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J Neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

what is the area called between 2 arterial territories

what is the clinical significance of this area

A

watershed area

more susceptible to hypoxia = ischaemia

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2
Q

what is a complication of untreated stroke/brain hypoxia

A

pan-necrosis

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3
Q

are infarct or haemorrhagic strokes more common

what are the %s

A

infarcts more common

infacrts 85%
haemorrhage 10%
subarachoid hemorrhage 5%

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4
Q

what are the 2 types of infarct that can cause a stroke

A

cardioembolic - clot forms in the heart and breaks off

atheroembolic - atherosclerosis of small vessels + carotids, clot breaks off from carotids = goes into brain

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5
Q

what colour is the thrombus in cardioembolic infarcts

what are they made of

A

red thrombus

fibrin

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6
Q

what colour is the thrombus in small vessel disease/atheroembolic infarcts

what is it made of

A

white thrombus (made of platelets)

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7
Q

causes of cardioembolic infarcts (2)

A

atrial fibrillation - most common!

prosthetic valves

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8
Q

where do haemorrhagic strokes normally occur (which area of brain)

A

basal ganglia

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9
Q

what is the most common cause of haemorrhagic strokes

A

hypertension

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10
Q

after hypertension, what are the other causes of haemorrhagic strokes (3)

A

amyloid angiopathy
tumour
aneurysms

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11
Q

an ischaemic stroke has occurred
has caused right sided face and arm paralysis/dysfunction (idk lol)
which artery has been blocked?

A

left MCA

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12
Q

hwo long are symptoms present for for it to be classed as a stroke

A

> 24 hours

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13
Q

how long do symptoms last in TIA

A

<24 hours

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14
Q

which classification of stroke (area of brain) has lots of small black dots (rather than one big one) on pathology and is associated with hypertension

A

lacunar infarcts (lacunar syndrome)

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15
Q

what Is the worst type of stroke to have

A

total anterior circulation syndrome (TACS)

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16
Q

presentation of total anterior circulation syndrome (TACS)

A

all 3 of;

hemiplegia of 2 of; face/arms/legs
homonymous hemianopia
cortical signs - dysplasia, neglect

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17
Q

presentation of lacunar syndrome

A

sensory OR motor (not both)

2 of; face/arms/legs

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18
Q

which classification (Area of brain) stroke has worst prognosis

A

total anterior circulation syndrome (TACS)

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19
Q

presentation of posterior circulation syndrome (POCS)

A

any one of;

homonymous hemianopia
CN palsy
cerebellar dysfunction
motor/sensory deficits

20
Q

how does the presentation of partial anterior circulation syndrome (PACS) differ from total anterior circulation syndrome (TACS)

A

only 2 of the 3 features present in TACS are in PACS;

hemiplegia of 2 of; face/arms/legs
homonymous hemianopia
cortical signs - dysphasia, neglect

21
Q

where do left sided problems present

what mental abilities are affected in a left sided stroke

A

right side of body

spoken language, number skills, reasoning, writing/reading

22
Q

where do right problems present

what mental abilities are affected in a right sided stroke

A

left side of body

music, creativity and spatial orientation

23
Q

is a R or L sided stroke harder for rehab

why

A

left sided stroke

bc controls speech, writing, reading etc (R sided is just creative stuff)

24
Q

what is the socring system used for patients with atrial fibrillation to assess their risk of stroke

how is this calculated

A

CHA2DS2VAS

congective heart failure 
hypertension 
age >75 (= 2) 
diabetes 
prev stroke/TIA/embolism (= 2) 
vascular disease 
age 65-74 
sex - female

score out of 9

25
Q

what medication are AF patients recommended to take to decrease their risk of stroke

A

warfarin or NOACs (noval oral anticoagulants)

26
Q

pros of warfarin over NOACs for AF patients preventing stroke

A

side effects known

cons - need monitoring

27
Q

pros of NOACs over warfarin for AF patients preventing stroke

A

no monitoring needed

28
Q

which type of stroke (infarct or haemorrhage) is more associated with hypertension

A

haemorrhage

29
Q

what is the scoring for calculating bleeding risk in patients on warfarin (eg if AF and stroke risk)

(name only)

A

HASBLED score

30
Q

what is the mneumonic for remembering stroke presentation

A

FAST

face drooping/weakness
arm weakness
speech slurring
time to call 999

31
Q

how does a haemorrhagic stroke appear on CT immediately after incident

why

A

white

bc blood contains iron

32
Q

how does a haemorrhagic stroke appear on CT 1 week after incident

why

A

black

blood has been reabsorbed

33
Q

how does an infarct stroke appear on CT immediately after incident

A

might not be able to see anything, but haemorrhagic stroke is immediately white so can exclude that!

will go dark when you can see it

34
Q

diagnostic test for what type of stroke has occurred (haemorrhagic or infarct)

A

CT

35
Q

if infarct stroke diagnosed on CT, what investigations do you do next

A

carotid scan - for atheroembolic disease

ECHO - for cardioembolic stroke

36
Q

what is the acute treatment for cardioembolic infarct stroke

A

thrombolysis and aspirin 300mg ASAP

37
Q

what is the long term treatment for cardioembolic infarct stroke

A

anti coagulant eg rivaroxaban
DVT prevention

bc problem is red thrombus = fibrin problem

38
Q

what is the acute treatment for atheroembolic infarct stroke

A

thrombolysis and aspirin 300mg ASAP

39
Q

what is the long term treatment for atheroembolic infarct stroke

A

anti platelet eg aspirin
DVT prevention

bc problem is atherosclerosis = white thrombus = platelet problem

40
Q

what is the acute treatment for haemorrhagic stroke

A

surgery

eg clip aneurysm

41
Q

what is the chronic treatment for haemorrhagic stroke after surgery

A

nothing - eg if aneurysm

fix hypertension - f hypertension cause

42
Q

apart from fixing the cause of the stroke, what other problems do you need to treat

A

dysphagia

paralysis

43
Q

what psych problem is common post stroke

A

depression

44
Q

how does brocas aphasia present

how would they reply to “when did you have your stroke?”

A

cant speak sentences in the right order, miss out filler words only ay the main words

eg in response to “ when did you have your stroke” they reply “ I 7 years ago”

Brocas area = Broken words

45
Q

where is brocas area

A

frontal lobe of dominant hemisphere (L)

46
Q

how does wernickes aphasia present

how would they reply to “when did you have your stroke?”

A

words and sentences are clear but they cant understand language

eg wouldn’t understand the question and would reply like “The sales were good in the 70s but that soon changed”

47
Q

where is wernickes area

A

temporal lobe of dominant hemisphere (L)

J Neuro (32 decks)

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