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CARDIOLOGY > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A
  • Acute onset of Focal neurological symptoms

- Due to disruption of blood supply

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2
Q

What are the two main types of stroke?

A

Ischaemic (80%)
- clot blocks area of brain from receiving blood flow

Haemorrhagic (20%)
- bleeding inside or around brain tissue

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3
Q

What risk factors usually precede a haemorrhagic stroke?

A
  • Raised BP
  • Weakened blood vessel wall due to
    • structural abnormalities (aneurysm/ AVM)
    • inflammation of vessel wall (vasculitis)
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4
Q

What are the different types of ischaemic stroke?

A

Thrombotic - clot blocks artery in which it forms

Embolic - clot has travelled from somewhere more proximal in the arteries or the heart

Hypoperfusion- reduced flow of blood due to stenosed artery causes ischaemia, rather than occlusion of artery

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5
Q

What are the 3 components of Virchow’s Triad which cause thrombosis to occur?

A
  • blood stasis
  • vessel wall damage/injury
  • hypercoagulable state
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6
Q

What risk factors for stroke are “Non-modifiable”?

A
  • Age
  • Family history of stroke
  • Gender
  • Race
  • Previous stroke
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7
Q

What risk factors for stroke are considered potenially “Modifiable”?

A
  • Hypertension
  • Hyperlipidaemia
  • Smoking
  • Atrial fibrillation
  • Diabetes
  • Congestive heart failure
  • Alcohol excess
  • Obesity /Physical inactivity
  • Poor socioeconomic status
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8
Q

Statins are NOT recommended in haemorrhagic stroke patients. TRUE/FALSE?

A

TRUE

- they are only recommended in ischaemic stroke patients

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9
Q

What rare causes of stroke are more likely to occur in younger stroke patients?

A
  • Vasculitis
  • Thrombophilias (Antiphospholipid, Protein S/C or Antithrombin deficiency)
  • Paradoxical embolism (venous clot to arterial side) through patent foramen ovale/pulmonary AV shunts
  • Genetic e.g. Factor V Leiden mutation
  • Cardioembolic = infective endocarditis, myxoma
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10
Q

How can the effects of stroke potentially be reversed with immediate treatment?

A 
Thrombolysis (up to 4.5 hrs from onset)
or Thrombectomy (up to 6 hrs from onset)
- scan first to make sure patient does NOT have haemorrhagic stroke
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11
Q

What conditions are considered stroke mimics? i.e. similar symptoms to stroke but are not caused by reduction of blood flow?

A
  • Hypoglycaemia
  • Seizure
  • Migraine
  • Other metabolic –hyperglycaemia, hyponatremia
  • SOLs e.g. brain tumours
  • Functional hemiparesis
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12
Q

What types of brain imaging can be used to differentiate between different types of stroke?

A
  • CT Brain +/- angiography
  • MRI with DWI +/- angiography
  • MRI with SWI - looks for old haemosiderin deposits (old bleed)
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13
Q

What blood tests would be carried out to investigate the cause of an ischaemic stroke?

A

Blood tests

  • glucose
  • lipids
  • thrombophillia screen in young patients
  • Assess for hypertension
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14
Q

What investigations can be completed to work out if an ischaemic stroke is atheroembolic or cardioembolic?

A

Atheroembolic
- carotid doppler US scan

Cardioembolic

  • ECG to look for AF
  • ECHO to check for possible valvular/mural emboli?
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15
Q

What may cause haemorrhagic strokes in older vs younger patients?

A

Older patients - hypertensive disease, bleeds usually deep in brain

Younger patients - not hypertensive, superficial bleed => often due to aneurysm/AVM

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16
Q

What conditions may cause multiple haemorrhgaes in the brain?

A
  • vasculitis
  • Moya Moya disease
  • cerebral amyloid angiopathy
17
Q

What medical treatment is used to prevent subsequent ATHEROEMBOLIC strokes

A
  • Antiplatelets (Aspirin/ clopidogrel/ ticagrelor)
  • Statins to treat high lipids
  • Diabetes management
  • Hypertension management
  • Lifestyle advice
18
Q

What medical treatments can be used to prevent subsequent CARDIOEMBOLIC strokes?

A
  • anticoagulants
    => Warfarin (Vitamin K antagonist)
    => DOACs e.g. Rivaroxaban, Apixaban, Edoxaban
19
Q

The PROGRESS trial for stroke management found which antihypertensives reduced stroke recurrence even in normotensive patients?

A

Perindopril + Indapamide

20
Q

HOw can strokes be surgically managed?

A
  • Haematoma evacuation
  • Relief of raised intracranial pressure
  • Carotid endarterectomy
21
Q

What is a Transient Ischaemic Attack?

A
  • Temporary neurological symptoms
  • due to occlusion of artery stopping flow of blood
  • clot is small enough for body to dissolve in these cases
  • but it indicates patients are at risk of stroke in future

CARDIOLOGY (14 decks)

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