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Nervous System > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

A sudden interruption of vascular supply of the brain, disrupting the oxygen supply leading to irreversible tissue damage

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2
Q

What are the two main types of strokes?

A
  • Ischaemic

* Haemorrhagic

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3
Q

What is an ischaemic stroke proportion compared to haemorrhagic stroke?

A
  • 85% ischaemic

* 15% haemorrhagic

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4
Q

What are the subtypes of ischaemic stroke?

A
  1. Thrombotic stoke =thrombosis from large vessels e.g. carotid
  2. Embolic stroke =usually blood clot (can be fat/air) AF most important cause of emboli forming
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5
Q

What are the subtypes of haemorrhagic stroke?

A
  1. Intracerebral haemorrhage =bleeding in brain

2. Subarachnoid haemorrhage

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6
Q

What is the difference between a TIA and Stroke?

A
  • Stroke lasts more than 24hours or can lead to death

* TIA symptoms and signs resolve within 24hrs and no apparent signs of infarction on MRI/CT

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7
Q

What are the generic features of a stroke?

A
  • Motor weakness
  • Dysphasia
  • Swallowing problems
  • Visual field defects
  • Balance problems
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8
Q

How does a cerebral hemisphere infarct present?

A
  • Contralateral hemiplegia: flaccid then spastic
  • Contralateral sensory loss
  • Homonymous hemianopia
  • Dysphasia
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9
Q

What is the presentation of a brainstem infract?

A

*Severe symptoms including quadriplegia and locked-in syndrome

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10
Q

What is the formal classification system used for strokes?

A

Oxford stroke classification also known as Bamford classification

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11
Q

How does the oxford/bamford stroke classification classify?

A

Based on initial symptom presentation. Indicates area the has infarcted

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12
Q

What criteria should be assessed in the oxford/bamford classification system?

A
  1. Unilateral hemiparesis and or hemisensory loss of face arm and legs
  2. Homonymous hemianopia
  3. Higher cognitive dysfunction e.g. dysphagia
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13
Q

What is present in a total anterior circulation infract? Caused by what vessels?

A

Due to middle and anterior cerebral arteries

> All 3 of oxford classification present

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14
Q

What is present in a posterior circulation infarct? Caused by what vessels?

A

Involves vertebrobasilar arteries

Presents with 1 of following:

  • Cerebellar or brainstem syndrome
  • Loss of consciousness
  • Isolated homonymus hemianopia
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15
Q

What is present in a lacunar infarct? Caused by what vessels?

A

Small infract involves perforating arteries around the internal capsule, thalamus and basal ganglia

Presents with 1 of:

  • Unilateral weakness of face and arm, arm and leg or all three
  • Pure sensory stroke
  • Ataxic hemiparesis
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16
Q

What is present in a partial anterior circulation infarct?

A

Smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

Present with 2/3 oxford classification

17
Q

What are patients who have suffered with haemorrhagic stroke more likely to present with than an ischaemia stroke?

A
  • Decrease in level of consciousness
  • headache
  • nausea and vomiting
  • seizures
18
Q

What investigations are done in suspected stroke?

A
  • first line non-contrast CT head

* MRI

19
Q

What is the main treatment of ischaemic stroke?

A

*Thrombolysis with alteplase given if
>Administered within 4.5hrs of onset of stroke symptoms
>haemorrhage definitevely excluded via imaging

20
Q

What is the overall management of ischaemic stroke as an FY1?

A
  1. A-E assessment + GCS
  2. Urgent CT head request
  3. Oxygen/fluid optimised, glycaemic control
  4. Ischaemic stroke diagnosed = give aspirin 300mg orally or rectally ASAP
  5. Within 4.5 hours given alteplase
  6. Consider need for thrombectomy
21
Q

What are absolute contraindications for thrombolysis?

A
  • Seizure at onset of stroke
  • Previous intracranial haemorrhage
  • Suspected subarachnoid
  • Stroke or traumatic brain injury preceding 3months
  • LP preceding 7 day
  • Active bleeding
  • Pregnancy
  • Oesophageal varices
  • Uncontrolled hypertension
22
Q

What is the secondary prevention of a stroke?

A

1st line: clopidogrel
2nd line: aspirin plus MR dipyridamole

Look at other risk factors and treat:

  • AF check
  • Cholesterol check -statins
  • Blood pressure check
23
Q

Why is regular antihypertensive withheld in stroke and only given is serious medical issue?

A

This is because lowering blood pressure too much can potentially compromise collateral blood flow to the affected region, and possibly hasten the time to complete and irreversible tissue infarction

24
Q

What must stroke patients be screened for before oral intake?

A

*Assess for dysphagia

25
Q

What scoring system can be used to help diagnose a stroke if unsure? What score makes it likely?

A

ROSIER score

Score of >0 likely

26
Q

What is the management of TIAs?

A
  1. Immediate aspiring 300mg unless contraindicated
  2. If more than one TIA need for admission/observation
  3. TIA in last 7 days arrange urgent assessment by specialist stroke physician (within 24hrs)
27
Q

What is the management of haemorrhagic stroke as an FY1?

A
  1. A-E assessment
  2. Optimise BP/Oxygen/blood glucose
  3. Urgent CT head
  4. Haemorhagic stroke&raquo_space; referral to neurosurgical consultant
  5. Stop anticoagulant and and antithrombotic meds

Nervous System (14 decks)

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