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Neuro and geriatrics > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the definition of a stroke?

A

Clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin

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2
Q

What is the onset of stroke like?

A

Sudden

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3
Q

What might carotid territory strokes look like?

A

Usually unilateral
Weakness of face, leg, arm
Amaurosis fugax
Impaired language

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4
Q

What might a posterior circulation stroke look like?

A 
Dysarthria
Dysphasia
Diplopia
Dizziness
Ataxia
Diplegia
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5
Q

What is an ischaemic stroke?

A

Interruption of cerebral blood supply

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6
Q

What might cause and ischaemic stroke?

A

Embolism
Thrombosis
Systemic hypoperfusion

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7
Q

What is the oxford classification of strokes?

A

Anterior circulation infarct - partial/total
Posterior circulation infarct
Lacunar infarction

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8
Q

What is an anterior circulation infarction and what are the symptoms?

A

Anterior and middle cerebral artery stroke
Contralateral weakness
Contralateral sensory loss/sensory inattention
Dysarthria
Dysphasia (receptive/expressive)
Homonymous hemianopia/visual inattention
Higher cortical dysfunction

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9
Q

What are the symptoms of a posterior circulation infarction?

A

CN palsies and contralateral motor/sensory deficit
Conjugate eye movement
Cerebellar dysfunction eg vertigo, nystagmus, ataxia, dysarthria
Isolated homonymous hemianopia
Bilateral events can cause reduced GCS

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10
Q

What is a lacunar infart?

A

Occlusion of deep penetrating arteries
Affects a small volume of subcortical white matter - no cortical features
Underlying process often small vessel disease

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11
Q

What are the lacunar syndromes?

A 
Pure motor hemiparesis
Ataxic hemiparesis
Clumsy hand and dysarthria
Pure hemisensory
Mixed sensorimotor
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12
Q

What is the Bamford stroke classification of a total anterior circulation stroke?

A

All 3 of the following:

  • Unilateral weakness (and/or sensory deficit) of the face, arm, and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
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13
Q

What is the Bamford stroke classification of a partial anterior circulation stroke?

A

2 of the following

  • Unilateral weakness (and/or sensory deficit) of the face, arm, and leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction (dysphasia, visuospatial disorder)
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14
Q

What is the Bamford stroke classification for lacunar syndrome?

A

1 of the following

  • Pure sensory stroke
  • Pure motor stroke
  • Sensori-motor stroke
  • Ataxia hemiparesis
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15
Q

What is the Bamford stroke classification of a posterior circulation stroke?

A

1 of the following

  • CN palsy and contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Conjugate eye movement disorder (eg gaze palsy)
  • Cerebellar dysfunction (ataxia, nystagmus, vertigo)
  • Isolated homonymous hemianopia or cortical blindness
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16
Q

How do you assess a stroke in A&E?

A

ABCDE assessment + bloods, BM
Brief Hx and examination (time of onset, RF, CI to thrombolysis)
BP
NIHSS - grade severity of stroke

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17
Q

What investigations should you do for a stroke?

A

Urgent CT head +/- CT angiography

18
Q

How can you treat a stroke?

A

Thrombolysis +/- mechanical thrombectomy if indicated
OR
Aspirin 300mg

19
Q

What should you do after someone has had a stroke?

A

Investigate the cause
Screen and prevent complications (dehydration, aspiration, VTEs, pressure sores, infection, depression)
Establish secondary prevention (lifestyle, medication, surgery)
Rehabilitation (physiotherapy, occupational therapy, SALT)

20
Q

What is the medication for secondary prevention?

A 
Aspirin 75mg for 3 weeks
Clopidogrel 75mg for life
Statin
BP medication
Ect
21
Q

What surgery can be done for secondary prevention?

A

Stents in carotids

Carotid surgery

22
Q

What is the NIHSS?

A

National Institutes of Health Stroke Scale

Grades and tracks severity of stroke

23
Q

What does the NIHSS look at?

