Stroke Flashcards
Define stroke:
An experience of persisting neurological complications of a cardiovascular event.
It is an abrupt onset lasting more than 24 hours
List the different types of stroke form most to least common:
Ischaemic - 85%
Haemorrhagic - 10%
Subarachnoid - 5%
What is the difference between a TIA and a stroke?
A TIA will never have deficits lasting more than 24 hours, whereas in a stroke, the deficits will persist.
How many stroke like presentations tend to be stroke mimics?
1/3rd
What are some causes of stroke mimics?
Seizures Sepsis Metabolic Toxic Pre-syncope Delirium Dementia
What scoring system can be used to differentiate between a stroke and a stroke mimic?
Rosier’s Score
>0 = stroke likely
= 0 means stroke less likely
What scoring system is used to assess risk of ischemic stroke?
CHADS-VASc
List some causes of ischaemic stroke:
Cardioembolic
Atheroembolic
Atrial Fibrillation
Small vessel occlusion
List some risk factors for ischaemic stroke:
High Cholesterol Smoking Obesity A. fib Asian
List the main causes of haemorrhagic stroke:
Aneurysms
Amyloid angiopathy
Hypertension
Structural Abnormality
What is the main cause of a subarachnoid haemorrhage/stroke?
Berry aneurysm
What are some symptoms that would be suggestive of a subarachnoid haemorrhage?
Sudden: (Occipital) Headache Neck stiffness Kernig's Sign Vomiting Loss of consciousness - (drowsiness may last a few days)
What is the process of hemorrhagic to ischaemic stroke in a subarachnoid stroke?
Haemorrhage leads to irritation causing vasospasm which causes an ischaemic attack
What artery does the anterior circulation branch off?
Internal carotid
Which of the anterior vessels is larger?
Middle cerebral artery
80% of the blood flows through here
Does the anterior cerebral artery supply the medial or lateral aspect of the cerebral hemisphere?
Medial
What is the most common type of ischaemic stroke?
Cardioembolic
An anterior circulatory stroke will result in weakness of the ipsilateral/contralateral side of the body?
Contralateral
What vessels supply to posterior circulation?
Vertebral
Basilar
Where is a common site for spontaneous intra-cerebral haemorrhage and why is it significant?
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
Which of the stroke syndromes carries the worst prognosis?
Total Anterior Cerebral Stroke
5% full recovery
Which of the stroke syndromes carries the best prognosis?
Lacunar Stroke
List the symptoms of a TAC stroke:
Hemiplegia involved at least 2 of the following: legs, arms and face
Homonymous hemianopia
Visospatial dyspraxia
Cortical signs e.g. dysphagia and neglect
What are some of the clinical features of a Partial anterior cerebral stroke?
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
What clinical features would be seen in a Posterior artery stroke? (POCS)
Cranial nerve deficits with contralateral hemiparesis OR Sensory deficit OR bilateral stroke Conjugate eye movements Cerebellar deficits
What features are not seen in POCS which are seen in a Lacunar stroke?
Ataxia hemiparesis
Stroke in which hemisphere is likely to affect the patients language, number skills, wriitng skills and reasoning?
Left side of brain
the dominant side is almost always left
What is affected should a stroke occur in the RHS (non dominant) hemisphere?
Artistic awareness
Spatial orientation
creativity
music
A stroke in the right/left hemisphere will require more intensive rehab?
Left
What are the clinical features of a lacunar infarct?
Ataxic hemiparesis
Pure motor / pure sensory loss of 2/3 of arms legs and face
Dysarthria and clumsy hands
Where are berry aneurysms common?
Junction of posterior communicating with internal carotid
OR
junction of anterior communicating with the anterior cerebellar artery
OR
bifurcation of middle cerebral artery
What other co morbidities are associated with Berry aneurysms?
Polycystic kidneys
Ehlers-Danlos syndrome
Coartication of aorta
What is the appropriate management for a subarachnoid haemorrhage?
Maintain cerebral perfusion through IV fluids Nimodipine - prevents vasospasm
Endovascular coiling - preferred over clipping
What investigation should you do in suspected subarachnoid haemorrhage and why?
Catheter or CT angiography
identifies if single or multiple aneurysms
List some complications of subarachnoid haemorrhage:
Rebleed Cerebral ischaemia due to vasospasm Hydrocephalus Hyponatraemia Increased risk of new aneurysms
What is the main cause of a cardioembolic stroke?
Atrial fibrillation
When can thrombolysis be used in the management of a stroke?
If symptoms presented less than 4.5 hours ago
Quadriplegia and “locked in” syndrome would suggest a stroke where?
Brainstem
Once hemorrhagic stroke has been excluded and thrombolysis potentially given, what is the next most appropriate management?
Aspirin 300mg
What medication will patients be on long term post an ischaemic stroke?
Anti-platelets
Or
Anti-coagulants
What can be done to manage a hemorrhagic stroke?
No specific interventions
Mainly supportive management
