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Brain and Behaviour > Stroke > Flashcards

Stroke Flashcards

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1
Q

What are the two types of stroke?

A

Haemorrhage or Ischaemia

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2
Q

What can cause haemorrhagic stroke?

A

Ruptured aneurysm, head trauma, dissection (tear of artery)

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3
Q

What causes ischaemic stroke?

A

Cerebral thrombosis, cerebral embolism (air, fat or thromoembolism) and lacunar stroke (occlusion to small arteries that provide blood to the brain’s deep structures)

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4
Q

What is lacunar stroke?

A

Lacunar stroke or lacunar infarct (LACI) is the most common type of ischaemic stroke, resulting from the occlusion of small penetrating arteries that provide blood to the brain’s deep structures.

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5
Q

List symptoms of stroke.

A

Weakness/paralysis, vertigo/dizziness, headache, visual loss/blurred vision, faintness. confusion, speech problems, difficulty swallowing, cognitive problems, memory problems and consciousness alterations.

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6
Q

What is the stroke classification called?

A

Oxford/Bamford stroke classification

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7
Q

What does TACS stand for?

A

total anterior circulation stroke

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8
Q

What does PACS stand for?

A

partial anterior circulation stroke

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9
Q

What does LACS stand for?

A

Lacunar syndrome

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10
Q

What does POCS stand for?

A

posterior circulation stroke

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11
Q

List the 3 symptoms of TACS/TACI. How many of these symptoms are required to call this a TACS?

A

Unilateral weakness
Homonymous hemianopia
Higher cortical dysfunction
All 3 required!

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12
Q

List the 3 symptoms of PACS/PACI. How many of these symptoms are required to call this a PACS?

A

Unilateral weakness
Homonymous hemianopia
Higher cortical dysfunction
Only 2 required!

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13
Q

List the 3 symptoms of LACS/LACI. How many of these symptoms are required to call this a LACS?

A

Unilateral weakness
Pure sensory or pure motor
Ataxic hemiparesis
Only one!

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14
Q

List the 4 symptoms of POCS/POCI. How many of these symptoms are required to call this a POCS?

A 
Bilateral motor or sensory deficit
Cerebellar/brainstem signs
Isolated homonymous hemianopia
Cranial nerve palsy & contralateral motor/sensory deficit
Only one!
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15
Q

Which small vessels can be occluded in lacunar infarcts?

A

Lenticulostriate
Thalamogeniculate
Brainstem perforating vessels

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16
Q

What are watershed infarcts?

A

Watershed cerebral infarctions, also known as border zone infarcts, occur at the border between cerebral vascular territories where the tissue is furthest from arterial supply and thus most vulnerable to reductions in perfusion.

17
Q

What can cause watershed infarcts?

A

Result from systemic hypotension causing infarct in areas of overlap of supply

18
Q

What is the most common watershed infarct and what are the symptoms?

A

Most common in ACA-MCA infarct caused by occlusion of carotid artery
Man in a barrel’: loss of trunk sensation/motor function and aphasia

19
Q

What is the other watershed infarct?

A

MCA-PCA affects visual processing

20
Q

What is spinal watershed and name some common areas that it affects?

A

Usually affects the anterior supply as one vessel only;
Autonomic supply plus motor and sensory tracts affected
Couple of watershed areas:
T4-T8 – watershed between radicular arteries (thoracic and great radicular artery)
L1 – watershed between Great radicular artery and ascending sacral arteries

21
Q

What are the 4 main steps you need to take in stroke management?

A

Scan CT – ischaemic or haemorrhagic

Blood Tests

Clot-Busting or haemorrhage evacuation (surgery)

Chest X-rays, ECG, Ultrasound

22
Q

What is the time window for thrombolysis?

A

4.5 hours

23
Q

What are the two main scans to perform for strokes?

A

CT – fast, easy to spot haemorrhage
DWI – Diffusion weighted imaging: best for ischaemic damage

Perform CT first*, rule out haemorrhage, then DWI when you have time

24
Q

What is the thrombolytic drug used to treat a ischaemic stroke?

A

IV rtPA (Alteplase) within a 4.5 hour window

25
Q

Apart from giving a thrombolytic drug, what other thrombolysis methods are there?

A

Intra-arterial (IA) thrombolysis possible
Interventional neuroradiology - thrombectomy
Endovascular thromboaspiration
Microcatheters can directly reach the thrombus
Variety of devices available

26
Q

What causes a transient ischaemic attack?

A

A.K.A. Mini-Stroke, usually results from drop in perfusion, often:
Carotid Artery Insufficiency
Vertebrobasilar Insufficiency

27
Q

What is the symptom of TIA and how long do they usually last and get better within?

A

Amourosis Fugax (black curtain descending down vision).
Severe symptoms should last less than 30 mins.
Full recovery within 24 hours.

28
Q

Describe the ABCD2 score.

A

A — Age: > 60 years, 1 point
B — BP: >140/90 mmHg, 1 point
C — Clinical features: unilateral weakness, 2 points; speech problems but no weakness, 1 point
D — Duration of symptoms: ≥ 60 mins, 2 points; 10–59 mins, 1 point
D — Diabetes: 1 point

Score ≥4, high risk of stroke

2 TIAs in close succession – high risk (even if ABCD2 <3)

1:10 TIAs with no treatment will have full stroke within 1 year

CHADVASC scale if patient has AF (atrial fibrillation)

29
Q

What scale would you use to test stroke if the patient has atrial fibrillation?

A

CHADVASC scale

30
Q

How can you do post-stroke management?

A

Combination medical and psychosocial rehabilitation (via an MDT)

31
Q

Describe post-stroke pain, where does it occur?

A

Also called thalamic pain, occurs 1 week- 6 months after stroke

Can occur anywhere in spinothalamic system

Generally occlusion of thalamogeniculate arteries

Symptom (referred to contralateral side):
Burning pain with sharp components
Hyperalgesia & Allodynia

Neuropathic pain

32
Q

What is vascular dementia?

A

Often result of many, or progressive, vascular CNS events, including stroke

33
Q

What can vascular dementia be caused by?

A

Multi-infarct dementia - from many small TIA
Single-infarct dementia - related to large stroke
Lacunar infarct – variable depending on size
Binswanger’s dementia – multiple lacunar infarcts caused by arteriosclerosis of subcortical vessels

Brain and Behaviour (28 decks)

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