Stroke Flashcards

1
Q

What is the difference between a stroke and a TIA?

A

Stroke >24 hours

TIA <24hours

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2
Q

Describe how atherosclerosis causes stroke

A

Thrombus forms on arterial atherosclerotic plaque in intracranial or internal carotid artery
Grows until artery is occluded or a piece can break off and block an artery downstream

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3
Q

Describe how cardioembolism causes stroke

A

Acute clots forms in the heart due to a change in blood flow (MI, AF, valve disease etc)
These embolise to cerebral arteries

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4
Q

Describe the pathology of a non-atheromatous stroke?

A

Thrombus in arteries developed through vasculitis or aortic dissection

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5
Q

How does small vessel occlusion occur?

A

Thrombosis in small arteries damaged by longstanding hypertension

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6
Q

Subarachnoid haemorrhage usually occurs as a result of….

A

Ruptured Berry aneurysm

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7
Q

What are the 3 criteria for TACS?

A

Contralateral motor or sensory deficit
Visual field defect
Higher cortical dysfunction

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8
Q

What are the criteria for PACS?

A

Two of:
Contralateral motor or sensory deficit
Visual field defects
Higher cortical dysfunction

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9
Q

Which areas does a lacunar stroke affect?

A

Thalamus, basal ganglia and internal capsule

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10
Q

How does lacunar stroke present?

A
Pure motor deficit 
OR
Pure sensory 
OR
Ataxic hemiparesis 
WITHOUT
Higher cortical dysfunction or POCS symptoms
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11
Q

What are the criteria for POCS?

A
Any of: 
Isolated hemianopia
Bilateral motor and sensory deficit 
CN deficits
Cerebellar symptoms
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12
Q

How does a stroke in the dominant hemisphere present?

A

Patient with insight
Difficulty reading and writing
Aphasia

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13
Q

How does a stroke in the non-dominant hemisphere present?

A

Patient without insight
Neglect and spatial disorientation
Apraxia

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14
Q

How does an infarct in the anterior cerebral artery present?

A

Contralateral lower limb motor and sensory deficit
Urinary incontinence
Behaviour change and disinhibition

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15
Q

How does an MCA infarct present?

A

Contralateral motor and sensory deficit usually in upper limb
Higher cortical dysfunction
Contralateral hemianopia

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16
Q

How does a vertebral artery infarct present?

A

Unilateral occlusion usually compensated for.

If not, presents like a basilar stroke

17
Q

How does a basilar artery stroke present?

A

Coma
Bilateral motor and sensory
Cerebellar signs
CN deficits

18
Q

How does a posterior inferior cerebellar artery stroke present?

A

Contralateral loss of pain and temperature
Ipsilateral loss of pain and temp in face
Vertigo
(D)ANISH

19
Q

How does a posterior cerebellar artery stroke present?

A

Cortical - visual and memory disturbance
Thalamus - chorea, hemiballismus
Midbrain - gaze palsies, pupillary abnormalities and decreased GCS

20
Q

How is an ischaemic stroke investigated?

A
Urgent CT
MRI 
Echo
Angio
Carotid imaging
21
Q

How is a haemorrhagic stroke investigated?

A

Urgent CT
MRI 6-8 weeks post-stroke
Vasculitis and thrombophilia screen

22
Q

How is ischaemic stroke acutely managed?

A

Thrombolysis - IV recombinant tissue plasminogen
Aspirin 300mg
Swallow assessment

23
Q

How is ischaemic stroke not caused by AF managed long term?

A

300mg aspirin for 2 weeks then clopidogrel 75mg

24
Q

How is a cardioembolic ischaemic stroke managed long term?

A

Started on anti-coagulants replaced after 2 weeks with Warfarin therapy

25
Q

Give 3 examples of contra-indications to thrombolysis

A
Over > 3.5 hours
Seizure since onset
CPR
Surgery in last 3 weeks
Pregnancy/recent delivery
Active bleeding
Current anticoag use
HTN >220/130mmHg
Major infarct
26
Q

In which scenarios may surgery be preferred to medication in the treatment of ischaemic stroke?

A

Posterior cerebellar infarction

Malignant MCA infarction

27
Q

How are haemorrhagic strokes managed?

A

Stop any anticoag/platelet therapy

Endovascular clip, stenting or coiling

28
Q

What is the ABCDD criteria for having a stroke after a TIA?

A

Age >= 60
BP >=140/90
Clinical features - weakness or speech (+2 or + 1)
Duration >= 60 mins or 10-59mins (+2 or +1)
Diabetes