Stroke Flashcards
what are the types of stroke
haemorrhage:
- structural abnormality
- hypertensive
- amyliod angiopathy
subarachnoid haemorrhage
infarct:
- cardioembolic
- small vessel
- atheroembolic
- other
what scan to work out type of stroke
CT (sees if bleed or infarct)
what are the features of a posterior circulatory infacrt
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
overall 1 year independence 60%
what are the features of a lacunar syndrome
pure motor or sensory deficit affecting two or three of face, arm, leg
or sensorimotor stroke (basal ganglia and internal capsule)
affects down one side but no cortical loss
what are the features of total anterior circulation infarct
(contains all three of)
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)
what type of infarct stroke has the worst prognosis
total anterior circulatory infarction
what are the features of a partial anterior circulatory syndrome
2 out of 3 features present in a TACS or;
Isolated Cortical Dysfunction such as dysphasia or;
Pure motor/sensory signs less severe than in lacunar syndromes (eg monoparesis).
which has the best prognosis of all the strokes
lacunar syndrome
what is lacunar syndrome
Lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem.
Caused by occlusion of a single deep penetrating artery. Affect 2 any two of face arm and leg
what is lacunar syndrome associated with
hptx
smoking
cholesterol
what does a stroke on the right side of the brain affect
creativity spatial orientation artistic awareness music left side of body
what does a stroke on the left side of the brain affect
right side of body spoken language reasoning number skills written language
which side of the brain is dominant in most people
left
what is the most common cause of ischaemic cerebrovascular disease
- atheroembolism
- intracranial small vessel disease
- cardiac source of embolism
- rare causes- thrombophillia, haemological disorders, genetic disorders
what are the most common types of haemorrhage in the brain
- ischaemic stroke
- primary intracerebral haemorrhage
- subarachnoid haemorrhage
what is a white plaque and how do you treat it
activated platelets (atherosclosis) antiplatelets (aspirin, clopidogrel)
what is a red clot and how do you treat it
clotting protein, cardioembolic (e.g. AF)
anticoagulants (heparins, doacs)
what investigations to look for vascular disease
USS, CT, MR angiography
what are the types of small vessel disease
- ateriosclerotic (age/ risk factor related, most common)
- fibrinoid necrosis
- lipohyalinosis
- microatheroma
- microaneurysm - sporadic and hereditary cerebral amyloid angiopathy
- genetic (not amyloid)
- CADASIL - inflammatory and immunologically mediated
- churg strauss, wegeners - venous collagenosis
- other
- post radiation
what can small vessel disease cause in the brain
dementia
what is leukoaraiosis
white matter disease (will show patchy white shadows around ventricles on CT)
what are the most common causes of cardioembolic strokes
AF acute MI ventricular thrombosis rheumatic heart disease prosthetic valves
is AF a big risk from strokes
yes increases 6xs
i in 6 strokes caused by AF
when do venous clots cause stroke
when there is a patent foramen ovale
what can prevent further risk of stroke in PFO
clopidogrel
surgery to close hole (only if fit and young)
how does arterial dissection cause stroke
tear in arterial wall exposes collagen clotting cascade embolises stroke
what can cause an arterial dissection
hptx
vertebral artery dissection (twisting neck)
what is the tx for arterial dissection
antiplatelets / anticoagulation (both effective)
do scan and if vessel healed can stop antithrombotics
what are the causes of primary intracranial haemorrhage
hptx amyloid angiopathy (deposition creates fragile vessels)
what are the causes of secondary intracerebral haemorrhage
AVM
aneurysm
tumour
etc
what is the main treatment for primary intracerebral haemorrhage
strict BP control
where in brain do the different types of primary intracerebral haemorrhage affect
lobar/ peripheral = amyloid angiopathy
deep/ central = BP (internal capsule, basal ganglia)
what is the result of early ICH hematoma expansion
Continued arterial bleeding
Secondary bleeding into perilesional tissue
Subsequent perilesional oedema
(mass effects of bleed and oedema damage brain)
what do you need to include in the diagnosis of a stroke
type
size
laterality
cause
what is the ABCDD of stroke prevention
Antithrombotic Therapy -Antiplatelet Therapy -Anticoagulant therapy Blood Pressure Cholesterol Diabetes Don’t Smoke
what does the CHA2DS2VASc score tell you
risk of getting stroke in patients with AF
2 or more needs anticoagulation
what is the HAS-BLED score
identifies reversible risks of a bleed to make it safer for patients to anticoagulated
should you give aspirin or warfarin
aspirin not as affect and just as high risk of a bleed
how many falls outweight the benefit of anticoagulation
300 times per year
what do you treat cardioembolic stroke with
NOT ASPIRIN
use oral anticoagulant
what drug can be used to protect against recurrent strokes
perindopril
what is low cholesterol associated with
haemorrhagic strokes
what surgery can be used to prevent further strokes
carotid endarterectomy (need to treat in 2 weeks after stroke) depends on patient and surgical centre expertise
how is dysphagia managed
swallow screen
assessment by s+t therapist if abnormal
may need NG tube/ textured diet and thickened fluids
assess nutrition and hydration
might need medications they dont need to swallow
