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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

define a stroke

A

focal neurological deficit that causes a vascular deficit and lasts longer than 24 hours

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2
Q

what parts of the brain does the anterior cerebral artery supply

A

superior and medial aspects of the cerebrum

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3
Q

what parts of the brain does the middle cerebral artery supply

A

majority of the lateral aspect of the cerebrum

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4
Q

what parts of the brain does the posterior cerebral artery supply

A

occipital lobe

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5
Q

if there is occlusion of the anterior cerebral artery, what clinical features occur

A

contralateral weakness and sensory loss to the leg
loss of bladder control
visual disturbance

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6
Q

if there is occlusion of the middle cerebral artery, what clinical features occur

A

contralateral weakness and sensory loss to the arm and face
homonymous hemianopia
visuospatial problems

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7
Q

if the middle cerebral artery is occluded on the dominant side, what additional features are seen

A

aphasia

apraxia

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8
Q

what is Wernickes aphasia

A

the ability to understand words and sentences is impaired but the ability to speak is not
therefore the speech is fluent but non-sensical

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9
Q

where is Wernicke’s area located

A

temporal lobe

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10
Q

what is Broca’s aphasia

A

the ability to produce speech is impaired but comprehension of language is not
therefore speech is laboured but makes sense

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11
Q

where is Broca’s area located

A

frontal lobe

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12
Q

if the posterior cerebral artery is occluded, what clinical features are seen

A

macular sparing homonymous hemianopia

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13
Q

what are the 2 types of stroke that can occur

A

ischaemic

haemorrhagic

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14
Q

outline the pathophysiology of ischaemic stroke

A

due to cerebral occlusion causing infarction

either thrombotic or embolic in origin causing occlusion of cerebral vessels and area of the brain is damaged

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15
Q

what is a thrombotic event causing a stroke

A

blockage of vessel at the site of occlusion

develops due to atherosclerosis of vessels

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16
Q

what is an embolic event causing a stroke

A

clots arise distally, break off from the site of origin and travel up to the brain via the internal carotids
usually due to previous MI, AF or endocarditis

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17
Q

what causes an haemorrhagic stroke to occur

A

develops as a result of intercerebral haemorrhage which reduces the blood supply to other parts of the brain

18
Q

what is the main risk factor for developing haemorrhagic stroke

A

uncontrolled hypertension

19
Q

which type of stroke is most common

A

ischaemic 80% of all strokes

20
Q

outline the main modifiable risk factors for having a stroke

A 
hypertension
diabetes 
smoking
increased clotting
heart disease - AF, ischaemic, valvular
21
Q

what areas of the brain are affected in a total anterior circulation stroke

A

blockage of both anterior and middle cerebral arteries

22
Q

for a diagnosis of TACS what 3 features must be present

A

unilateral weakness of face, arm and leg
homonymous hemianopia
higher cerebral dysfunction - dysphasia and visuospatial problems

23
Q

what areas of the brain are affected in a partial anterior circulation stroke

A

smaller than TACS, blockage of one of anterior or middle cerebral artery

24
Q

for diagnosis of PACS what features must be present

A

2 of the following
unilateral weakness of face, arm and leg
homonymous hemianopia
higher cerebral dysfunction - dysphasia and visuospatial problems

25
Q

what areas of the brain are affected in posterior circulation syndrome

A

damage to the areas supplied by posterior cerebral artery - vertebral and basilar arteries

26
Q

for diagnosis of POCS, what features must be present

A

one of the following present
isolated homonymous hemianopia
cerebellar/brainstem syndrome - ataxia, nystagmus and diplopia
+/- confusion and mood changes

27
Q

what causes a lacunar stroke to develop

A

due to multiple small vessel infarcts in basal ganglia and thalamus, it is a subcortical stroke therefore higher cerebral functions are preserved

28
Q

what features are present in a lacunar stroke

A

one of the following
purely sensory stroke
ataxic hemiparesis
unilateral weakness +/- sensory symptoms in face, arms and legs

29
Q

what causes a stroke from a carotid artery dissection to occur

A

spontaneously

whiplash trauma

30
Q

how does a stroke from carotid artery dissection present

A

focal neuro deficits
pain in neck/face
Horner’s syndrome
lower cranial nerve symptoms

31
Q

what is the first line investigation for someone presenting with symptoms of a stroke

A

CT brain if presenting acutely

MRI if presenting several days after the onset of symptoms

32
Q

what is the immediate findings of an ischaemic stroke on CT

A

hyperdense segment representing intravascular thrombus/embolism - most commonly seen within the MCA

33
Q

after the first few hours of a stroke what findings develop

A

loss of grey-white matter differentiation

34
Q

what are the CT features of a chronic stroke

A

swelling reduces and gliosis begins to set in, very dense region around the area of infarction which causes a negative mass effect

35
Q

what is the first line management of acute stroke

A

ABCDE
establish whether the stroke is ischaemic or haemorrhagic
monitor glucose and ensure adequate hydration

36
Q

if an ischaemic stroke is detected within 4.5 hours of first presentation, how is it managed

A

thrombyolsis

37
Q

what are the 2 agents that can be used for thrombolysis

A

IV altepase and tissue plasminogen activator

38
Q

list some contraindications to thrombolysis

A 
seizures 
recent surgery 
major infarct 
haemorrhagic stroke 
currently on anti-coags 
ischaemic stroke in last 3 months
39
Q

if a patient presents after 4.5 hours of symptoms thrombolysis is ineffective true/false

A

true

40
Q

how is a stroke managed after presenting after 4.5 hours

A

aspirin 300mg

41
Q

following an ischaemic stroke, what secondary prevention measures must be in place

A

ABC - anti-platelets, blood pressure medication and cholesterol control

42
Q

after a stroke, what medication is commenced irrespective of the extent of patient risk factor

A

statins and anti-platelets

whereas anti-hypertensives only commenced if clinical hypertension

Neurology (19 decks)

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