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Cardiovascular System > Stroke > Flashcards

Stroke Flashcards

1
Q

Most common cause of long term disability in UK
20% of hospital beds
£5bn per year

A

Stroke

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2
Q

Definition of a stroke

A

Neurological deficit of sudden onset lasting over 24hrs if vascular origin

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3
Q

Symptoms of stroke

A 
Loss of
Power
Sensation
Speech 
Vision
Coordination
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4
Q

Dysarthria Vs dysphasia

verbal problems

A

Dysarthria is muscles

Dysphasia is processing in brain

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5
Q

2 causes of stroke

A

Blockage of blood vessel to brain (ischaemic stroke) - dark 85%

Haemhorragic stroke from ruptured blood vessel in brain - white 15%

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6
Q

2 arteries to brain

A

Internal carotid and vertebral

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6
Q

2 arteries to brain

A

External carotid and vertebral

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7
Q

What blood vessels supply anterior brain

A

Internal carotid, into middle cerebral and anterior cerebral

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8
Q

What blood vessels supply posterior brain

A

Vertebral artery into cerebellar, basilar and posterior cerebral

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9
Q

The homunculus

A

Supplies foot and leg centrally then hip trunk arm and and face

A small stroke in the pons or internal capsule of these nerves will result in major deficit

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10
Q

Causes of ischemic stroke

A

Large artery atherosclerosis 35%
Cardioembolic eg AF 25%
Small artery occlusion eg lacunar stroke 25%
Undetermined 10-15%
Rare eg arterial dissection of venous sinus thrombosis <5%

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11
Q

Causes of haemorrhagic stroke

A

Primary intracerebral hemorrhage 70%

Secondary eg subarachnoid or artiovenous 30%

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12
Q

Where does carotid stenosis usually happen

A

Internal and external bifurcation

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12
Q

Where does carotid stenosis usually happen

A

Internal and external bifurcation

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13
Q

Cardioembolic stroke

A

AF causes clot formation in atrium then this goes to brain

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14
Q

Lacunar stroke

A

Affects a small part of brain in medial and lateral lenticulostriate arteries off of middle cerebral artery

May be unnoticed

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15
Q

Carotid dissection

A

Can happen with lots of exercise

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16
Q

What can you tell from symptoms and signs

A 
What side of brain
Brainstem or not
If cortex is involved
If lesion is in deep white matter (lacunar)
What blood vessel
17
Q

Why bother with localisation of embolus/haemorrhage

A

Confirm stroke
Better image selection
Indication of cause
Prognosis

18
Q

Unilateral (one eye) field loss

A

One optic nerve compression

19
Q

Bitemporal hemianopia (tunnel vision)

A

Chiasmal (cross over of optic nerves) by pituitary tumor

20
Q

Homonymous hemianopia (can’t see one side from both eyes)

A

Left cerebrovascular event

21
Q

Stroke subtypes

A

TACS
PACS
LACS
POCS

22
Q

TACS

A

20% of strokes

Weakness and sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction (can’t talk or is clumsy)

Usually due to occlusion if proximal middle cerebral artery or internal carotid artery

60% m@1y and 6% r@1y

23
Q

PACS

A

35% of strokes

2 or 3 of TACS criteria or restricted motor/sensory deficit eg one limb face and hand or just higher cerebral dysfunction

More restricted cortical infarcts eg occlusion if branches of middle cerebral artery

16% m@1y and 17% r@1y

24
Q

LAC

A

Most common is pure weakness in one side in whole of 2 of face/arm/leg

Pure sensory in same distribution

Sensorimotor is combination

11% m@1y and 9% r@1y

25
Q

POCS

A

25%
Affects brainstem, cerebellar or occipital lobes

Variable, complex presentation eg

Bilateral motor/sensory deficit
Disordered conjugate eye movements
Homonymous hemianopia
Disordered breathing
Tinnitus vertigo

19% 1 year mortality and 20% recurrence

26
Q

Why do patients do better in stroke wards

A 
Mobile asap
Concentration on simple things 
Swallowing problems common in half
Earth therapy
Concentration of expertise
27
Q

How many neurons are lost each minute a large vessel occlusion isn’t treated

A

1.9 million

28
Q

Time after which TPA (tissue plasminogen activator) isnt beneficial

A

330mins (4.5 hours)

29
Q

Clot busting drug found beneficial up to 4.5 hours by MHRA

A

Alteplase

30
Q

% of patients alive and independent T 90days

A

With just IVT >40%

With IVT and early thrombectomy 62%

31
Q

Assessment of stroke patients in A&E

A

If no neuro problems and AF or resolved AC problems, discuss with stroke bleep holders

Neuro problems>4.5hrs contact stroke team
<4.5hrs urgent CT then stroke bleep

32
Q

Contraindications to thrombolysis

A

Age (<80years usually)

Recent bleeding, high BP etc

33
Q

SIGN guidelines

A

Mortality with MCA (middle cerebral artery) stroke is up to 80%

In under 60s hemicraniectomy reduced mortality from 80% to 27%

33
Q

SIGN guidelines

A

Mortality with MCA (middle cerebral artery) stroke is up to 80%

In under 60s hemicraniectomy reduced mortality from 80% to 27%

34
Q

When to do hemicraniectomy

A

Up to 60y with MCA ischemic stroke with massive cerebral oedema, within 48 hours of onset

35
Q

What % of patients does aspirin in 0-48 hours benefit

A

65% of ischemic stroke, 12 prevented deaths per 100 treated

36
Q

Benefits of giving stroke unit

A

90% of patients benefit, 5 deaths per 100 prevented

37
Q

Benefits of thrombolysis

A

10% of strokes, 1 death prevented per 100

38
Q

Benefits of hemicraniectomy

A

0.5% of strokes, 22 deaths prevented per 100

39
Q

Risk for early recurrent stroke in the first 2 weeks

A

14% in Tia and stroke

1/3 of Tia patients will have an acute stroke at some point

40
Q

treatment of tia and secondary prevention drugs used

A

Decreases risk of recurrent stroke

Clopidogrel 75mg or aspirin 75mg with MR 200mg

Statins

Blood pressure drugs

41
Q

When to do carotid endarterectomy

A

Anterior circulation occluded
Tia or stroke with good recovery
70% occlusion

Cardiovascular System (33 decks)

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