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YR3: NEURO LO's > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

Rapidly developing clinical signs of focal (or global) disturbance of cerebral function + lasting > 24h

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2
Q

Give the incidence of each type of stroke

A

Ischaemic 85%
Intracerebral Haemorrhage 10%
SAH 5%

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3
Q

List 3 causes of ischaemic stroke

A

Thrombus
Embolism
Hypoperfusion

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4
Q

List 3 causes of intracerebral haemorrhage causing stroke

A

Ruptured cerebral artery
Trauma
Reperfusion injury after ischaemic stroke

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5
Q

List 3 causes of subarachnoid haemorrhage causing stroke

A

Ruptured Berry aneurysm
Arteriovenous malformation
Trauma

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6
Q

List 5 risk factors for ischaemic stroke

A 
Age >65
HTN
Diabetes
AF
Carotid artery stenosis
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7
Q

List 5 risk factors for intracerebral haemorrhage stroke

A 
Age >65
HTN 
Vasculitis
Malignancy
Altered haemostasis e.g. Anticoagulant
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8
Q

List 3 risk factors for subarachnoid haemorrhage stroke

A

HTN
Smoking
FHx

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9
Q

Describe the epidemiology of stroke

A

COMMON
Largest cause of disability
3rd most common cause of death in UK
Usual age of stroke patients: 70+

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10
Q

Which vessel is most commonly affected in embolic strokes?

A

Middle cerebral artery

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11
Q

What are the origins of thrombotic stroke?

A

Large vessels: Atherosclerosis

Small vessel occlusion (Lacunar)

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12
Q

What causes hypo perfusion and subsequent stroke?

A

Shock/ bilateral large artery atherosclerosis decreases O2 to whole brain
Results in watershed infarct

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13
Q

Give 5 signs of anterior cerebral artery ischaemic strokes

A 
Hemiparesis (contralateral LOWER LIMB)
Hemisensory loss (contralateral LOWER LIMB)
Abulia
Disinhibition
Executive dysfunction
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14
Q

List 5 signs of middle cerebral artery ischaemic strokes

A

Hemiparesis (contralateral FACE + UPPER LIMB)
Hemisensory loss (contralateral FACE + UPPER LIMB)
Visual field deficits
Apraxia (Parietal lobe)
Speech deficits

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15
Q

List 4 signs of posterior cerebral artery ischaemic strokes?

A

Contralateral homonymous Hemianopea with macular sparing
Contralateral sensory loss
Memory impairment
Vertigo + nausea

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16
Q

What 8 structures are affected in brainstem stroke?

A

Medial longitudinal fasciculus; impaired ipsilateral adduction
Motor tract of UMN (corticospinal); ipsilateral face, contralateral body weakness
Medial lemniscus; contralateral loss of proprioception/ vibration
Motor nuclei of CN 3,4,6,12 (ipsilateral)
Spinothalamic tract (contralateral pain + temp): ipsilateral face, contralateral body
Spinocerebellar tract: Ipsilateral ataxia arm + leg
Sympathetic chain: ipsilateral Horner’s
Sensory CN nuclei

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17
Q

List 6 signs seen in intracerebral haemorrhage strokes

A 
Headache
Meningism 
Focal neurological signs 
N+V
Signs of raised ICP 
Seizures
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18
Q

List 3 signs of SAH strokes

A

Rapid onset severe headache
Meningeal signs
Sudden onset focal neurological deficits

19
Q

What bloods should be taken in suspected stroke?

A

FBC: exclude anaemia + thrombocytopenia
Electrolytes: exclude electrolyte imbalance
Cardiac enzymes: exclude concurrent MI
Glucose
Urea + creatinine: exclude renal failure (choosing tx)
Toxicology screen
Clotting screen: exclude coagulopathy

20
Q

Why measure serum glucose in suspected stroke?

A

Hypoglycaemia MIMICS stroke

Hyperglycaemia associated with intracerebral bleeding

21
Q

Why take a toxicology screen in suspected stroke?

A

Alcohol/ drugs may mimic

Cocaine + sympathomimetrics associated with ICH

22
Q

What is the first line investigation in suspected stroke? What can this detect?

A

Non contrast CT head
Acute hemorrhage: hyperattentuation (blood) + surrounding hypoattenuation (oedema)
Ischemic changes after 6–24h

23
Q

What further investigations may be performed to identify the cause of a stroke?

A

ECG: arrhythmias
MRI: if uncertain of dx

24
Q

How should an ischaemic stroke presenting in less than 4.5 hours be treated medically?

