

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16
Q

Does the anterior cerebral artery supply the medial or lateral aspect of the cerebral hemisphere?

A

Medial

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17
Q

What is the most common type of ischaemic stroke?

A

Cardioembolic

18
Q

An anterior circulatory stroke will result in weakness of the ipsilateral/contralateral side of the body?

A

Contralateral

19
Q

What vessels supply to posterior circulation?

A

Vertebral

Basilar

20
Q

Where is a common site for spontaneous intra-cerebral haemorrhage and why is it significant?

A

Basal ganglia and internal capsule - lenticular striate from MCA
This area does not have collateral blood supply, therefore it is high risk of suffering from tissue damage if blood supply is compromised

21
Q

Which of the stroke syndromes carries the worst prognosis?

A

Total Anterior Cerebral Stroke

5% full recovery

22
Q

Which of the stroke syndromes carries the best prognosis?

A

Lacunar Stroke

23
Q

List the symptoms of a TAC stroke:

A

Hemiplegia involved at least 2 of the following: legs, arms and face
Homonymous hemianopia
Visospatial dyspraxia
Cortical signs e.g. dysphagia and neglect

24
Q

What are some of the clinical features of a Partial anterior cerebral stroke?

A

it will either have 2/3 signs from a TAC
OR
Isolated cortical dysfunction e.g dysphasia
OR
Pure motor/sensory signs which are less severe than a lacunar stroke

25
Q

What clinical features would be seen in a Posterior artery stroke? (POCS)

A 
Cranial nerve deficits with contralateral hemiparesis
OR
Sensory deficit
OR bilateral stroke
Conjugate eye movements
Cerebellar deficits
26
Q

What features are not seen in POCS which are seen in a Lacunar stroke?

A

Ataxia hemiparesis

27
Q

Stroke in which hemisphere is likely to affect the patients language, number skills, wriitng skills and reasoning?

A

Left side of brain

the dominant side is almost always left

28
Q

What is affected should a stroke occur in the RHS (non dominant) hemisphere?

A

Artistic awareness
Spatial orientation
creativity
music

29
Q

A stroke in the right/left hemisphere will require more intensive rehab?

A

Left

30
Q

What are the clinical features of a lacunar infarct?

A

Ataxic hemiparesis
Pure motor / pure sensory loss of 2/3 of arms legs and face
Dysarthria and clumsy hands

31
Q

Where are berry aneurysms common?

A

Junction of posterior communicating with internal carotid
OR
junction of anterior communicating with the anterior cerebellar artery
OR
bifurcation of middle cerebral artery

32
Q

What other co morbidities are associated with Berry aneurysms?

A

Polycystic kidneys
Ehlers-Danlos syndrome
Coartication of aorta

33
Q

What is the appropriate management for a subarachnoid haemorrhage?

A

Maintain cerebral perfusion through IV fluids Nimodipine - prevents vasospasm
Endovascular coiling - preferred over clipping

34
Q

What investigation should you do in suspected subarachnoid haemorrhage and why?

A

Catheter or CT angiography

identifies if single or multiple aneurysms

35
Q

List some complications of subarachnoid haemorrhage:

A 
Rebleed
Cerebral ischaemia due to vasospasm
Hydrocephalus
Hyponatraemia 
Increased risk of new aneurysms
36
Q

What is the main cause of a cardioembolic stroke?

A

Atrial fibrillation

37
Q

When can thrombolysis be used in the management of a stroke?

A

If symptoms presented less than 4.5 hours ago

38
Q

Quadriplegia and “locked in” syndrome would suggest a stroke where?

A

Brainstem

39
Q

Once hemorrhagic stroke has been excluded and thrombolysis potentially given, what is the next most appropriate management?

A

Aspirin 300mg

40
Q

What medication will patients be on long term post an ischaemic stroke?

A

Anti-platelets
Or
Anti-coagulants

41
Q

What can be done to manage a hemorrhagic stroke?

A

No specific interventions

Mainly supportive management

Neurology (15 decks)

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