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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the different types of haemorrhagic stroke?

A

Structural abnormality
Hypertensive
Amyloid angiopathy

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2
Q

What are the different types of infarct stroke?

A

Cardioembolic
Small vessel
Atheroembolic

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3
Q

What are the features of a POCI?

A 
CN deficit with contralateral hemiparesis or sensory deficit
OR 
Bilateral stroke
OR
Disorders of conjugate eye movement
OR
Isolated cerebellar stroke
OR
Isolated homonymous hemianopia
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4
Q

What are the features of a TACI?

A

NEED ALL 3:
New higher cerebral function dysfunction: dysphasia, dyscalculia, apraxia, neglect, visuospatial problems
Homonymous visual field defect
Ipsilateral motor and/ or sensory deficit of at least two areas of face, arm and leg

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5
Q

What are the features of a PACI?

A

Two of 3 components of TACI
OR
Isolated dysphasia or other cortical dysfunction
OR motor/ sensory loss more limited than for a LACI

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6
Q

What are the features of a LACI?

A

Pure motor OR pure sensory deficit affecting two of face, arm and leg
Sensorimotor stroke (basal ganglia and internal capsule)
Ataxic hemiparesis (cerebellar type ataxia with ipsilateral pyramidal signs; internal capsule or pons)
OR
Dysarthria plus clumsy hand
OR
Acute onset movement disorders (hemichorea, hemiballismus; basal ganglia)

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7
Q

Which stroke has the worst outcomes?

A

TACI; total anterior circulation infarction

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8
Q

What are lacunar strokes associated with?

A

Hypertx
Diabetes
Smoking etc

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9
Q

What does the left side of the brain control?

A 
Motor and sensory of right side
Language centers
Reasoning 
Written language
Number skills
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10
Q

What does the right hemisphere control?

A 
Motor and sensory of left body
Creativity
Music
Artistic awareness
Spatial awareness; neglect syndrome
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11
Q

What is the 1st line investigation in carotid disease?

A

USS for narrowing

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12
Q

What should be done if narrowing of the carotid vessels is seen on USS?

A

CTA or MRA

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13
Q

What is the threshold of narrowing for referral for carotid endarterectomy?

A

50-99%

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14
Q

What is type 1 small vessel disease?

A 
Arteriosclerotic; 
Fibrinoid necrosis
Liophylaniosis
Microatheroma
Microaneurysm
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15
Q

What is type 2 small vessel disease?

A

Sporadic and hereditary cerebral amyloid angiopathy

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16
Q

What is type 3 small vessel disease?

A

Genetic small vessel disease; CADASIL

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17
Q

What is type 4 small vessel disease?

A

Inflammatory and immunologically mediated:

eGPA, GPA

18
Q

What is type 5 small vessel disease?

A

Venous collagenosis

19
Q

What is type 6 small vessel disease?

A

Post radiation angiopathy

20
Q

What are the MRI expressions of small vessel disease?

A

White matter hyperintensities
Microbleeds
Leukoaraiosis

21
Q

What conditions result in cardioembolic strokes?

A 
AF; 50% 
Acute MI
Prosthetic valves
Ventricular thrombus
Rheumatic heart disease
22
Q

Why can PFO result in a stroke?

A

Due to patent foramen ovale; venous clots can pass from the venous to arterial side and travel up to the brain

23
Q

What is the treatment for PFO?

A

If it causes a stroke in a younger patient; surgical closure and clopidogrel

24
Q

Why can arterial dissection result in a stroke?

A

Exposure of underlying collagen

Clot formation

25
Q

What is the treatment for arterial dissection?

A

Treat like normal stroke
Give antiplatelets OR anticoags
Recan after 6 months to see if abnormality persists; if it does then continue antiplatelets, if it has completely healed with no structural abnormalities then antiplatelets can be stopped

26
Q

What can cause a primary intracerebral haemorrhage?

A

Hypertx

Amyloid angiopathy

27
Q

What can cause a secondary intracerebral haemorrhage?

A

AVM
Aneurysm
Tumour

28
Q

What does a peripheral and lobar haemorrhage suggest?

A

Amyloid angiopathy

29
Q

What does a deep, central haemorrhage suggest?

A

Hypertensive in nature

30
Q

What is early haematoma expansion?

A

Continued arterial bleeding
Secondary bleeding into perilesional tissue
Subsequent perilesional oedema

31
Q

What is a good example of a description of a stroke?

A

Type, size, laterality and cause
E.g.
Right hemispheric, cardioembolic, partial anterior circulation infarction

32
Q

What is the ABCD of medical stroke prevention?

A 
Antithrombotic therapy 
Blood pressure control
Cholesterol control
Diabetes assessment
Don't smoke
33
Q

When will antiplatelets and anticoags be used?

A

Antiplatelets; atherosclerotic or small vessel disease

Anticoag: cardioembolic

34
Q

Which scoring system is used to assess clot risk for patients with AF?

A

CHA2DS2 VASc score

35
Q

What score on CHA2DS2 VASc indicates that anticoagulation should be give?

A

2 or more

36
Q

Which scoring system is used to assess bleeding risk on blood thinners?

A

HAS-BLED

37
Q

What statin should be given to reduce stroke risk?

A

High dose atorvastatin; 80mg

38
Q

Should a statin be given post-haemorrhagic stroke?

A

Need to weigh up pros and cons; slight increase risk of haemorrahgic stroke

39
Q

How is dysphagia managed post-stroke?

A

Initial swallow screen, if abnormal then a formal assessment by a speech and language therapist
May need NG tube placement or textured diet and thickened lfuids

40
Q

How quickly should patients have their swallow assessed post stroke?

A

4 hours of arrival at hospital and before being given any oral food, fluid or medication

41
Q

How quickly should an NG tube be placed?

A

Within 24 hours

42
Q

What are C, D and E textured diets?

A

E; fork mashable dysphagia diet
D; pre-mashed dysphagia diet
C; thick puree dysphagia diet

Neurology (48 decks)

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