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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Define stroke

A

Clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24hrs or leading to death with no apparent cause other than a vascular origion (WH)

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2
Q

What is the prevalence of stroke?

A
  1. More than 100,000 strokes in the UK per year

2. 4th biggest killer in UK, 2nd in world

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3
Q

Are strokes more prevalent in men or women?

A

1 in 6 men

1 in 5 women

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4
Q

What is the average age for strokes?

A

72 for men, 78 for women

Most likely to have a stroke after 55, but 1/4 happen to people of working age

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5
Q

Describe ischaemic strokes (3)

A
  1. Clots form in brain’s blood vessels and block flow to brain cells
  2. Occur in a brain artery or small blood vessel deep in brain
  3. Account for 80% of strokes
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6
Q

Give the classifications and percentages of ischaemic strokes (4)

A
  1. Large vessel disease 50%
  2. Small vessel disease 30%
  3. Cardioembolic 20%
  4. Cryptogenic/rarities 5%
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7
Q

Describe haemorrhagic stroke (3)

A
  1. Blood vessel in the brain breaks/ruptures
  2. Blood seeps into brain tissue causing brain cell damage
  3. 20% of strokes
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8
Q

What is the most severe type of stroke?

A

Haemorrhagic

Generally associated with a considerably higher risk of dying within the first 3 months

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9
Q

What are 2 types of haemorrhagic stroke?

A 
Primary intracerebral haemorrhage (bleeding from blood vessel inside brian)
Subarachnoid haemorrhage (bleeding from blood vessel into he subarachnoid space)
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10
Q

What are 2 causes of haemorrhagic strokes?

A
  1. High blood pressure

2. Brain aneurysms (weakness or thinness in blood vessel)

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11
Q

What causes arterial ischaemic stroke?

A
  1. Atheroma (affects mainly large and medium sizes arteries)
    (Blood clot blocks flow of blood and oxygen when they form here)
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12
Q

What is atheroma?

A
  1. Degeneration of the artery walls caused by fatty deposits and scar tissue
  2. Leads to restriction of the circulation and a risk of thrombosis
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13
Q

What are 6 causes of atheroma/narrowing of the arteries?

A
  1. Smoking
  2. High blood pressure
  3. Obesity
  4. High cholesterol levels
  5. Diabetes
  6. Excessive alcohol intake
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14
Q

What are 5 risk factors of high blood pressure?

A
  1. Being overweight or obese
  2. Excessive alcohol intake
  3. Smoking
  4. Lack of exercise
  5. Stress
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15
Q

What are 7 non-modifiable risk factors of stroke?

A
  1. Age
  2. Ethnicity
  3. Gender
  4. Family history of heart disease
  5. PFO (hole in heart)
  6. Diabetes (type 1)
  7. Atrial fibrillation
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16
Q

What is atrial fibrillation?

A

Irregular and abnormally fast heart rate

17
Q

What is the FAST acronym?

A

Face
Arms
Speech
Time (act quickly)

18
Q

Describe F of FAST acronym

A

Face may droop to one side and may not be able to smile

19
Q

Describe A of FAST acronym

A

May not be able to lift both arms because of weakness or numbness in one arm

20
Q

Describe S of FAST acronym

A

Speech may be slurred and problems in understanding

21
Q

What are 8 other symptoms of stroke?

A
  1. Complete paralysis on one side of body
  2. Sudden loss or blurry vision
  3. Dizziness
  4. Confusion
  5. Problems with balance/co-ordination
  6. Dysphagia
  7. Severe headache
  8. Loss of consciousness
22
Q

What are the symptoms of a stroke in the dominant hemisphere?

A

Language dysfunction: expressive aphasia, receptive aphasia, dyslexia and dysgraphia

23
Q

What are the symptoms of a stroke in the non-dominant hemisphere?

A
  1. Anosognosia: neglect of paralysed limb, denial of weakness
  2. Visuo-spatial dysfunction: geographical aphasia, dressing apraxia, constructional apraxia
24
Q

What are the symptoms of a stroke in either hemisphere?

A
  1. Hemiparesis
  2. Hemisensory loss
  3. Visual field neglect
25
Q

What investigations are used to diagnose stroke?

A
  1. Blood tests
  2. CT head or MRI brain scan
    Heart and blood vessel tests:
  3. ECG (echocardiogram)
  4. Carotid ultrasound
26
Q

What is the prognosis of stoke?

A
  1. 30 day case fatality: 20%
27
Q

Give the percentages for the symptoms which may remain at 6 months

A 
Hemiparesis 50%
Cognitive deficit 50%
Hemianopia 20%
Aphasia 20%
Sensory deficits 20%
28
Q

What are the 2 strongest predictors of outcome in stroke?

A
  1. Severity (degree of neurologic impairment and size/location of infarction)
  2. Patient age
29
Q

What 2 factors can improve outcome?

A
  1. Opening up blocked vessel early

2. MDT care on a dedicated stroke unit

30
Q

Give 5 interventions for ischaemic strokes

A
  1. Thrombolysis
  2. Thrombectomy
  3. Carotid intervention
  4. Cholestoral lowering
  5. Long-term blood pressure lowering
31
Q

What is thrombolysis? (3)

A
  1. Injecting alteplase to dissolve blood clots and restore blood flow to the brain
  2. As soon as possible after stroke - not recommended if more than 4.5 hours have passed
  3. Only used in ischaemic, can worsen haemorrhagic
32
Q

What is thrombectomy? (3)

A
  1. Emergency treatment used for a small proportion of ischaemic stroke
  2. Inserting catheter into large artery in brain to remove clot through suction
  3. Most effective ASAP
33
Q

What is carotid intervention?

A

Unblocking the carotid artery in the neck if ischaemic stroke is caused by narrowing of this artery

34
Q

How is cholesterol lowered? (5)

A
  1. Using statins (medicine) to reduce future vascular events
  2. Lower plasma LDL cholesterol
  3. Inhibit cholesterol production in the liver
  4. Stabilise atherosclerotic plaques
  5. Have anti-inflammatory properties
35
Q

How is blood pressure lowered in the long-term at discharge?

A
  1. Antihypertensives such as ACE inhibitors, thiazide diuretics, calcium channel blockers
36
Q

What are 3 interventions for haemorrhagic stroke?

A
  1. Medication to lower blood pressure and prevent future strokes
  2. Surgery (craniotomy)
  3. Surgery for hydrocephalus
37
Q

What does surgery involve in haemorrhagic strokes?

A
  1. Craniotomy involves removing blood from the brain and repairing burst blood vessels
  2. Surgery for hydrocephalus (complication) involves using a shunt to drain CSF from the ventricles of the brain

Neurology (17 decks)

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