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neuro > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke signs

A 
Bleeding signs (unreliable: meningism/headache/coma)
Ischaemia signs (carotid bruit/AF/IHD/past TIA)
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2
Q

Lacunar infarct signs

A 
5 syndromes (all conscious unless thalamus involved)
Ataxic hemiparesis/Dysarthria
Pure motor
Pure sensory
Sensorimotor
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3
Q

Stroke acute management

A 
Only BP down if hypertensive emergency as lowering BP may impair cerebral perfusion)
Screen swallow (NBM if not good)

CT/MRI within 1hr if needs thrombolysis/likely to be haemorrhagic
Thrombolysis (alteplase) within 4.5 hrs unless (haemorrhagic/rapidly improving/bleeding risk)
Thrombectomy for large artery occlusion within 6 hrs (or 6-24 if potential to save brain tissue from MRI)

Antiplatelet (aspirin 300mg OD) once haemorrhagic excluded then longer term drug (clopidogrel) after 2 wks

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4
Q

Stroke prevention (1˚)

A

Treat hypertension/DM/hyperlipidaemia
Quit smoking
Exercise
Anti-coagulation in AF + prosthetic heart valves

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5
Q

Stroke prevention (2˚)

A

Control 1˚ RF even if not raised
Clopidogrel monotherapy post-acute stroke treatment or low dose aspirin + slow-release dihydropyridamole (thromboxane A2 inhibitor)

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6
Q

Stroke RFs

A

Hypertension
Thrombocytopaenia/Hyperviscosity

Cardiac emboli (e.g. AF/post-MI)
Carotid a. stenosis

Hypo/hyperglycaemia; dyslipidaemia; hyperhomocysteinaemia

Vasculitis

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7
Q

Stroke post-op rehab points

A

Swallowing with SALT
Reduce further injury e.g. falls/pressure sores
Bladder/bowel remobilisation (without catheter)
Physio + botox for spasticity
Monitor progress e.g. time to sit up in chair
Monitor mood

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8
Q

Functional evaluation system in stroke rehab

A

Barthel’s index of ADLs

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9
Q

TIA signs

A

Specific to artery involved, generally not global signs (e.g. dizziness/syncope)
Short duration and signs resolve e.g. 1 hr

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10
Q

TIA causes

A

Atherothromboembolism
Cardioembolism
Hyperviscosity
Vasculitis

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11
Q

TIA treatment

A

Control CV RFs
Antiplatelet drugs in same way as stroke
Anticoagulation indications e.g. for cardiac emboli
Carotid endarcterectomy within 2 wks if 70% stenosis

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12
Q

TIA emergency referral criteria

A

ABCDD
Age ≥60 - 1
BP ≥140/90 - 1
Clinical features (weakness - 2/speech disturbance alone - 1)
Duration of symptoms (10-59mins - 1, ≥60 - 2)
Diabetes - 1

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13
Q

Subarachnoid haemorrhage signs

A

Thunderclap (typically occipital) headache
Vomiting
Collapse/seizures/coma
Focal neurology at presentation may show site of aneurysm

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14
Q

Subarachnoid haemorrhage causes

A

80% berry aneurysm rupture

Commonly at posterior communicating/internal carotid junction or anterior communicating/anterior cerebral junction

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15
Q

Subarachnoid haemorrhage tests

A

CT (light grey in subarachnoid space)

LP if CT -ve but history suggests SAH, >12h after headache onset CSF xanthochromic due to bilirubin

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16
Q

Subarachnoid haemorrhage management

A

Refer to neurosurgery for endovascular coiling (if accessible) or surgical clipping
CT angiography to identify aneurysm(s)
Re-examine CNS, BP, pupils, GCS often
Hydrate and maintain cerebral perfusion but SBP <160
Nimodipine 60mg/4h for 3wks prevents vasospasm + cerebral ischaemia complications

17
Q

Subarachnoid haemorrhage complications

A

Rebleeding
Cerebral ischaemia due to vasospasm
Hydrocephalus due to arachnoid granulation block, ventricular/lumbar drain needed
Hyponatraemia should not be managed with fluid restriction

18
Q

Unruptured aneurysm when to intervene

A 
Preventative risks outweigh benefits unless:
Young pt
 >7mm diameter
Junction of PCCA + internal carotid
Basilar artery bifurcation
Uncontrolled HT
History of bleeds
19
Q

