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Year 4: Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

what are the two types of stroke

A

ischaemic

haemorrhage

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2
Q

what type of stroke is more common

A

ischaemic (85%)

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3
Q

what are the two mechanisms of ischaemic stroke

A
  1. thrombotic - thrombosis from large vessels e.g. carotid
  2. embolic - emboli from heart e.g. in AF
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4
Q

definition of a stroke

A

rapid onset neurological deficit resulting from altered blood supply to brain lasting >24 hours

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5
Q

what is a TIA

A

transient ischaemic attack due to temporary occlusion of circulation - signs and symptoms last less than 24 hours

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6
Q

what investigation should every patient with TIA get

A

carotid doppler - thrombosis from carotids most common cause

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7
Q

immediate management of patient who presents with TIA

A

300mg aspirin

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8
Q

management of patient who has had suspected TIA in last - 7 days - over 7 days ago

A

if within 7 days – urgent (within 24 hours) assessment if over 7 days – assessment within 7 days

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9
Q

secondary prevention TIA

A

1st line = clopidogrel

2nd line = aspirin + dipyridamole if patients cannot tolerate clopidogrel

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10
Q

symptoms of stroke/TIA

A

motor weakness

speech problems

swallowing difficulty

visual field defects

balance problems

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11
Q

blood supply to medial + lateral brain

A
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12
Q

draw circle of willis

A
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13
Q

what vessels are occluded in total anterior circulation stroke

A

anterior + middle cerebral arteries

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14
Q

criteria for total anterior circulation stroke

A
  1. unilateral weakness +/- sensory loss of arm, leg, face
  2. homonymous hemianopia
  3. higher cognitive dysfunction e.g dysphasia
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15
Q

if there is left sided weakness + sensory loss in a TACS stroke, where is the infarct?

A

RIGHT side of brain

  • contralateral to the lesion
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16
Q

what artery is affected in stroke with predominant leg symptoms?

A

Anterior cerebral

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17
Q

what artery is affected in stroke with predominant arm/face symptoms?

A

middle cerebral artery

18
Q

Criteria for partial anterior circulation stroke? (PACS)

A

2 out of 3 criteria for TACS

  1. Unilateral weakness +/- sensory loss of arm/leg/face
  2. homonymous hemianopia
  3. Higher cortical dysfunction
19
Q

describe visual field defect in homonymous hemianopia

A

person only sees half the visual field of each eye

  • in left homonymous hemianopia, person cannot see left side of visual field in each eye due to lesion in right occipital lobe/optic tract
20
Q

what vessels are occluded in posterior circulation stroke? (POCS)

A

vertebrobasilar arteries

21
Q

criteria for posterior circulation stroke

A

any 1 of:

  1. cerebellar symptoms
  2. isolated homonymous hemianopia
  3. loss of consciousness
22
Q

what artery is affected in lateral medullary syndrome

A

posterior inferior cerebellar artery

23
Q

signs of lateral medullary syndrome

A

ipsilateral horners

contralateral loss of pain/temperature sensations

24
Q

what is a lacunar stroke?

A

infarcts around basal ganglia, thalamus and internal capsule

presentations include:

  1. unilateral weakness +/- sensory loss of leg,arm,face
  2. pure sensory loss
  3. ataxic hemiparesis
25
Q

what is locked in syndrome?

what artery is most commonly affected?

A

patient is aware + cognitively intact but completely paralysed apart from eye muscles

basilar artery

26
Q

features of haemorrhagic stroke

A

loss of consciousness (50%)

headache

nausea + vomitting

seizures (25%)

27
Q

what imaging is used to differentiate between ischaemic + haemorrhagic stroke

A

CT

  • If negative, rules out haemorrhagic stroke and allows treatment for ischaemic stroke to be started
  • may initially be normal in ischaemia – MRI better for infarction
28
Q

management of ischaemic stroke presenting within 4.5 hours

A

thrombolysis with IV alteplase

29
Q

management of ischaemic stroke presenting > 4.5 hours duration of symptoms

A

300mg aspirin

30
Q

secondary prevention drugs post ischaemic stroke

A

aspirin for 14 days

then 75 mg clopidogrel after that (aspirin 75mg + dipyridimole 200mg 2nd line)

statin

31
Q

secondary prevention ischaemic stroke in AF patient

A

anticoagulants 2 weeks post stroke

  • warfarin or rivaroxaban
32
Q

what is done 24 hours after administration of thrombolysis

A

CT to check for haemorrhage (increased risk)

33
Q

first line radiological investigation for suspected stroke

A

CT

34
Q

what scoring system is used for suspected stroke

A

ROSIER score

35
Q

what is webers syndrome

A

ipsilateral cranial nerve 3 palsy (eye is down + out)

contralateral weakness

36
Q

lacunar infarcts are strongly associated with what condition

A

hypertension

37
Q

What can mimic TIA symptoms and needs to be ruled out

A

hypoglycaemia

38
Q

if a patient is on warfarin / anticoagulant / has a bleeding disorder and is suspected of having a TIA, what do they need urgenty?

A

CT head to exclude a bleed

39
Q

when is a carotid endarterectomy considered in a patient?

A

patient who has had a TIA with carotid artery stenosis >70%

40
Q

what are some common stroke mimics

A

post ictal states

complicated migraine

hypoglyaemia / hyponatraemia

bells palsy

sepsis

41
Q

criteria for thrombectomy in ischaemic stroke

A
  • within 6 hours of symptom onset if confirmed occlusion of proximal anterior circulation
  • between 6-24 hours if confirmed occlusion of proximal anterior circulation PLUS potential to salvage brain tissue, as shown on CT

Year 4: Neurology (24 decks)

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