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Acute Care & Trauma > Stroke > Flashcards

Stroke Flashcards

1
Q

Define Stroke?

A

Rapid permenant neurological deficit from cerebrovascular insult

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2
Q

How is stroke defined clinically?

A

Focal or global impairment of CNS function developing rapidly and lasting > 24hrs

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3
Q

How can stroke be subdivided?

A

Location - anterior circulation vs posterior circulation

Pathological Process - infarction vs haemorrhage

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4
Q

What is the ratio between Infarction and Haemorrhage?

A

Infarction (80%)

Haemorrhage (10%)

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5
Q

Whatt are some of the causes of Infarction?

A 
Thrombosis
Emboli
Hypotension
Vasculitis 
Cocaine (arterial spasm)
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6
Q

Where can thrombosis occur?

A

Can occur in small vessels (lacunar infarcts)
Can occur in larger vessels (e.g. middle cerebral artery)
Can arise in prothrombotic states (e.g. dehydration, thrombophilia)

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7
Q

Where can Emboli occur?

A

Carotid Dissection
Carotid Atherosclerosis
Atrial Fibrillation
Venous blood clots that pass through a septal defect and get lodged in the cerebral circulation

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8
Q

How can Hypotension cause Infarction?

A

If the bp is below the autoregulatory range required to maintain cerebral blood flow, you can get infarction in the watershed zones between different cerebral artery territories

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9
Q

What can cause Haemorrhage?

A 
Hypertension 
Charcot-Bouchard microaneurysm rupture
Amyloid Angiopathy
Arteriovenous Malformations 
Trauma 
Tumours
 Vasculitis
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10
Q

What is Charcot-Bouchard Microaneurysm Rupture?

A

Aneurysms within the brain vasculature that occur in small blood vessels

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11
Q

What is the epidemiology of stroke?

A

COMMON
Incidence: 2/1000
3rd most common cause of death in industrialised countries
Usual age of patients are 70+

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12
Q

What are the presenting symptoms of stroke?

A 
Sudden Onset 
Weakness 
Sensory, visual or cognitive impairment 
Impaired Coordination
Impaired Consciousness 
Head or neck pain
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13
Q

What do we usually enquire about when talking about stroke?

A

Time of Onset (Critical for emergency management if <4.5 hrs)
History of AF, MI, Valvular Heart Disease, Carotid Artery Stenosis, Recent Neck Trauma or pain

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14
Q

What do we usually do when doing a physical examination for stroke?

A

Examine for underlying cause (e.g. atrial fibrillation)

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15
Q

What are the signs of Lacunar Infarcts that affect the internal capsule or pons?

A

Pure sensory or motor Deficit

Occasionally both

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16
Q

What are the signs of Lacunar Infarcts that affect the thalamus?

A

Loss of consciousness

Hemisensory Deficit

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17
Q

What are the signs of Lacunar Infarcts that affect the basal ganglia?

A

Hemichorea
Hemiballismus
Parkinsonism

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18
Q

What are the signs of an Anterior Cerebral Infarct?

A

Lower Limb Weakness

Confusion

19
Q

What are the signs of a Middle Cerebral Infarct?

A 
Facial Weakness 
Hemiparesis
Hemisensory Loss 
Apraxia 
Hemineglect 
Receptive or expressive dysphasia 
Quadrantopia
20
Q

What is Hemiparesis and what part of the brain is it related to?

A

Weakness on one side of the body

Motor Cortex

21
Q

What is Hemisensory loss and what part of the brain is it related to?

A

Loss of Sensation on one side of the body

22
Q

What is Hemineglect and what part of the brain is it related to?

A

It is an unawareness or unresponsiveness to things on one side of them
Parietal Lobe

23
Q

What is receptive and expressive dysphasia due to?

A

Due to involvement of Wernicke’s and Broca’s Areas

24
Q

When does Quadrantopia occur?

A

If superior or inferior optic radiations are affected

25
Q

What signs do Posterior Cerebral Infarcts present with on physical examination?

A

Hemianopia

26
Q

What signs do Anterior Inferior Cerebellar Infarcts present with on physical examination?

A

Vertigo
Ipsilateral Ataxia
Ipsilateral Deafness
Ipsilateral Facial Weakness

27
Q

What signs do Posterior Inferior Cerebrallar Infarcts present with on physical examination?

A 
Vertigo 
Ipsilateral Ataxia 
Ipsilateral Horner's Syndrome
Ipsilateral Hemisensory Loss 
Dysarthria 
Contralateral Spinothalamic Sensory Loss
28
Q

When is the Posterior Inferior Cerebellar artery affected?

A

Lateral Medullary Syndrome

29
Q

What signs do Basilar Artery Infarcts present with on physical examination?

A

Cranial Nerve Pathology and Impaired Consciousness

30
Q

What signs do Multiple Lacunar Infarcts present with on physical examination?

A 
Vascular Dementia 
Urinary Incontinence 
Gait Apraxia
Shuffling Gait 
Normal or Excessive Arm-Swing
31
Q

What signs do Intracerebral Infarcts present with on physical examination?

A 
Headache 
Meningism 
Focal Neurological Signs
Nausea/vomiting 
Signs of raised ICP 
Seizures
32
Q

What bloods would you do for a stroke?

A

Clotting profile -check if thrombophilia (especially in young patients)

33
Q

Why would you do an ECG in stroke?

A

Check for arrhythmias that may be the source of the clot

34
Q

Why would you do an Echocardiogram for stroke?

A

Identify cardiac thrombus, endocarditis and other cardiac sources of embolism

35
Q

Why would you do a Carotid Doppler Ultrasound in stroke patients?

A

Check for carotid artery disease (e.g. atherosclerosis)

36
Q

Why do we do a CT head scan in stroke patients?

A

Rapid Detection of haemorrhages

37
Q

Why do we do an MRI (brain) in stroke patients?

A

Higher sensitivity for infarction but less available

38
Q

Why do we do a CT Cerebral Angiogram for stroke patients?

A

Detect Dissections or intracranial stenosis

39
Q

What is the management plan for Hyperacute Stroke?

A

If < 4.5 hours from onset
Exclude haemorrhage using CT-head
If haemorrhage excluded, thrombolysis may be considered

40
Q

What is the management plan for Acute Ischaemic Stroke?

A

Aspirin + Clopidogrel to prevent further thrombosis (once haemorrhage excluded on CT head)
Heparin anticoagulation considered if there is a high risk of emboli recurrence or stroke progression
Formal Swallow Assessment (NG tube may be needed)
GCS monitoring
Thromboprophylaxis

41
Q

What is the secondary prevention for stroke?

A

Aspirin and dipyridamole
Warfarin anticoagulation (atrial fibrillation)
Control Risk Factors

42
Q

What are the risk factors for stroke?

A

Hypertension
Hyperlipidaemia
Treat Carotid Artery Disease

43
Q

What surgical treatment could we do in stroke patients?

A

Carotid Endarterectomy

44
Q

What are the possible complications of stroke?

A 
Cerebral Oedema (increased ICP)
Immobility 
Infections
DVT
Cardiovascular Events 
Death

Acute Care & Trauma (25 decks)

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