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Stroke Flashcards

1
Q

What is the definition of stroke?

A

A sudden onset of focal or global neurological symptoms caused by ischameia or haemorrhage which lasts >24hrs.

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2
Q

What is the most common type of stroke?

A

Ischaemic

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3
Q

How long do symptoms of TIAs usually resolve in?

A

1-60 mins

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4
Q

What is the time period that TIAs are defined by?

A

Symptoms lasting < 24hrs

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5
Q

What are the main causes of ischaemic stroke?

A

Large artery atherosclerosis
Cardioembolic
Small artery occlusion
Arterial dissection

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6
Q

What are the main causes of haemorrhagic stroke?

A

Primary intracerebral haemorrhage

Secondary (SAH, AV malformation)

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7
Q

What imaging would you use in stroke?

A

CT (acute)

MRI

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8
Q

What is the pathophysiology behind an ischaemic stroke?

A

Failure of cerebral blood flow due to interruption. This causes hypoxia and
Ischaemic penumbra.
When there is no oxygen (anoxia), infarction occurs & cell death.

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9
Q

What are some of the modifiable risk factors for stroke?

A 
Smoking 
Hypertension 
Diet 
Cholesterols
Exercise 
Obesity
Diabetes
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10
Q

What are some of the non-modifiable risk factors for stroke?

A

> Age
Male
Family history
Previous history of stroke

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11
Q

What is the most important modifiable risk factor for stroke?

A

HYPERTENSION

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12
Q

What is the name of the small end arteries?

A

Lacunar arteries

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13
Q

What area of the brain will be affected in a receptive dysphagia?

A

Wernickes area

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14
Q

What area of the brain will be affected in a expressive dysphagia?

A

Brocas Area

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15
Q

If the ACA is blocked, where will symptoms be observed?

A

Legs

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16
Q

IF the MCA is blocked, where will symptoms be observed?

A

Arms, hands, face

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17
Q

What arteries comprise the anterior circulation of the brain? What is their origin

A

ACA
MCA

ICA

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18
Q

What arteries comprise the posterior circulation of the brain? What is their origin

A

PCA
(2 verebral arteries which form basilar)

3 cerebellar arteries

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19
Q

What arteries are responsible for the anatostomoses that comprise the Circle of Willis?

A

Anterior & posterior communicating arteries

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20
Q

Where does the anterior circulation of the brain arise?

A

ICA

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21
Q

What are the symptoms of ACA occlusion?

A

Contralateral foot & leg paralysis
Sensory loss
Impairment of gait

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22
Q

What are some of the symptoms of MCA occlusion?

A

Contralateral:
Leg/Arm/Face paralysis & loss of sensation
Homonymous hemianopia
Gaze paralysis
Aphasia (if affected dominant hemisphere)
Unilateral neglect & agnosia

23
Q

If a stroke affects the Left side of the brain, what will be observed?

A

Dysphagia
Homonymous hemianopia
Right sides hemiplegia

24
Q

What artery supplies the internal capsule?

25
What symptoms will be observed in a stroke on the right side of brain?
``` Left hemiplegia Homonymous hemianopia Visual & sensory agnosia Anasagnosia Prosapagnosia ```
26
What is hemiparesis?
Loss of motor function on one side of body
27
What are some of the symptoms of a lacunar artery stroke?
Pure motor Pure sensory Dysarthria Ataxic hemiparesis
28
What are some of the symptoms of a PCA stroke?
``` Vertigo Coma Nausea, vomiting Hemiparesis & sensory loss Visual field defects ```
29
What are the different stroke classifications?
TACS PACS LACS POCS
30
What is the most effective stroke treatment in first 3 hrs?
Thrombolytic therapy (TPA)
31
What type of treatment can be used in large vessel occlusions?
Thrombectomy (clot retrieval)
32
Who are the different people present on a stoke unit?
``` Stroke nurse Physio OT Speech & language therapist Dietician Psychologist ```
33
What are the strict criteria for TPA use?
< 4.5 hrs onset of symptoms Have to show disabling neulogical deficits Symptoms > 1hr
34
What may prevent the use of TPA?
Any signs of haemorrhagic/ bleeding tendency
35
For what stroke types can TPA be used?
Ischaemic
36
What investigations may you do in stroke patient?
Bloods (FBC, Glucose, lipids) CT or MRI head scan ECG Anterior circular - carotid doppler US scan Echocardiogram Cerebral angiogram
37
What treatment may be given to someone following TIA to prevent stroke?
Antihypertensives Antiplatelets Statins Endarterectomy
38
What are the differentials for a stroke?
``` Hypoglycaemia Post-ictal state Intracranial mass Vestibular disease Migraine Demented patient with UTI Bell's palsy ```
39
What preventative drugs would be given after?
Anti-hypertensives Anti-platelets Statins (Anti-coagulate in AF)
40
What does ischaemia mean?
Lack of blood flow
41
What does hypoxia mean?
Lack of oxygen
42
The interruption of blood flow to the brain can be defined by Virchows triad whats this?
Vessel wall Change in blood flow Change in blood constituents
43
What are the 3 main causes of localised interrupted blood flow?
Atheroma + thrombosis Thromboembolism Aneurysm
44
If thrombus is present in ICA, which cerebral artery will be affected?
MCA
45
Where will a thromboembolism usually originate?
Left atrium in those with AF
46
What arteries will it move through until it reaches the brain?
Left atrium > Common carotid artery > ICA > MCA
47
If rupture of cerebral artery occurs, what will be observed?
Haemorrhage | Distal ischaemia
48
Where are the 2 most common sites of haemorrhagic stroke?
``` Basal ganglia (microaneurysms) Circle of Willis (berry aneurysms) ```
49
What are 3 examples of brain injury caused by generalised interrupted blood flow?
Hypotension Cardiac arrest Complex case
50
When will Watershed infarcts present?
When there is poor perfusion with oxygenated blood
51
What are Watershed infarcts?
Areas of ischaemias that are present at the zonal territory of arterial supply
52
What will hypotension at the brain result in?
Watershed infarcts
53
What will cardiac arrest result in?
Cortical infarcts
54
What will complex cases result in?
Complex infarction pattern

Neurology (16 decks)

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