Stroke Flashcards
What are the different types of strokes?
Haemorrhagic = structural abnormality, hypertensive, amyloid angiopathy
Infarct = atheroembolic, small vessel, cardioembolic, other
Subarachnoid haemorrhage
What imaging modality is used to diagnose strokes?
CT scans
What are the different classifications of stroke?
POCI, LACI, TACI, PACI
What are the symptoms of total anterior circulation syndrome (TACS)?
Hemiplegia involving at least two of face, arm and leg
Hemisensory loss
Homonymous hemianopia and cortical signs
What is the prognosis of total anterior circulation syndrome (TACS)?
Most severe type of stroke = only 5% alive and independent at one year
What are the symptoms of partial anterior circulation syndrome (PACS)?
2 out of 3 features present in a TACS or isolated cortical dysfunction or pure motor/sensory signs less severe than in lacunar syndromes
What is the prognosis of partial anterior circulation syndrome (PACS)?
About 55% alive and independent at 1 year
What are lacunar infarcts?
Small infarcts in deeper parts of the brain and in the brainstem
What causes lacunar syndrome (LACS)?
Occlusion of a single deep penetrating artery
What parts of the body are affected by lacunar syndrome (LACS)?
Any two of the face, arms or legs
What is the prognosis of lacunar syndrome (LACS)?
Best prognosis of all strokes = 60% alive and independent at 1 year
What are the symptoms of posterior circulation syndrome (POCS)?
Cranial nerve palsies, bilateral motor and/or sensory deficits and cerebellar deficits without ipsilateral motor/sensory signs
What are the ocular symptoms of posterior circulation syndrome (PCOS)?
Conjugate eye movement disorders, isolated homonymous hemianopia, cortical blindness
What is the prognosis of posterior circulation syndrome (PCOS)?
About 60% are alive and independent at 1 year
What do dominant (left) hemisphere cortical events impact?
Affect language = huge implications for rehab
What do non-dominant (right) hemisphere cortical events impact?
Affect spatial awareness
What are the causes of ischaemic disease?
Atherothromboembolism (50%), intracranial small vessel disease (25%), cardiac source of embolism (20%), rare causes (5%)
What are the causes of intracranial small vessel disease?
Ischaemic stroke (80%), primary intracerebral haemorrhage (15%), subarachnoid haemorrhage (5%)
What are types 1-3 of small vessel disease?
1 = arteriosclerotic 2 = sporadic + hereditary cerebral amyloid angiopathy 3 = genetic small vessel disease
What is type 1 small vessel disease related to?
Age and risk factor related = fibrinoid necrosis, lipohyalinosis, microatheroma, microaneurysm
What are types 4-6 of small vessel disease?
4 = inflammatory and immunologically mediated 5 = venous collagenosis 6 = other small vessel disease
How does atrial fibrillation impact the likelihood of strokes?
5x increased risk of stroke if patient has AF
1 in 6 strokes are due to AF
What are the causes of primary intracerebral haemorrhage?
Hypertension (deep haemorrhage) and amyloid angiopathy (lobar haemorrhage)
What are the causes of secondary intracerebral haemorrhage?
Arteriovenous malformations, aneurysms or tumours
What is the ABC of stroke prevention?
Antithrombotic therapy
Blood pressure
Cholesterol
Diabetes and don’t smoke
What is the maximum score on the CHA2DS2-VaSc score?
9 = stroke and age >=75 get 2 points each, all others get 1 point
What are the other criteria on the CHA2DS2-VaSc?
Congestive heart failure, hypertension, diabetes, vascular disease, age 65-74, female
What did the PROGRESS study show?
Perindopril reduces the relative risk of stroke
What does low cholesterol increase the risk of?
Haemorrhagic stroke
What is the benefit of performing a carotid endarterectomy?
Reduces recurrent stroke risk at 2 years by 65%
What morbidities occur after a stroke?
Dysphagia, malnutrition and dehydration
When should patients with an acute stroke have their hydration assessed?
Within 4hrs of arrival
What is the treatment of an acute ischaemic stroke?
IV tPA = must be given < 4.5 hrs after symptom onset
What are the two acute treatments for strokes?
Thrombolysis and thrombectomy
What type of clot is thrombectomy used for?
Treating proximal clots with evidence of necrosis
What is the treatment if the NIHSS is <=3?
Aspirin and clopidogrel for up to three weeks
