Stroke Flashcards
What are the 4 characteristic features of a stroke syndrome?
- neurological distruption evolves suddenly
- deficit is focal
- neuological symptoms are predominantly negative (loss of movement/ sensation rather than gain eg tremour)
- symptoms should fit into a vascular territory- almost impossible to get two strokes at the same time
Describe the clinical features required for a total anterior circulation stroke (proximal MCA or ICA occulsion) and partial anterior circulation stroke syndrome (branch of MCA)
TACS: hemiparesis AND higher cortical dysfunction (dysphasia/ neglect) AND homonymous hemianopia
PACS: isolated higher cortical dysfunction OR any two of: hemiparesis, higher cortical dysfunction and hemianopia
What sides of the brain are affected to cause neglect/ alien hand/ visual or tactile extinction and to cause dysphasia
dysphasia: left/ dominant hemisphere
neglect: right hemisphere (parietal lobe
Describe the clincial features for posterior circulation stroke? (PCA, cerebellar, vertebral or cerebellar vessels)
POCS: isolated hemianopia (PCA), brainstem (bulbar) or cerebellar syndromes
Describe the clinical features of a lacunar stroke syndrome (lenticulostiate or thalamoperforator vessel occlusion)
LACS: pure motor stroke OR pure sensory stroke OR sensorimotor stroke OR ataxic hemiparesis OR clumsy hand dysarthria
What is stereotyping and migration of symptoms?
- stereotyping: episodic recurrance of symptoms- more likley migraine or seizure
- migration of symptoms: slow sequential change of symptoms as different parts of brain are affected, again more likely to be migraine or seizure
List 5 differentials for stroke
- seizure
- migraine
- space occupying lesions
- MS
- subdural haematoma
- BPPV/ vestibular neuronitis
- transient global amnesia
- functional syndrome
- amyloid spells
What is apparent neurological deficit?
Neuro dysfunction in pts with chronic stroke but seemingly good recovery and residual areas of scar tissue. Symptoms can return (ie become apparent) due to underperformance of the scar tissue in context of suboptimal physiology eg infection, low BP, hypoglycaemia, hypoxia, fatigue etc. They go back to normal with return of baseline function.
List 5 stoke charmelons (atypical strokes)
- venous infarcts (gradual onset, ++ seizure activity)
- small cortical strokes (cause peripheral nerve lesions)
- limb shaking TIA (mistaken for seizure)
- occipital strokes (predominantly presents with confusion and visual feild defect is often missed)
- stroke amnestic syndromes
- stroke mimicking vestibular dysfunction
What is the NIHSS assessment used for?What broad areas does it test?
- score for severity of stroke
- assesses level of consciousness, gaze, visual feilds, facial paresis, motor function, limb ataxia, sensation, language, dysarthria, extinction and inattention
Describe the findings of non contrast CT in ischaemic and haemorrhagic strokes
- ‘stroke protocol’ MRI will also be done
- Early signs of ischaemia: effacement (loss of grey/ white matter distinction) due to electrolyte shifts and brain swelling, as well as increased density of the relevant blood vessel
- Haemorrhage: increased attenuation (density)- need to report on the location, size, age and presence of complications eg hydrocephalus
What is are the commonest underlying cause of deep (basal ganglia or cerebellum) and peripheral/ lobar bleeds?
Deep bleeds usually due to HTN
Lobar/ peripheral bleeds have variety of causes: underlying tumour, vascular abnormality eg AVM or aneurysm, vascular degeneration eg cerebral amyloid angiopathy
What is cerebral amyloid angiopathy
deposits of amyloid in blood vessel walls which weakens them- seen with age and dementia. cause of peripheral strokes
What type of strokes are commonly caused by cardiac emboli and how should these strokes be investigated for the exact source?
- cause partial anterior circulation strokes, multifocal and lacuna strokes
- from AF–> do 24-72 hr ecg
- valvular heart disease/ endocarditis–> ascultation and echo
- post MI–> PMH. ecg,echo
What type of strokes are caused by large vessel emboli and how should they be investigated?
- PACs and TACS
- carotid duplex USS
When should vasculitis be suspected as a cause of stroke
suspect in elderly lady with history of headache for few months, weightloss, lethargy, pallor, temporal arteritis symptoms or the pt with history of SLE or young and no other RFs
when should thrombophilia be suspected as a cause of stroke?
- in pregnancy
- hx VTE
- multiple miscarriages
- active cancer
What type of stroke does arteriosclerosis cause and which pts tend to get them
- LACS
- diabetic and/ or hypertensive pts
What stroke classication relates to the cause of strokes
TOAST classification
What background factors predispose someone to a stroke and should be checked in all pts
- diabetes
- htn
- obesity
- dyslipidaemia
- age
- fhx
What complications are important to consider post stroke (9)
- death
- raised ICP
- reoccurrance and extension of stroke
- complications of immobility (VTE, constipation, bed sores)
- infections (resp common due to aspiration, UTIs due to incomplete bladder emptying, constipation and bed bound posture)
- mood and cognitive disorders (delerium, depression)
- pain and fatigue
- secondary epilepsy
When does stroke reoccurance and extension occur?
- when cause not addressed or secondary prevention not put in place
- when havent maximised physiology fast enough so stroke extends
What can caused raised ICP in stroke
- haematoma expansion
- malignant odema
- haemorrhagic transformation
- hydrocephalus
How should pain and fatigue be managed post stroke
- related to spasticity (splints, physio, botulinum, antispasmodics)
- joint dislocation (relocate, WHO pain ladder)
- neuropathic (pregabalin, gabapentin, amitriptyline)
