Stroke Flashcards
What are the different types of haemorrhagic stroke?
Structural abnormality
Hypertensive
Amyloid angiopathy
What are the different types of infarct stroke?
Cardioembolic
Small vessel
Atheroembolic
What are the features of a POCI?
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
What are the features of a TACI?
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
What are the features of a PACI?
Two of 3 components of TACI
OR
Isolated dysphasia or other cortical dysfunction
OR motor/ sensory loss more limited than for a LACI
What are the features of a LACI?
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)
Which stroke has the worst outcomes?
TACI; total anterior circulation infarction
What are lacunar strokes associated with?
Hypertx
Diabetes
Smoking etc
What does the left side of the brain control?
Motor and sensory of right side Language centers Reasoning Written language Number skills
What does the right hemisphere control?
Motor and sensory of left body Creativity Music Artistic awareness Spatial awareness; neglect syndrome
What is the 1st line investigation in carotid disease?
USS for narrowing
What should be done if narrowing of the carotid vessels is seen on USS?
CTA or MRA
What is the threshold of narrowing for referral for carotid endarterectomy?
50-99%
What is type 1 small vessel disease?
Arteriosclerotic; Fibrinoid necrosis Liophylaniosis Microatheroma Microaneurysm
What is type 2 small vessel disease?
Sporadic and hereditary cerebral amyloid angiopathy
What is type 3 small vessel disease?
Genetic small vessel disease; CADASIL
What is type 4 small vessel disease?
Inflammatory and immunologically mediated:
eGPA, GPA
What is type 5 small vessel disease?
Venous collagenosis
What is type 6 small vessel disease?
Post radiation angiopathy
What are the MRI expressions of small vessel disease?
White matter hyperintensities
Microbleeds
Leukoaraiosis
What conditions result in cardioembolic strokes?
AF; 50% Acute MI Prosthetic valves Ventricular thrombus Rheumatic heart disease
Why can PFO result in a stroke?
Due to patent foramen ovale; venous clots can pass from the venous to arterial side and travel up to the brain
What is the treatment for PFO?
If it causes a stroke in a younger patient; surgical closure and clopidogrel
Why can arterial dissection result in a stroke?
Exposure of underlying collagen
Clot formation
What is the treatment for arterial dissection?
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
What can cause a primary intracerebral haemorrhage?
Hypertx
Amyloid angiopathy
What can cause a secondary intracerebral haemorrhage?
AVM
Aneurysm
Tumour
What does a peripheral and lobar haemorrhage suggest?
Amyloid angiopathy
What does a deep, central haemorrhage suggest?
Hypertensive in nature
What is early haematoma expansion?
Continued arterial bleeding
Secondary bleeding into perilesional tissue
Subsequent perilesional oedema
What is a good example of a description of a stroke?
Type, size, laterality and cause
E.g.
Right hemispheric, cardioembolic, partial anterior circulation infarction
What is the ABCD of medical stroke prevention?
Antithrombotic therapy Blood pressure control Cholesterol control Diabetes assessment Don't smoke
When will antiplatelets and anticoags be used?
Antiplatelets; atherosclerotic or small vessel disease
Anticoag: cardioembolic
Which scoring system is used to assess clot risk for patients with AF?
CHA2DS2 VASc score
What score on CHA2DS2 VASc indicates that anticoagulation should be give?
2 or more
Which scoring system is used to assess bleeding risk on blood thinners?
HAS-BLED
What statin should be given to reduce stroke risk?
High dose atorvastatin; 80mg
Should a statin be given post-haemorrhagic stroke?
Need to weigh up pros and cons; slight increase risk of haemorrahgic stroke
How is dysphagia managed post-stroke?
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
How quickly should patients have their swallow assessed post stroke?
4 hours of arrival at hospital and before being given any oral food, fluid or medication
How quickly should an NG tube be placed?
Within 24 hours
What are C, D and E textured diets?
E; fork mashable dysphagia diet
D; pre-mashed dysphagia diet
C; thick puree dysphagia diet
