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Week A12 - Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

Label the following diagram of the circle of Willis:

A
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2
Q

What are the 3 main types of strokes? [3]

A
  1. Ischemic Stroke
    • clot occluding artery
  2. Intracerebral Haemorrhage
    • bleeding into brain
  3. Subarachnoid Haemorrhage
    • bleeding around brain
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3
Q

How do you determine the location of an ischaemic stroke, between large vessel, small vessel and posterior circulation? [4]

A
  1. Large Vessel:
    • look for cortical signs
  2. Small Vessel:
    • No cortical signs on exam
  3. Posterior Circulation:
    • Crossed signs
    • Cranial nerve findings
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4
Q

What are the cortical signs:

  1. right brain cortical signs? [2]
  2. left brain cortical signs? [2]
A
  1. Right brain cortical signs:
    • right gaze preference
    • neglect
  2. Left brain cortical signs:
    • left gaze preference
    • aphasia
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5
Q

What are the clinical signs of the following large vessel stroke syndromes?

  1. middle cerebral artery? [7]
  2. anterior cerebral artery? [5]
  3. posterior cerebral artery? [4]
  4. cerebellum? [1]
A
  1. Middle Cerebral Artery
    • Arm>leg weakness
    • Left MCA cognitive: Aphasia
    • Right MCA cognitive: Neglect, topographical difficulty, apraxia, constructional impairment, anosognosia
  2. Anterior Cerebral Artery
    • Leg>arm weakness, grasp
    • Cognitive: muteness, perseveration, abulia
  3. Posterior Cerebral Artery
    • Hemianopia
    • Cognitive: memory loss/confusion, alexia
  4. Cerebellum
    • Ipsilateral ataxia
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6
Q

What are the 2 types of aphasia? [2]

A
  1. Broca’s Aphasia
  2. Wernicke’s Aphasia
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7
Q

Describe Broca’s aphasia: what type of defect is it caused by and what are its clinical signs? [4]

A
  1. Defect in the left posterior inferior frontal gyrus
  2. Non fluent, can comprehend
  3. Other symptoms:
    • weak limbs
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8
Q

Describe Wernicke’s aphasia: what type of defect is it caused by and what are its clinical signs? [3]

A
  1. Posterior part of the superior temporal gyrus
    • located on the dominant side (left) of the brain
  2. Fluent, can’t comprehend
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9
Q

What are the risk factors for small vessel stroke? [5]

A
  1. Hypertension
  2. Hypersensitivity lung disease
  3. Diabetes mellitus
  4. Tobacco use
  5. Sleep apnoea
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10
Q

What are the typical clinical findings in brainstem stroke syndromes? [8]

A
  • Usually a combination of cranial nerve abnormalities, and crossed motor/sensory findings such as:
    1. Double vision
    2. Facial numbness and/or weakness
    3. Slurred speech
    4. Difficulty swallowing
    5. Ataxia
    6. Vertigo
    7. Nausea and vomiting
    8. Hoarseness
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11
Q

What are the causes of intracranial haemorrhage? [8]

A
  1. Non-traumatic:
    • Hypertension
    • Aneurysm
    • AV malformation
  2. Other causes:
    • Bleeding into tumour
    • Hypocoagulable state
    • Haemorrhage infarction
    • Iatrogenic
    • Trauma
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12
Q

Describe intracranial haemorrhage under the following headings:

  1. cause? [1]
  2. typical sites? [3]
  3. typical clinical presentation? [3]
A
  1. Caused by spontaneous rupture of a small artery deep in the brain
  2. Typical sites
    • Basal Ganglia
    • Cerebellum
    • Pons
  3. Typical clinical presentation
    • Patient typically awake and often stressed
    • then abrupt onset of symptoms with acute decompensation and smooth progression
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13
Q

What are the signs and symptoms of cerebellar haemorrhage? [5]

A
  1. Vomiting (more common in ICH than SAH or Ischemic CVA)
  2. Ataxia
  3. Eye deviation toward the opposite side of the bleed
  4. Small sluggish pupils
  5. Atypical measles syndrome (AMS)
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14
Q

What are the signs and symptoms of pontine haemorrhage? [4]

A
  1. Pin-point but reactive pupils
  2. Abrupt onset of coma
  3. Decerebrate posturing or flaccidity
  4. Ataxic breathing pattern
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15
Q

What investigations would be used in a patient presenting with suspected stroke and what are each used for? [3]

A
  1. Non-contrast CT scan
    • shows IVH and ICH
  2. CT with contrast
    • may help identify aneurysms, arteriovenous malformation (AVMs), or tumors
  3. MRI
    • superior for showing underlying structural lesions
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16
Q

What are the contraindications to using the “clot buster” tissue plasminogen activator (tPa)? [8]

A
  1. Haemorrhage
  2. SBP> 185 or DBP> 110
  3. Recent surgery, trauma or stroke
  4. Coagulopathy
  5. Seizure at onset of symptoms
  6. NIHSS
  7. Age?
  8. Glucose < 2.2
17
Q

What blood thinning strategies should be used for:

  1. High risk transient ischemic attack (TIA) or minor ischaemic stroke? [1]
  2. Low risk TIA or other ischaemic stroke in SR? [2]
  3. Ischaemic stroke or TIA in AF? [1]
A
  1. DAPT for 10-21 days
  2. Aspirin 300mg od until discharge then clopidogrel
  3. NOAC (or warfarin)
18
Q

What supportive therapy should be given for a patient with a stroke? [2]

A
  1. Glucose Management
  2. Blood pressure management

Week A12 - Neurology (15 decks)

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