Stroke Flashcards

1
Q

What’s Stroke?

A

A stroke can be defined as a sudden global or focal Neurological deficit resulting from spontaneous hemorrhage or infarction of the CNS with objective evidence of infarction irrespective of duration of clinical symptoms.
(According to WHO)

Stroke is also called Cerebrovascular accident.

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2
Q

what’s the classification of Stroke?

And which is more common?

A

Hemorrhagic
Ischemic

Ischemic stroke; Embolic , Thrombotic

Hemorrhagic stroke: Intracranial hemorrhage, Subarachnoid hemorrhage.

Ischemic is the most common while Hemorrhagic is more severe!!

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3
Q

Risk factors for Stroke (modifiable)

A

Modifiable includes

Alcohol
DM
Smoking
Hyperlipidemia
Obesity
Atrial fibrillation
OCP - oral contraceptives 
Drugs
Hyperviscosity syndrome
Carotid artery stenosis
Etc
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4
Q

Non modifiable risk factors for Stroke

A
Non Modifiable risk factors include
Race(blacks)
Age(advanced)
Sex(male)
Genetics(CADASIL)
Family hx
Previous hx
Gender
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5
Q

Hemorrhagic stroke occurs at the rest. T/F?

A

F

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6
Q

Ischemic stroke occurs with history of TIA? T/F

A

T

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7
Q

There’s severe headache in ischemic stroke T/F?

A

F

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8
Q

Cause of severe headache in hemorrhagic stroke

A

Ruptured berry aneurysm at the peak of physical activity will lead to Subarachnoid hemorrhage and sudden onset of THUNDER CLAP HEADACHE.

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9
Q

Risk factors for hemorrhagic Stroke

A
Severe hypertension 
Bleeding disorders 
Prolonged antiplatelet use
Arteriovenous malformation 
APS
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10
Q

Monroe Kelly rule

A
Monroe Kelly’s rule states that the pressure in the skull cavity is always constant as the skull is a rigid structure. It comprises of the following

1. Cerebrospinal fluid
2. Brain mass
3. Blood(bleeding)
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11
Q

Ischemic Stroke Syndtomes according to affected artery

A
Ischemic stroke syndromes 
1- middle cerebral artery occlusion 
   Signs and symptoms 
-Hemiparesis
-hemisensory deficit
-motor aphasia
-central aphasia
-quadrantanopia
-eye deviation to side of lesion

2-Anterior Cerebral Artery

  • contralateral weakness of lowerlimb more than upper
  • mood and cognition impairments
  • urinary incontinence
  • gait apraxia

3- posterior cerebral artery

- memory deficit
 - cortical blondness
  - dense sensory loss,dysethesias
  - cortical blindness 
   - homonymous hemianopia
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12
Q

the most common site affected in the brain is? (Stroke)

A

Internal capsule

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13
Q

AREA of dead tissue that is irreversibly damaged IN THE BRAIN is called?

A

Umbra

Penumbra is the area around it.

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14
Q

So which type of necrosis occurs in Stroke???

A

It’s LIQUEFACTIVE or COLLIQUATIVE NECROSIS

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15
Q

Investigation for Stroke

A

Specific: non contrast CT scan of the brain ~> Hypodense lesion
CT is normal in first 24 - 72 hrs
Signs of cerebral edema( flattened gyri, effaced sulci)

Non specific:

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16
Q

Management of Stroke

A

ADMIT PATIENT
•RESUSCITATE USING ABC PROTOCOL
•PERFORM HEAD CT
•IF ISCHEMIC, INITIATE THROMBOLYTICS(tPA) IF < 4,5 HOURS OF ONSET or INTRA-ARTERIAL REPERFUSION
•GIVE ANTIPLATELETS (ASPIRIN), LMW HEPARIN AND STATIN AS PROPHYLAXIS
•MECHANICAL THROMBOECTOMY
•CONTROL BP ONLY IF MAP > 145mmHg or SBP > 220mmHg or DBP > 120mmHg
•CONTROL CEREBRAL EDEMA WITH MANNITOL
•TURN PATIENT REGULARLY TO PREVENT BED SORES
•EARLY PHYSIOTHERAPY IS ESSENTIAL TO REGAIN FUNCTIONS
•GIVE ANTIOXIDANTS Vitamins A,C,E

•In HEMORRHAGIC STROKE, THROMBOLYTIC THERAPY AND ASPIRIN ARE CONTRAINDICATED!!!!

17
Q

What is ‘Permissive Hypertension’ in management of Stroke ?

A

Allowing a SBP OF LESS THAN 220, DBP LESS THAN 120

We do this to allow perfusion to the area of PENUMBRA.
If we quickly crash the BP, the UMBRA are will widen due to poor perfusion of blood.

18
Q

Complications of Stroke

A
Trauma from falling 
Loss of bowel function 
Loss of sphincter function 
Paralysis 
Decubitus ulcers 
Paresis

Acute complications >7days

Cerebral edema 
Increased ICP
Seizures 
Hypoxia
Cardiac arrythmias

Chronic complications

Dementia
Epilepsy
Speech difficulty
Gait problems