Stroke Flashcards
how can type of stroke be determined?
only by imaging
how can size of stroke be determined?
oxford stroke classification scale
divides stroke into 4 syndromes
total anterior circulation syndrome features?
big stroke affecting most of anterior circulation
all 3 of
- hemiplegia in 2 of face, arm and leg +/- hemisensory loss
- homonymous hemianopia
- cortical signs (dysphasia, neglect etc)
most severe stroke
60% dead at 1 year
PACS features?
2 of 3 of:
- isolated cortical dysfunction such as dysphasia
- pure motor/sensory signs less severe than lacunar syndromes (e.g monoparesis)
lacunar syndrome features?
small stroke
hemiplegia but no cortical loss
small infarcts in deeper parts of the brain (ganglia, thalamus etc)
caused by occlusion of single deep penetrating artery
affects 2 of face, arm and leg
best prognosis
assoc with cardio risk factors
POCS features?
areas supplied by posterior circulation cranial nerve palsies bilateral motor and/or sensory deficits conjugate eye movement disorders isolated homonymous hemianopia cortical blindness cerebellar deficits without ipsilateral motor/sensory signs (in contrast to ataxic hemiparetic lacunar syndrome) can cause locked in syndrome
function of right side of brain?
left side of body creativity music spatial orientation artistic awareness
function of left side of brain?
right side of body spoken language written language reasoning number skills
dominant hemisphere (left) cortical events often affect what?
language
non-dominant hemisphere (right) cortical events often affect what?
spatial awareness
can cause neglect syndrome
main causes of ischaemic cerebrovascular disease?
atheroembolism - usually carotid (50%)
intracranial small vessel disease (25%)
cardiac source of embolism (20%)
other (5%)
atheroembolism vs cardiac embolism treatment??
antiplatelets (stops platelet cascade which is causing the problem)
anticoagulation
type 1 small vessel disease?
arteriosclerotic (age/risk factor related)
- fibrinoid necrosis
- lipohyalinosis
- microatheroma
- microaneurysm
type 2 small vessel disease?
sporadic and hereditary amyloid angiopathy
type 3 small vessel disease?
genetic small vessel disease distinct from cerebral amyloid angiopathy
small lacunar infarctions
cognitive impairment at younger age
no real treatment
type 4 small vessel disease?
inflammatory and immunologically mediated
e.g - vasculitis
type 5 small vessel disease?
venous collgenosis
type 6 small vessel disease?
other small vessel disease
e.g - post radiation angiopathy
what usually causes cardioembolic related ischaemic stroke?
AF (increases risk 5X)
other causes also (prosthetic valves, MI, thrombus etc)
PFO?
patent foramen ovale
(between atria)
allows venous clots to pass into arterial chambers of heart which are then pumped out causing a stroke
arterial dissection?
tear in arterial wall
exposes collagen etc in wall initiating the clotting cascade etc
can occur due to hypertension or artery disease
can occur in sudden turning of head (swimming, driving etc)
management of arterial dissection?
antiplatelets
anticoagulation
rescan after 6 months
2 groups of haemorrhagic stroke?
primary intracerebral haemorrhage - hypertension - amyloid angiopathy secondary - AVM - aneurysm - tumour - etc
amyloid vs hypertensive bleed?
amyloid = peripheral hypertensive = centrally
describe expansion of early haematoma?
continued arterial bleeding
secondary bleeding into perilesional tissue
subsequent perilesional oedema
ABCD of stroke prevention?
antithrombotic therapy BP control cholesterol control diabetes control don't smoke
what score is used for stroke risk in AF?
CHA2DS2VASc score - CHF - hypertension - age >75 (worth 2) - diabetes - stroke/TIA/thromboembolism (worth 2) - vascular disease - 65-74 yrs old - female 2+ = antiplatelet/anticoagulation
what score for bleeding risk?
HAS-BLED - hypertension - abnormal renal/liver function (1 each) - stroke - bleeding - liable INRs - elderly - drugs or alcohol don't give aspirin or warfarin if significant bleeding risk
is aspirin used in stroke?
no
increases bleeding risk and doesn’t reduce stroke risk enough to make it worth it
use anticoagulation instead
what are the effects of reducing cholesterol?
low cholesterol = increased haemorrhagic stroke risk but reduced overall stroke risk
what surgery can be done for severe arterial disease?
carotid endarterectomy
number needed to treat for carotid endarterectomy to prevent 1 stroke 2 years post op?
6
management of small vessel disease?
manage risk factors
how is dysphagia managed?
initial swallow screen by nurse
if abnormal > assessment by speech and language therapist
may need NG tube placement or textured diet and thickened fluids depending on swallow
risks of dysphagia after stroke?
aspiration - pneumonia
malnutrition
dehydration
cant take medication
