Stroke Flashcards
what is the area called between 2 arterial territories
what is the clinical significance of this area
watershed area
more susceptible to hypoxia = ischaemia
what is a complication of untreated stroke/brain hypoxia
pan-necrosis
are infarct or haemorrhagic strokes more common
what are the %s
infarcts more common
infacrts 85%
haemorrhage 10%
subarachoid hemorrhage 5%
what are the 2 types of infarct that can cause a stroke
cardioembolic - clot forms in the heart and breaks off
atheroembolic - atherosclerosis of small vessels + carotids, clot breaks off from carotids = goes into brain
what colour is the thrombus in cardioembolic infarcts
what are they made of
red thrombus
fibrin
what colour is the thrombus in small vessel disease/atheroembolic infarcts
what is it made of
white thrombus (made of platelets)
causes of cardioembolic infarcts (2)
atrial fibrillation - most common!
prosthetic valves
where do haemorrhagic strokes normally occur (which area of brain)
basal ganglia
what is the most common cause of haemorrhagic strokes
hypertension
after hypertension, what are the other causes of haemorrhagic strokes (3)
amyloid angiopathy
tumour
aneurysms
an ischaemic stroke has occurred
has caused right sided face and arm paralysis/dysfunction (idk lol)
which artery has been blocked?
left MCA
hwo long are symptoms present for for it to be classed as a stroke
> 24 hours
how long do symptoms last in TIA
<24 hours
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
lacunar infarcts (lacunar syndrome)
what Is the worst type of stroke to have
total anterior circulation syndrome (TACS)
presentation of total anterior circulation syndrome (TACS)
all 3 of;
hemiplegia of 2 of; face/arms/legs
homonymous hemianopia
cortical signs - dysplasia, neglect
presentation of lacunar syndrome
sensory OR motor (not both)
2 of; face/arms/legs
which classification (Area of brain) stroke has worst prognosis
total anterior circulation syndrome (TACS)
presentation of posterior circulation syndrome (POCS)
any one of;
homonymous hemianopia
CN palsy
cerebellar dysfunction
motor/sensory deficits
how does the presentation of partial anterior circulation syndrome (PACS) differ from total anterior circulation syndrome (TACS)
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
where do left sided problems present
what mental abilities are affected in a left sided stroke
right side of body
spoken language, number skills, reasoning, writing/reading
where do right problems present
what mental abilities are affected in a right sided stroke
left side of body
music, creativity and spatial orientation
is a R or L sided stroke harder for rehab
why
left sided stroke
bc controls speech, writing, reading etc (R sided is just creative stuff)
what is the socring system used for patients with atrial fibrillation to assess their risk of stroke
how is this calculated
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
what medication are AF patients recommended to take to decrease their risk of stroke
warfarin or NOACs (noval oral anticoagulants)
pros of warfarin over NOACs for AF patients preventing stroke
side effects known
cons - need monitoring
pros of NOACs over warfarin for AF patients preventing stroke
no monitoring needed
which type of stroke (infarct or haemorrhage) is more associated with hypertension
haemorrhage
what is the scoring for calculating bleeding risk in patients on warfarin (eg if AF and stroke risk)
(name only)
HASBLED score
what is the mneumonic for remembering stroke presentation
FAST
face drooping/weakness
arm weakness
speech slurring
time to call 999
how does a haemorrhagic stroke appear on CT immediately after incident
why
white
bc blood contains iron
how does a haemorrhagic stroke appear on CT 1 week after incident
why
black
blood has been reabsorbed
how does an infarct stroke appear on CT immediately after incident
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
diagnostic test for what type of stroke has occurred (haemorrhagic or infarct)
CT
if infarct stroke diagnosed on CT, what investigations do you do next
carotid scan - for atheroembolic disease
ECHO - for cardioembolic stroke
what is the acute treatment for cardioembolic infarct stroke
thrombolysis and aspirin 300mg ASAP
what is the long term treatment for cardioembolic infarct stroke
anti coagulant eg rivaroxaban
DVT prevention
bc problem is red thrombus = fibrin problem
what is the acute treatment for atheroembolic infarct stroke
thrombolysis and aspirin 300mg ASAP
what is the long term treatment for atheroembolic infarct stroke
anti platelet eg aspirin
DVT prevention
bc problem is atherosclerosis = white thrombus = platelet problem
what is the acute treatment for haemorrhagic stroke
surgery
eg clip aneurysm
what is the chronic treatment for haemorrhagic stroke after surgery
nothing - eg if aneurysm
fix hypertension - f hypertension cause
apart from fixing the cause of the stroke, what other problems do you need to treat
dysphagia
paralysis
what psych problem is common post stroke
depression
how does brocas aphasia present
how would they reply to “when did you have your stroke?”
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
where is brocas area
frontal lobe of dominant hemisphere (L)
how does wernickes aphasia present
how would they reply to “when did you have your stroke?”
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”
where is wernickes area
temporal lobe of dominant hemisphere (L)
