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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the main causes of stroke?

A

Small vessel occlusion, thrombosis in situ, cardiac emboli, atherothromboembolism, CNS bleeds

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2
Q

What imaging result can indicate cardiac emboli?

A

Bilateral infarcts

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3
Q

What cardiac condition can cause cardiac emboli?

A

Atrial fibrillation, MI, valve disease, IE

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4
Q

What are risk factors for an ischaemic stroke?

A

Age, male, HTN, smoking, DM, past TIA, heart disease, combined oral contraceptive pill

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5
Q

What clinical presentations suggest haemorrhage?

A

Meningism, severe headache, coma

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6
Q

What clinical presentations suggest a cerebral infarct?

A

Contralateral sensory loss, contralateral hemiplegia that’s initially flaccid but becomes spastic, dysphasia, homonymous hemianopia, visuo-spatial deficit, UMN facial weakness that’s forehead sparing

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7
Q

What clinical presentations suggest a brainstem infarct?

A

Quadriplegia, locked-in syndrome, facial numbness/paralysis, gaze/vision disturbances, dysarthria and speech impairment, altered consciousness

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8
Q

Where are lacunar infarcts?

A

Basal ganglia, internal capsule, thalamus, pons

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9
Q

What are the 4 clinical presentations that suggest a lacunar infarct?

A

Ataxic hemiparesis, unilateral motor weakness, sensory loss, dysarthria/clumsy hand

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10
Q

In which lacunar stroke is consciousness/cognition not intact?

A

Thalamic strokes

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11
Q

When would you do a diffusion-weighted MRI?

A

If diagnosis is uncertain

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12
Q

How would you check for a cardiac embolus?

A

ECG

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13
Q

What blood tests should you do?

A

Glucose, FBC, U&Es, Cholesterol, INR if on warfarin

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14
Q

How would you check for vasculitis?

A

ESR increased

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15
Q

What are some differential diagnoses?

A

Head injury, hypo/hyperglycaemia, subdural haemorrhage, Intracranial tumours, hemiplegic migraine, encephalopathy

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16
Q

How can you test perceptual function?

A

Point to a named part of the body

17
Q

How can you test spatial ability?

A

Copying matchstick patterns

18
Q

How can you test apraxia?

A

Dressing, copying a clock face

19
Q

How can you test agnosia?

A

Picking out and naming easy objects from a pile

20
Q

How can you monitor progress?

A

Time taken to sit up and transfer to a chair

21
Q

What are some potential complications due to immobility?

A

Pressure sores, aspiration pneumonia, constipation, contractures

22
Q

What primary prevention is there?

A

Control risk factors, exercise, lifelong anticoagulation AF and prosthetic heart valves

23
Q

What secondary prevention is there?

A

Control risk factors, antiplatelets, anticoagulation after stroke from AF

24
Q

What areas does Barthel’s index of activity of daily living cover?

A

Bowels, bladder, grooming, toilet use, feeding, transfer, mobility, dressing, stairs, bath/shower

25
Q

How do you distinguish between an ischaemic and haemorrhagic stroke?

A

An urgent CT/MRI

26
Q

What is the first thing you should do once a haemorrhagic stroke is excluded?

A

Aspirin 300mg

27
Q

What antiplatelet therapy would you start after an ischaemic stroke?

A

Aspirin 300mg daily for 2 weeks then clopidogrel

28
Q

When would you start anticoagulation?

A

If the patient has AF

29
Q

How soon must you do thrombolysis?

A

Within 4.5 hours of symptoms onset

30
Q

How is thrombolysis done?

A

IV Alteplase

31
Q

Why must thrombolysis be done within 4.5 hours?

A

It can cause massive bleeds so benefits outweigh risk only within this time

32
Q

Other than thrombolysis, what is a management option?

A

Mechanical thrombectomy

33
Q

How would you manage an intracerebral haemorrhage?

A

Stop anti-coagulants immediately, control BP, reduce ICP

34
Q

How can you reduce ICP?

A

Mechanical ventilation, IV mannitol

35
Q

What is the first thing you would do?

A

CT imaging of the head

Neurology (22 decks)

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