Stroke Flashcards
What 4 things are required in the description of a stroke?
- Type of stroke
- Size of stroke
- Laterality of stroke
- Cause of stroke
How are strokes classified?
Posterior circulation infarction (POCI)
Lacunar circulation infarct (LACI)
Total anterior circulation infarct (TACI)
Partial anterior circulation infarct (PACI)
Where are lacunar infarcts most likely to occur?
Basal Ganglia
or thalamus / white matter
What type of stroke causes the least number of deaths after 1 year?
Lacunar infarcts
LACI
What stroke has the worst outcome after 1 year?
Total anterior circulation infarcts (TACI)
What symptoms are seen in a TACI?
- Hemiplegia (At least 2 of face, arm and leg)
+/- hemisensory loss - Homonymous Hemianopia
- Cortical signs (dysphasia, neglect etc)
What symptoms indicate a partial anterior circulation stroke (PACI)?
2/3 features of TACI:
- Hemiplegia
- Homonomous hemianopia
- Focal Cortical sign (dysphagia etc)
motor/sensory symptoms not as severe as TACI
How do lacunar infarcts show symptoms?
Only occlude one deep penetrating vessel => symptoms usually affect 2 of: - face - arm - leg
What variety of symptoms can be caused by posterior circulation infarcts (POCI)?
- Cranial nerve palsies
- Bilateral motor and/or sensory deficits
- Eye movement disorders
- homonymous hemianopia
- Cortical blindness
- Cerebellar deficits => balance, ataxia
Why is laterality of stroke important?
If it occurs in the dominant hemisphere, speech and language can become affected
If occurs in non-dominant, then spatial awareness is affected
Where can clots originate to cause infarctions?
- atherothromboembolic (carotids/ larger vessels)
- cardioembolic (AF)
- Small vessel disease (clot forms in small vessel itself)
Describe the difference in appearance and treatment of clots which have formed in the carotids compared to cardioembolic clots.
Carotid/atherothromboembolic = white and platelet rich => Tx = antiplatelets
Cardioembolic = red and protein rich
=> Tx = anticoagulants
What investigations can be used to visualise atherothromboembolic disease in the carotid?
Ultrasound (doppler)
CT/MRI angiogram (often more visible)
What are the possible contributors to small vessel disease?
- Ateriosclerotic (Age/risk factor related)
- Genetic - related to cerebral amyloid angiopathy
- Inflammatory/ immunologically mediated (e.g. eosinophilic granulomatosis/ granulomatosis with polyangitis)
What signs on MRI indicate small vessel disease?
White matter hyperintensities
Previous lacunes
Microbleeds
How large is a risk of stroke in those with AF compared to the normal population?
AF patients 5x more likely to have stroke
especially if they have atrial appendage as this is where clot is formed
What heart defect can also predispose to stroke?
Patent foramen ovale
venous clots can cross to arterial side of heart
How is a patent foramen ovale treated?
Clopidogrel
OR if younger - surgery to close
What causes a Primary intracerebral haemorrhage vs a Secondary intracerebral haemorrhage?
Primary = Hypertension, amyloid angiopathy
Secondary = Arteriovenous malformation, Aneurysm, Tumour
What cause of primary intracerebral haemorrhage is more likely to be lobar than deep?
Amyloid angiopathy more likely lobar
Hypertension = deep
What is meant by Early haematoma expansion?
Continued arterial bleeding into perilesional tissue
causes oedema around the original area
What is the ABCD of stroke prevention?
- Antithrombotic/Antiplatelet/Anticoagulant Therapy
- Blood Pressure
- Cholesterol
- Diabetes
- Don’t Smoke
What score is used to predict AF patients risk of a further stroke?
CHADVASC score
Score of >2 = indication for anticoagulation
What gender is more prone to stroke if they have AF?
Females
What scoring system is used to estimate patients risk of bleeding, and what else is it used for?
HASBLED score
- allows you to fix reversible causes of bleeding
e. g. hypertension or INR
What statin is usually started after a stroke?
High dose atorvastatin
(eventually reduced)
**beware of giving in haemorrhagic stroke as low cholesterol could be a cause of this type)
What is an endarterectomy?
Removal of material to correct stenosis in the common carotid artery or internal carotid artery
How long after a stroke is endarterectomy no longer of benefit?
2 weeks
Why is there a risk of stroke during endarterectomy?
Easy for bits of material to break off and travel up carotids during surgery
How should dysphagia after a stroke be managed?
- Initial swallow screen
- If abnormal - assessment by speech and language
- NG tube placement OR textured diet/thickened fluids
