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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

what are the types of stroke

A

haemorrhage:

  • structural abnormality
  • hypertensive
  • amyliod angiopathy

subarachnoid haemorrhage

infarct:

  • cardioembolic
  • small vessel
  • atheroembolic
  • other
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2
Q

what scan to work out type of stroke

A

CT (sees if bleed or infarct)

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3
Q

what are the features of a posterior circulatory infacrt

A

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%

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4
Q

what are the features of a lacunar syndrome

A

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

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5
Q

what are the features of total anterior circulation infarct

A

(contains all three of)
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)

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6
Q

what type of infarct stroke has the worst prognosis

A

total anterior circulatory infarction

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7
Q

what are the features of a partial anterior circulatory syndrome

A

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).

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8
Q

which has the best prognosis of all the strokes

A

lacunar syndrome

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9
Q

what is lacunar syndrome

A

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

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10
Q

what is lacunar syndrome associated with

A

hptx
smoking
cholesterol

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11
Q

what does a stroke on the right side of the brain affect

A 
creativity 
spatial orientation
artistic awareness 
music 
left side of body
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12
Q

what does a stroke on the left side of the brain affect

A 
right side of body 
spoken language 
reasoning 
number skills 
written language
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13
Q

which side of the brain is dominant in most people

A

left

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14
Q

what is the most common cause of ischaemic cerebrovascular disease

A
  1. atheroembolism
  2. intracranial small vessel disease
  3. cardiac source of embolism
  4. rare causes- thrombophillia, haemological disorders, genetic disorders
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15
Q

what are the most common types of haemorrhage in the brain

A
  1. ischaemic stroke
  2. primary intracerebral haemorrhage
  3. subarachnoid haemorrhage
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16
Q

what is a white plaque and how do you treat it

A 
activated platelets (atherosclosis)
antiplatelets (aspirin, clopidogrel)
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17
Q

what is a red clot and how do you treat it

A

clotting protein, cardioembolic (e.g. AF)

anticoagulants (heparins, doacs)

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18
Q

what investigations to look for vascular disease

A

USS, CT, MR angiography

19
Q

what are the types of small vessel disease

A
  1. ateriosclerotic (age/ risk factor related, most common)
    - fibrinoid necrosis
    - lipohyalinosis
    - microatheroma
    - microaneurysm
  2. sporadic and hereditary cerebral amyloid angiopathy
  3. genetic (not amyloid)
    - CADASIL
  4. inflammatory and immunologically mediated
    - churg strauss, wegeners
  5. venous collagenosis
  6. other
    - post radiation
20
Q

what can small vessel disease cause in the brain

A

dementia

21
Q

what is leukoaraiosis

A

white matter disease (will show patchy white shadows around ventricles on CT)

22
Q

what are the most common causes of cardioembolic strokes

A 
AF
acute MI 
ventricular thrombosis 
rheumatic heart disease 
prosthetic valves
23
Q

is AF a big risk from strokes

A

yes increases 6xs

i in 6 strokes caused by AF

24
Q

when do venous clots cause stroke

A

when there is a patent foramen ovale

25
Q

what can prevent further risk of stroke in PFO

A

clopidogrel

surgery to close hole (only if fit and young)

26
Q

how does arterial dissection cause stroke

A 
tear in arterial wall 
exposes collagen 
clotting cascade 
embolises 
stroke
27
Q

what can cause an arterial dissection

A

hptx

vertebral artery dissection (twisting neck)

28
Q

what is the tx for arterial dissection

A

antiplatelets / anticoagulation (both effective)

do scan and if vessel healed can stop antithrombotics

29
Q

what are the causes of primary intracranial haemorrhage

A 
hptx 
amyloid angiopathy (deposition creates fragile vessels)
30
Q

what are the causes of secondary intracerebral haemorrhage

A

AVM
aneurysm
tumour
etc

31
Q

what is the main treatment for primary intracerebral haemorrhage

A

strict BP control

32
Q

where in brain do the different types of primary intracerebral haemorrhage affect

A

lobar/ peripheral = amyloid angiopathy

deep/ central = BP (internal capsule, basal ganglia)

33
Q

what is the result of early ICH hematoma expansion

A

Continued arterial bleeding
Secondary bleeding into perilesional tissue
Subsequent perilesional oedema

(mass effects of bleed and oedema damage brain)

34
Q

what do you need to include in the diagnosis of a stroke

A

type
size
laterality
cause

35
Q

what is the ABCDD of stroke prevention

A 
Antithrombotic Therapy
-Antiplatelet Therapy
-Anticoagulant therapy
Blood Pressure
Cholesterol
Diabetes
Don’t Smoke
36
Q

what does the CHA2DS2VASc score tell you

A

risk of getting stroke in patients with AF

2 or more needs anticoagulation

37
Q

what is the HAS-BLED score

A

identifies reversible risks of a bleed to make it safer for patients to anticoagulated

38
Q

should you give aspirin or warfarin

A

aspirin not as affect and just as high risk of a bleed

39
Q

how many falls outweight the benefit of anticoagulation

A

300 times per year

40
Q

what do you treat cardioembolic stroke with

A

NOT ASPIRIN

use oral anticoagulant

41
Q

what drug can be used to protect against recurrent strokes

A

perindopril

42
Q

what is low cholesterol associated with

A

haemorrhagic strokes

43
Q

what surgery can be used to prevent further strokes

A 
carotid endarterectomy (need to treat in 2 weeks after stroke)
depends on patient and surgical centre expertise
44
Q

how is dysphagia managed

A

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

Neurology (35 decks)

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