Most common intracranial venous thromboses

A

Sagittal sinus thrombosis (47%)

Transverse sinus thrombosis (35%)

20
Q

Intracranial venous thrombosis presentation

A

Symptoms over a days/weeks
Depends on sinus affected:
Sagittal has seizures/vision loss
Transverse has headache/mastoid pain
Sigmoid has cerebellar signs
Inferior petrosal shows Vth/VIth cranial n. palsy
Cavernous causes headache/chemosis/proptosis

21
Q

Cortical vein thrombosis pathology

A

Occurs with sinus thrombosis, extends into cortical veins and occludes causing focal pathology including thunderclap headache

22
Q

Intracranial venous thrombosis investigations

A

Exclude SAH + meningitis
Thrombophilia screen

CT/MRI venography may show absence of sinus (although transverse sometime absent anyway)
CT may be normal early but show filling defect at 1wk
MRI T2 weighted may show thrombus directly

LP raised opening pressure, may be normal/RBCs

23
Q

Intracranial venous thrombosis management

A

Anticoag with Heparin/LMWH then warfarin, INR 2-3
Endovascular thrombolysis/thrombectomy if still no improvement
Raised ICP needs decompressive hemicraniectomy to prevent transtentorial herniation (main complication)

24
Q

Subdural haematoma pathology

A

Bleeding from veins between cortex + venous sinuses (vulnerable to deceleration injury)
Haematoma accumulated between dura and arachnoid, ICP raises, midline structures shifted away from clot

25
Q

Subdural haematoma signs

A

Trauma (can be minor, up to 9 mths previous)
More common in elderly as brain atrophy so bridging veins under more stress
Seizures, localised symptoms late after injury
Fluctuating conscious levels

26
Q

Subdural haematoma imaging

A

CT/MRI shows clot ± midline shift, crescent shape over 1 hemisphere

27
Q

Subdural haematoma management

A

Reverse clot abnormalities
>10mm clot or midline shift >5mm needs evacuation via burr hole
Address cause of trauma e.g. frequent falls/alcoholism

28
Q

Extradural haematoma pathology

A

No loss of consciousness after initial drowsiness post injury
Often caused by fractured temporal/parietal bone damaging middle meningeal artery/vein

29
Q

Extradural haematoma clinical features

A

Decreased GCS from rising ICP after lucid interval
Headaches, vomiting, seizures ±hemiparesis with brisk reflexes
Breathing may become deep and irregular if brainstem compressed
Bradycardia + inc BP are late signs

30
Q

Extradural haematoma tests

A

CT shows convex lens shape
Skull Xray may be normal or show fracture lines near middle meningeal vessels
LP contraindicated

31
Q

Extradural haematoma management

A

Stabilise + evacuate clot + ligation of bleeding vessel

Measure ICP often + mannitol IVI

32
Q

Predicting risk for pt with AF

A 
ChadsvaSc
Congestive HF
Hypertension
Age >75 (2)
Diabetes
Stroke/TIA/embolism (2)
Vascular disease
Age 65-74
Sex category female
33
Q

Identifying stroke vs other

A

ROSIER score >0, stroke likely

LOC/syncope yes? (-1)
Seizure activity yes? (-1)
Asymmetrical facial/arm/leg weakness? (+1 for each yes)
Visual field disturbance yes? (+1)
Speech disturbance yes? (+1)
34
Q

Bamford/Oxford ischaemic stroke classification

A

TACS - total anterior circulation stroke
PACS - partial ant circ
LACS - lacunar syndrome
POCS - Posterior circulation syndrome

35
Q

Bamford TACS stroke

A

3 from:

Unilateral weakness of arm/leg/face
Homonymous hemianopia
Higher cerebral dysfunction

36
Q

Bamford PACS stroke

A

2 from:

Unilateral weakness of arm/leg/face
Homonymous hemianopia
Higher cerebral dysfunction

37
Q

Bamford LACS stroke

A

1 from:

Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis

38
Q

Bamford POCS stroke

A

1 from:

Cranial nerve palsy and a contralateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction
Isolated homonymous hemianopia
Bilateral motor/sensory deficit

neuro (17 decks)

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