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Neurology > stroke > Flashcards

stroke Flashcards

1
Q

Define stroke?

A

Rapid permanent neuro deficit from cerebrovascular insult lasting >24hrs

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2
Q

what are the 2 types of stroke and what are the proportions of each one?

A

85% infarction/ischaemia

15% haemorrhagic

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3
Q

what are the causes of an ischaemic stroke?

A

- Thrombosis

  • 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)

- Emboli- majority of strokes

  • From carotid dissection, carotid atherosclerosis, atrial fibrillation
  • they can arise from venous blood clots that pass through a septal defect (e.g. VSD) and get lodged in the cerebral circulation

- Hypotension

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

  • Vasculitis
  • Cocaine (arterial spasm)
  • Smoking
  • DM
  • cholersterol
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4
Q

what are the causes of a haemorrhagic stroke?

A

HTN, Charcot-Bouchard microaneurysms, AVM

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5
Q

what are the risk factors for ischaemic and haemorrhagic stroke?

A

Older age

FH

HT - MOST IMPORTANT

Hypercholesterolemia

DM

Smoking

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6
Q

what are the pointers to a haemorrhagic stroke?

A

meningism, severe headache and coma within hrs

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7
Q

what are the pointers for an ischaemic stroke?>

A

carotid bruit, AF, past TIA, IHD

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8
Q

which underlying cause is important to investigate in a patient with stroke?

A

AF

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9
Q

what are the signs of a stroke affecting the anterior cerebral artery?

A

ACA: -> Frontal Lobe + Medial part of motor cortex​

Contralateral hemiparesis​​​

Lower > Upper Limbs

Disturbance of intellect, executive function, judgement and appropriate social behaviour

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10
Q

what are the signs of a stroke affecting the middle cerebral artery?

A

classic stroke

Facial weakness – contralateral side

Contralateral hemiparesis - arms> legs

Hemisensory loss (sensory cortex) - contralateral

Apraxia- If you think about it it makes sense to have this in lesions where the parietal lobe is affected, bc the parietal lobe is involved in bringing together and combining information needed to perform skillfull actions.

Hemineglect (parietal lobe)

If left sided will also cause aphasia - Receptive or expressive dysphasia (due to involvement of Wernicke’s and Broca’s areas)

Quadrantanopia (if superior or inferior optic radiations are affected)

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11
Q

what is the function and position of Wernicke’s area?

A

superior left temporal lobe

comprehension

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12
Q

What is the function and position of broca’s area?

A

left frontal lobe (inferior frontal gyrus)

speech productioin and articulation

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13
Q

what are the signs of a stroke affecting the posterior circulation?

A

homonymous contralateral hemianopia ( macular sparing)

visual agnosia (unable to recognise things)

prosopagnosia (inability to recognise faces)

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14
Q

why is damage to the visual cortex often macula sparing?

A

This is bc macular representation, found at the posterior pole of the occipital lobe, is disproportionately large. Because of the large macular representation, as well as the dual blood supply to the posterior occipital lobe (both PCA and MCA), sparing of the centre of the visual field is commonly found with occipital lobe lesions. (Macular sparring can also occur with lesions of the optic radiations or optic tracts. Even without macular sparing, an HH itself does not generally affect visual acuity. If visual acuity is reduced, an accompanying lesion involving the anterior visual pathway should be suspected).

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15
Q

what are the signs of a stroke affecting the cerebellum?

A

Ipsilateral signs = DANISH​

​

Dysdiadochokinesia​

Ataxia ​

Nystagmus – vertical ​

Intension tremor ​

Slurred, staccato speech​

Hypotonia, Heel-shin test fail

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16
Q

what are the signs of lacunar infarcts?

A

Affecting the internal capsule or pons: pure sensory or motor deficit (or both)

Affecting the thalamus: loss of consciousness, hemisensory deficit

Affecting the basal ganglia: hemichorea, hemiballismus, parkinsonism

17
Q

what are the investigations for a stroke?

A

URGENT CT HEAD (within 1hr), ECG, glucose​

18
Q

what is the management of a stroke?

A

<4.5hrs -> IV alteplase ​

>4.5 (or tPA CI) -> 300mg aspirin​

​

19
Q

A 70yo male with a PMH of HTN is brought in to A&E by ambulance, he is slurring his speech and cannot raise his left arm and hold it there, he has been like this for about 60 mins. What is the most important thing to do first?​

300mg Aspirin​

IV alteplase​

CT Head​

MRI Head​

ECG

A

300mg aspirin

20
Q

what are lacunar infarcts?

A

small infarcts (2–20 mm in diameter) in the deep cerebral white matter, basal ganglia, or pons, presumed to result from the occlusion of a single small perforating artery supplying the subcortical areas of the brain

21
Q

A 70-year-old right-handed man is discovered by a family member to have difficulty speaking and comprehending spoken language, and an inability to raise his right arm. On examination, power is 2/5 in his right arm, 4/5 in his right leg and 5/5 in his left arm and leg.A CT head scan is performedand an ischaemic stroke is diagnosed.

What type of stroke is it?

A.Left total anterior circulation stroke

B.Right anterior cerebral artery stroke

C.Left middle cerebral artery stroke

D.Right middle cerebral artery stroke

E.Left brainstem stroke

A

A.Left middle cerebral artery stroke

22
Q

what are the features of a total anterior circulation stroke?

A

All 3 of:

  • Contralateral motor or sensory deficit
  • Homonymous hemianopia
  • Higher cortical dysfunction
23
Q

what are the features of partial anterior circulation stroke?

A

Any 2 of:

  • Contralateral motor or sensory deficit
  • Homonymous hemianopia
  • Higher cortical dysfunction
24
Q

what are the features of a posterior circulation stroke?

A

Any of:

  • Isolated homonymous hemianopia
  • Brainstem signs
  • Cerebellar ataxia
25
Q

what are the features of a lacunar stroke?

A

Lacunar Stroke (LACS)

Any of:

  • Pure motor deficit
  • Pure sensory deficit
  • Sensorimotor deficit
26
Q

what are the contraindications for thrombolysis?

A

onset of symptoms >4.5 hrs, CT reveals acute trauma or haemorrhage, symptoms suggestive of SAH, high INR, APPT, PT

27
Q

describe the further management at the stroke unit?

A
  • Swallowing assessment
  • VTE prophylaxis
  • GCS monitoring
  • Early mobilization and rehabilitation
  • MDT approach
28
Q

what other investigations can be done?

A

CT or magnetic resonance angiography should be performed in all patients with acute ischaemistroke and suspicion of a large vessel occlusion who would be candidates for endovascular thrombectomy (individuals with large vessel occlusion)

Carotid doppler: checks for carotid artery stenosis: if >70% occlusion, carotid endarterectomy recommended.

29
Q

what is the secondary prevention of a stroke?

A
30
Q

describe the management of a haemorrhagic stroke/

A
31
Q

what are the complications of a stroke?

A
  • Aspiration pneumonia
  • Cerebral oedema(↑ ICP)
  • Immobility
  • Depression
  • DVT
  • Seizures
  • Death
32
Q

what is used to assess the complications of a TIA?

A

ABCD2

33
Q

Outline the prognosis of a stroke?

A

Ø10% mortality in the first month

ØUp to 50% that survive will be dependent on others

Ø10% recurrence within 1 year

ØPrognosis for haemorrhagic is WORSE than ischaemic

ØFor patients with TIA, 8% will have a stroke during hospitalization and >10% in the next 3 months

ØABCD2 score estimates the risk of stroke after TIA

Neurology (29 decks)

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