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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What are risk factors for a haemorrhage stroke?

A 
Trauma 
Male, older age, FHx 
Arteriovenous malformation
Cerebral amyloid antipathy
Hypertension 
Haemophilia 
Anticoagulation therapy 
Illicit sympathomimetic drug use (cocaine)

Weak risk factors: Thrombocytopenia, NSAIS, heavy alcohol use

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2
Q

what are the causes of an ischaemic stroke?

A

thrombus (atheromatous plaque)
embolus (AF)
arterial dissection

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3
Q

what is the definition of a stroke ?

A

sudden onset of focal or global neurological deficit which lasts > 24 hours with evidence of infarction

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4
Q

what classification system is used for stroke?

A

Bamford/ Oxford classification

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5
Q

what is the diagnostic criteria of a TACS and PACS?

A

TACS: (all 3 of)

  • unilateral weakness in arms, legs or face
  • homonymous hemianopia
  • higher cerebral dysfunction (i.e. dysphagia, visiospacial disturbance)

PACS: (2/3 of TACS)

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6
Q

what are the diagnostic criteria of a LACS?

A

1 of the following;

  • pure motor
  • pure sensory
  • mixed sensor-motor
  • ataxia hemiapresis

(no higher cerebral dysfunction)

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7
Q

what are the diagnostic criteria for a POCS?

A

1 of the following;
- cranial nerve palsy with contralateral sensorimotor deficit
- bilateral motor/sensory deficit
conjugate eye movement disorder (e.g. horizontal gaze palsy)
cerebellar dysfunction (e.g. ataxia, vertigo, nystagmus)
isolated homonymous hemianopia

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8
Q

what artery is affected in a TACS?

A

anterior and middle cerebral artery

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9
Q

what artery is affected in a POCS?

A

vertebrobasillar arteries

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10
Q

what artery is affected in a LACS?

A

deep perforating arteries - branches of middle cerebral artery

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11
Q

infarction of what artery causes locked in syndrome?

A

basilar artery

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12
Q

infarction of what artery causes Wallenberg syndrome?

A

posterior inferior cerebellar artery

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13
Q

what clinical syndrome occurs from occlusion of the posterior inferior cerebellar artery?

A

Wallenberg syndrome / lateral medullary syndrome

  • ipsilateral horners syndrome
  • ipsilateral loss of pain and temperature in face
  • contralateral loss of pain and temperature in body
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14
Q

what scoring system is used to predict outcome in stroke?

A

NIH Stroke Scale

- score out of 42

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15
Q

what score of the NIHSS is contraindicative of thrombolysis?

A

score > 26

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16
Q

how is a haemorrhage stroke managed?

A

small bleed - no surgery.

large bleed - decompressive hemicraniotomy

17
Q

how is an ischaemic stroke managed?

A

Onset < 4.5 hours then thrombolysis (i.e. Alteplase)
Followed by 75mg Clopidogrel 24-48hrs after thrombolysis

Thrombectomy can be combined with thrombolysis

If thrombolysis contraindicated;
300g Aspirin for 2 weeks followed by 75mg Clopidogrel

18
Q

at what NIHSS score is thrombolysis indicated?

A

> 5 (or equal to) and < 26

19
Q

what is the ongoing management for ischaemic stroke?

A

HALSS
Hypertension: manage with antihypertensives > 2 weeks post-stroke
Anti-platelet therapy: 75mg Clopidogrel or Warfarin if AF
Lipid lowering drug: 20-80mg atorvastatin
Sugar: test and manage diabetes
Surgery: carotid artery stenosis 70-90% considered for endarectomy

20
Q

what are the early complications of stroke?

A 
death 
haemorrhage 
cerebral oedema 
seizure 
cardiac arrhythmia 
venous thromboembolism 
aspiration pneumonia
21
Q

what are the late complications of stroke?

A 
swallowing difficulties
mobility issues 
bladder/bowel dysfunction 
cognitive problems
pain
fatigue
emotional and psychological issues
22
Q

what is malignant MCA infarction?

A

rapid neurological deterioration due to cerebral oedema following a MCA territory stroke

may require urgent decompressive hemicraniotomy

23
Q

what are the presenting features of a haemorrhage stroke?

A 
headache 
nausea/vomiting 
seizure
altered consciousness
focal neurological deficit depending on location of bleed
hypertension
24
Q

what investigations would you carry out in a suspected stroke?

A

immediately:
- CT head

bedside:

  • Blood glucose
  • ECG (possible AF)

bloods:

  • FBC
  • U&E
  • LFT
  • Bone profile
  • Clotting profile
  • Lipid profile
  • HbA1c
  • ESR

imaging:
- CT head +/- CT angiography

Neurology (20 decks)

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