A 
Level of consciousness
Best gaze
Visual symptoms
Facial palsy severity
Motor arm and leg symptoms
Limb ataxia severity
Sensory loss severity
Best language
Dysarthria severity
Extinction and inattention
24
Q

What are the pros of doing a CT in an acute stroke?

A

Quick
Readily available 24/7
Sensitive for haemorrhage
May see hyperdense vessels

25
Q

What are the cons of doing a CT in acute stroke?

A

Cannot usually diagnose an infarct in acute phase
Less sensitive than MRI for picking up other abnormalities eg demyelination, mass lesions, microhaemorrahges and for lacunar and PCI

26
Q

What is thrombolysis?

A

Breaking down an acute clot

27
Q

What do you give in thrombolysis?

A

Alteplase - IV - tissue plasminogen activator

0.9mg/kg

28
Q

When can you give thrombolysis?

A

Within 4.5 hours of symptom onset

29
Q

What are the CI of thrombolysis?

A

Symptoms only minor or rapidly improving
Haemorrhage on imaging
Suspected SAH
Active bleed from any site
Recent GI/urinary tract haemorrhage within 21 days
Platelet count < 100,000/mm3
Recent treatment with heparin and APTT above normal
Recent treatment with warfarin and INR elevated
Recent major surgery or trauma within last 14 days
Recent post MI pericarditis
Neurosurgery, serious head trauma or previous stroke within 3 months
Hx of intracranial haemorrhage ever
Known arteriovenous malformation or aneurysm
Recent arterial puncture at non-compressible site
Recent LP
BP > 185/110
Abnormal BM
Suspected/known pregnancy
Active pancreatitis
Epileptic seizure at stroke onset

30
Q

What care needs to be given post-thrombolysis?

A

More aggressive BP monitoring
Vigilance for complications
24 hr CT head

31
Q

What is a mechanical thrombectomy?

A

Mechanical recanalisation of culprit vessel
Proximal stenosis
Can be used with thrombolysis

32
Q

What is the time frame for anterior circulation stroke treatment with thrombectomy?

A

6 hours

33
Q

What bloods should you do in stroke?

A 
FBC
ESR
U&E
Lipid profile
LFT
CRP
Clotting screen
Glucose and HbA1c
34
Q

What investigations should you do after a stroke?

A 
Bloods
ECG
Carotid doppler USS
Echo
MRI
35
Q

What extra investigations should you do in a young person?

A

Bloods - HIV and vasculitis screen, thrombophilia screen, homocysteine
Cardiac investigations - 7 day holter recorder, implantable loop recorder, transcranial doppler, transoesophageal echo
Vascular imaging - CT/MRI angiography

36
Q

What is a watershed stroke?

A

A stroke occurring due to lack of blood supply in areas that are supplied by 2 arteries

37
Q

Who is involved in stroke care from the MDT?

A 
Nurses
Physio
OT
SALT
Dieticians
Orthoptics
38
Q

What lifestyle changes can be made following a stroke?

A 
Smoking cessation
Drug and alcohol cessation
Dietary modifications
Exercise
Driving advice
39
Q

What medical treatment can be given post-stroke?

A 
VTE assessment
Hydration
NG feeding +/- PEG
Spasticity - physio/botox
Monitor for infection
Antiplatelets
Anticoags
Hypertension treatment
Statins
40
Q

What are the 5 aspects in the management of haemorrhagic strokes?

A

ABCDE
BP
Bleeding tendency (coagulopathy/low platelets/medication related)
Underlying malformation - tumour aneurysm, amyloid angiopathy, AV malformation, cavernoma
Need for neurosurgery - useful for superficial clots, CSF obstruction causes hydrocephalus, posterior fossa decompression

41
Q

What can reverse anticoagulation?

A

Warfarin - beriplex and vit K
Heparin - protamine
LMWH - protamine (only partially)

42
Q

What can mimic stroke?

A 
Seizures
Tumours/abscess
Migraine
Metabolic - hypoglycaemia, hyponatraemia
Functional
Spinal cord/peripheral nerve/cranial nerve

Neuro and geriatrics (21 decks)

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