Stroke Flashcards
What are the three main types of stroke?
Ischaemic stroke
Intracerebral haemorrhage
Subarachnoid haemorrhage
What are the signs of right brain large vessel ischaemic stroke?
Right gaze preference
Neglect
What are the signs of left brain large vessel ischaemic stroke?
Left gaze preference
Aphasia
Describe the clinical signs of middle cerebral artery ischaemic stroke?
More arm weakness than leg weakness
If in the left MCA then aphasia
If in right MCA then neglect, topographical difficulty, apraxia, constructional impairment and anosognosia
Describe the clinical signs of anterior cerebral artery ischaemic stroke?
More leg weakness than arm weakness with a poor grasp
Muteness, perseveration and abulia
Describe the clinical signs of posterior cerebral artery ischaemic stroke?
Hemianopia, memory loos/confusion, Alexia
Describe brocca’s aphasia
Non-fluent speech but with comprehension of language
Where is brocca’s area situated?
Left posterior inferior frontal gyrus
Describe Wernicke’s aphasia
Fluent speech but no comprehension of language
Where is Wernicke’s aphasia?
Posterior part of the superior temporal gyrus on dominant (usually left) side
What are the risk factors for small vessel ischaemic stroke?
Hypertension Hyperlipidaemia Diabetes mellitus Tobacco use Sleep apnoea
Brainstem ischaemic stroke usually results in a combination of cranial nerve abnormalities and crossed motor/sensory findings. These can include…?
Double vision Facial numbness and/or weakness Slurred speech Difficulty swallowing Ataxia Vertigo Nausea and vomiting Hoarseness
What are the possible causes of intracerebral haemorrhage?
Hypertension Aneurysm AV malformation Bleeding into tumour Hypocagulable state Haemorrhagic ifnarction Iatrogenic Other
Where in the brain does hypertensive intracerebral haemorrhage typically occur?
Basal ganglia
Cerebellum
Pons
Describe the presentation of hypertension intracerebral haemorrhage
Abrupt onset of symptoms with acute decompensation and smooth progression. Typically patient is awake and often stressed
What symptoms commonly occur in cerebellar haemorrhage?
Vomiting Ataxia Eye deviation toward opposite side of the bleed Small sluggish pupils Altered mental status
Describe the clinical features of a pontine haemorrhage
Pin point but reactive pupils
Abrupt onset of coma
Decerbate. posturing or flaccidity
Ataxic breathing pattern
What investigation is most commonly used to diagnose a stroke?
Non-contrast CT
A GCS score of what level requires intubation?
8 or less
Why are stroke patients labelled nil by mouth until a swallow assessment is completed?
These patients have a high aspiration risk
How soon after the onset of symptoms of ischaemic stroke should tissue plasminogen activator be administered?
4.5 hours
What are the contraindications to the use of tissue plasminogen activator in stroke?
Haemorrhage Systolic BP >185 or diastolic >110 Recent surgery/trauma/stroke Coagulopathy Seizure at onset of symptoms Age Glucose <2.2 NIHSS score of >21
What anticoagulation should be used in patients with a high risk TIA or minor ischaemic stroke?
Dual anti platelet therapy for 10-21 days
What anticoagulation should be used in patients with a low risk TIA or other ischaemic stroke?
300mg OD aspirin until discharge then clopidogrel thereafter
What anticoagulation should be used in patients with an ischaemic stroke or TIA and AF?
NOAC or warfarin
The size of infarction in ischaemic stroke increases with hypoglycaemia. T/F?
True
Hyperglycaemia is an independent risk factor for haemorrhage when stroke is treated with tPA. T/F?
True
When should antihypertensives be considered in the treatment of intracerebral haemorrhage?
Systolic bp >150
When should antihypertensives be considered in the treatment of ischaemic stroke?
Systolic BP 180-200