A

Alteplase (rtPA) IV (after CT excludes haemorrhage)

Aspirin 300mg or Clopidogrel 75mg 24hrs later

25
Q

What surgical intervention may be considered in ischaemic stroke patients? What is the time frame for this?

A

Mechanical thrombectomy

< 24 hours since onset

26
Q

How should an ischaemic stroke presenting later than 4.5 hours be treated?

A

Aspirin 300mg or Clopidogrel 75mg to prevent further thrombosis
Formal swallow assessment (NG tube may be needed)
GCS monitoring
Thromboprophylaxis

27
Q

Describe the secondary prevention of stroke

A 
Aspirin 300mg or Clopidogrel 75mg 
Manage RF:
HTN: Antihypertensive
AF/ Thrombophilia: anticoagulant e.g. Warfarin
High cholesterol: Atorvostatin
28
Q

What surgical intervention may be performed in an ischaemic stroke no matter the timeframe? In which patients?

A 
Carotid endarterectomy (removal of plaque in carotid artery)
In those with carotid stenosis >70% or those with previous stroke stenosis >50%
29
Q

List 3 sources of emboli that may result in ischaemic stroke

A

Carotid dissection
Carotid atherosclerosis
Atrial fibrillation

30
Q

Give 2 prothrombotic states that increase risk of thrombus formation and thus ischaemic strokes

A

Dehydration

Thrombophilia

31
Q

Describe the management of haemorrhagic strokes

A

Mannitol to reduce BP
Reversal of concomitant anticoagulation
Head elevation
Consider craniotomy + surgical clipping of vessel

32
Q

List 7 complications of stroke

A 
Aspiration pneumonia  
Cerebral oedema (increased ICP) 
Immobility: pressure sores, constipation, depression 
Infections  
DVT  
Cardiovascular events  
Death
33
Q

What is the prognosis in stroke?

A

10% mortality in 1st month
Up to 50% that survive will be dependent on others
10% recurrence within 1y
Prognosis for haemorrhagic is WORSE than ischaemic

34
Q

What speech deficits may manifest in a middle cerebral artery stroke?

A 
Expressive aphasia (Broca's areas) 
Receptive aphasia (Wernicke's area)
35
Q

What visual field deficits may arise in middle cerebral artery strokes?

A

Gaze deviates towards side of infarction
Homonymous hemianopia without macular sparing (contralateral)
Quadrantopia (if superior/ inferior optic radiations affected)

36
Q

Ischaemic stroke in the right MCA stopping flow to the parietal lobe will cause what additional sign?

A

Hemineglect (contralateral)

37
Q

What happens to neurones in ischaemic stroke?

A

Cell membrane of neurones not getting O2- functionality stops
thus electrical signals not working
Brain cell needs functional membrane for transport- begins to fail.
Water seeps in uncontrollably as membrane loses integrity, cell swells
Swollen cells may undergo apoptosis + necrosis
Whilst swelling with water, density decreases, appears darker (water less dense that brain cells)

38
Q

How does ischaemic stroke lead to formation of a fluid filled cavity?

A

Swollen cells go through necrosis + inflammation + permanent damage
Broken down brain cells in brain activates immune system
Macrophages remove necrotic tissue
Results in fluid filled cavity

39
Q

List 9 common sources of emboli causing ischaemic stroke

A 
Intracranial atherosclerosis (in brain, travels downstream)
Small artery disease (in brain- clot break off)
Carotid plaque
Carotid stenosis
Aortic arch plaque
AF
Cardiogenic emboli
Valve disease
Ventricular thrombi
40
Q

What scoring system can assess risk of stroke in patients with AF, and thus guide as to whether anticoagulants would be beneficial?

A 
CHA2DS2VASc
CHF 
HTN
Age (2 points if > 75)
Diabetes 
Stroke or clot Hx(2 points)
Vascular disease 
Age (1 point if 65-74)
Sex (1 point if F)
41
Q

Which scoring system estimates risk of major bleeding for patients on anticoagulation for AF?

A 
HAS BLED
HTN  
Abnormal Renal/ Liver Function (1 each)
Stroke Hx
Bleeding tendency
Labile INR (<60% of time in therapeutic range)
Elderly (>65)
Drugs predisposing to Bleeding or Alcohol Use
42
Q

What are anticoagulants?

A 
Inhibit clotting factors
Red clots: AF + DVT
Slow clotting + formation of fibrin
Heparin
Warfarin
Apixaban
Rivaroxaban
43
Q

What are anti platelets?

A 
inhibit platelet aggregation
White clots: Stroke + MI
Clump when blood is stagnant
Aspirin
Clopidogrel

YR3: NEURO LO's (31 decks)

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