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Older Persons Medicine > Stroke > Flashcards

Stroke Flashcards

1
Q

What is stroke?

A

Infarctions or bleeding into the brain manifests c sudden onset focal CS sign

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2
Q

What is TIA

A
  • Sx in TIA resolve in 24hrs (old definition)
  • transient neurological dysfunction secondary to ischaemia without infarction
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3
Q

What is Cresendo TIA?

A
  • multiple recurrent episodes of TIA occuring over hours to days
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4
Q

What are the two types of stroke?

A
  • Ischaemic stroke (majority)
    • thrombotic
    • embolic
    • hypoxic
  • Haemorrhagic stroke
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5
Q

What are the causes of stroke?

A

Ischaemic

  • atherosclerosis
  • fibromuscular dysplasia
  • vasculitis
  • AF
  • paradoxical embolus
  • septic shock
  • drowning

Haemorrhagic

  • intracerebral
  • subarachnoid
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6
Q

What are the RF for stroke?

A
  • HTN
  • smoking
  • DM
  • PVD
  • Heart Disease
  • Hypercholesterolaemia
  • alcohol
  • syphilis
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7
Q

What are the general sx for stroke?

A

* they all occur sudden onset

  • Facial drooping
  • limb weakness
  • Speech difficulties
    *
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8
Q

What tool can be used for rapid recognition of stroke?

A

FAST tool

  • F: facial drooping
  • A: arm weakness
  • S: speech difficulties
  • T: time - call 999
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9
Q

What tool can be used to rapidly diagnose stroke in the emergency department?

A

Recognition of stroke in emergency room (ROSIER)

  • anything
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10
Q

Using the Oxford classification of stroke, how would you diagnose Total Anterior Circulation Stroke TACS?

A

All three

  • Unilateral weakness and/or sensory deficit of face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
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11
Q

Using the Oxford classification of stroke, how would you diagnose Partial Anterior Circulation Stroke PACS?

A

2 of

  • Unilateral weakness and/or sensory deficit of face, arm and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
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12
Q

Using the Oxford classification of stroke, how would you diagnose Posterior Circulation Syndrome POCS?

A

1 of

  • Cerebellar/brainstem syndrome
  • Loss of consciousness
  • Isolated homonymous hemianopia
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13
Q

Using the Oxford classification of stroke, how would you diagnose Lacunar Syndrome LACS?

A

1 of

  • unilateral weakness and/or sensory deficit of face, arm, leg
  • pure sensory stroke
  • ataxic hemiparesis
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14
Q

What are the sx for cerebellar occlusion?

*remember DANISH

A
  • Dysdiadochokinesia
  • Ataxia
  • Nystagmus
  • Intention tremor
  • Slurred speech
  • Hypotonia
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15
Q
A
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16
Q

Why do you get macula sparing in POCS?

A
  • macula area supplied by MCA
17
Q

How would you mx TIA?

A

Initial

  • 300mg aspirin daily
  • secondary prevention for heart disease
  • refer to stroke specialist within 24 hrs of sx

Imaging

  • MRI - determine teritory of sichaemia or detect haemorrhage
    *
18
Q

What medications are used for the secondary prevention of stroke?

A
  • clopidogrel 75mg OD
  • Artovastatin 80mg OD
    *
19
Q

How would you initially mx stroke?

A

Initial

  • admit to specialist stroke centre
  • exclude hypoglycaemia
  • immediate non enhanced CT brain - exclude haemmorhage
  • aspirin 300mg - continued for 2 weeks
20
Q

How would you pharmacologically and surgically mx stroke?

A
  • Alteplase
    • start within 4.5 hours onset pf sx
    • intracranial haemorrhage has been excluded
  • Thrombectomy
    • offered within 6hrs of sx onset
    • occlusion confirmed on imaging
21
Q

What is the imaging sequence for pt c stroke?

A
  1. non-enhanced CT
  2. CT contrast Angiography - if thrombectomy needed
  3. CT perfusion/MRI if thrombectomy needed beyond 6hrs
22
Q

What is the NIH Stroke Scale?

A
  • Diagnostic method of providing quantitative measure of stroke-related neurologic deficit
23
Q

What to be aware when administering Alteplase with ACEi?

A
  • risk of Angiodemea
24
Q

What medication is used to control BP in stroke pt?

A
  • Labetelol
25
Q

What is the function of Alteplase?

A
  • Tissue Plasminogen Activator
26
Q

How would an ischaemic stroke appear on CT immediately?

How would a haemorrhagic stroke appear on CT immediately?

A
  • normal
  • white pool of blood
27
Q

What type of MRI is used in stroke?

A
  • MRI DWI
    • diffusion-weighted imaging
    • highlight water - good for haemorrhagic stroke
28
Q

What are the differentials for stroke?

A
  • head injury
  • hype/hyper glycaemia
  • subdural haemorrhage
  • intracranial tumours
  • hemiplegic migraine
  • todd’s palsy
  • CNS lymphoma
  • wernicke’s/hepatic encephalopathy
  • toxoplasmosis
  • cerebral abcess
  • aneurysm
  • drug overdose

Older Persons Medicine (3 decks)

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