Stroke Flashcards
What are the two types of stroke?
Haemorrhage or Ischaemia
What can cause haemorrhagic stroke?
Ruptured aneurysm, head trauma, dissection (tear of artery)
What causes ischaemic stroke?
Cerebral thrombosis, cerebral embolism (air, fat or thromoembolism) and lacunar stroke (occlusion to small arteries that provide blood to the brain’s deep structures)
What is lacunar stroke?
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.
List symptoms of stroke.
Weakness/paralysis, vertigo/dizziness, headache, visual loss/blurred vision, faintness. confusion, speech problems, difficulty swallowing, cognitive problems, memory problems and consciousness alterations.
What is the stroke classification called?
Oxford/Bamford stroke classification
What does TACS stand for?
total anterior circulation stroke
What does PACS stand for?
partial anterior circulation stroke
What does LACS stand for?
Lacunar syndrome
What does POCS stand for?
posterior circulation stroke
List the 3 symptoms of TACS/TACI. How many of these symptoms are required to call this a TACS?
Unilateral weakness
Homonymous hemianopia
Higher cortical dysfunction
All 3 required!
List the 3 symptoms of PACS/PACI. How many of these symptoms are required to call this a PACS?
Unilateral weakness
Homonymous hemianopia
Higher cortical dysfunction
Only 2 required!
List the 3 symptoms of LACS/LACI. How many of these symptoms are required to call this a LACS?
Unilateral weakness
Pure sensory or pure motor
Ataxic hemiparesis
Only one!
List the 4 symptoms of POCS/POCI. How many of these symptoms are required to call this a POCS?
Bilateral motor or sensory deficit Cerebellar/brainstem signs Isolated homonymous hemianopia Cranial nerve palsy & contralateral motor/sensory deficit Only one!
Which small vessels can be occluded in lacunar infarcts?
Lenticulostriate
Thalamogeniculate
Brainstem perforating vessels
What are watershed infarcts?
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.
What can cause watershed infarcts?
Result from systemic hypotension causing infarct in areas of overlap of supply
What is the most common watershed infarct and what are the symptoms?
Most common in ACA-MCA infarct caused by occlusion of carotid artery
Man in a barrel’: loss of trunk sensation/motor function and aphasia
What is the other watershed infarct?
MCA-PCA affects visual processing
What is spinal watershed and name some common areas that it affects?
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
What are the 4 main steps you need to take in stroke management?
Scan CT – ischaemic or haemorrhagic
Blood Tests
Clot-Busting or haemorrhage evacuation (surgery)
Chest X-rays, ECG, Ultrasound
What is the time window for thrombolysis?
4.5 hours
What are the two main scans to perform for strokes?
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
What is the thrombolytic drug used to treat a ischaemic stroke?
IV rtPA (Alteplase) within a 4.5 hour window
Apart from giving a thrombolytic drug, what other thrombolysis methods are there?
Intra-arterial (IA) thrombolysis possible
Interventional neuroradiology - thrombectomy
Endovascular thromboaspiration
Microcatheters can directly reach the thrombus
Variety of devices available
What causes a transient ischaemic attack?
A.K.A. Mini-Stroke, usually results from drop in perfusion, often:
Carotid Artery Insufficiency
Vertebrobasilar Insufficiency
What is the symptom of TIA and how long do they usually last and get better within?
Amourosis Fugax (black curtain descending down vision).
Severe symptoms should last less than 30 mins.
Full recovery within 24 hours.
Describe the ABCD2 score.
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)
What scale would you use to test stroke if the patient has atrial fibrillation?
CHADVASC scale
How can you do post-stroke management?
Combination medical and psychosocial rehabilitation (via an MDT)
Describe post-stroke pain, where does it occur?
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
What is vascular dementia?
Often result of many, or progressive, vascular CNS events, including stroke
What can vascular dementia be caused by?
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
