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Y4: Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

2 main types of stroke

A

ischaemic 85% (TIA if <24hr, ischaemic stroke if >24hr)

haemorrhagic 15%

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2
Q

subtypes of ischaemic stroke?

A

thrombotic

embolic (AF big risk factor)

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3
Q

subtypes of haemorrhagic stroke?

A

intracerebral haemorrhage

SAH

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4
Q

risk factors for
1) ischaemic
2) haemorrhagic
stroke

A

1) cardiovascular: age, hypertension, smoking, hyperlipidaemia, DM
2) age, hypertension, AVM, anticoagulation therapy

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5
Q

what is stroke (WHO defintion)

A

rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin

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6
Q

symptoms of a cerebral hemisphere infarct?

A

contralateral hemiplegia (flaccid then spastic)
contralateral sensory loss
homonymous hemianopia
dysphasia

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7
Q

symptoms of brainstem infarction?

A

may have more severe symptoms including quadriplegia and lock-in syndrome

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8
Q

what are lacunar infarcts?

A

small infarcts around the basal ganglia, internal capsule, thalamus and pons

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9
Q

symptoms of lacunar infarcts?

A

pure motor, pure sensory, mixed motor and sensory signs or ataxia

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10
Q

what 3 criteria is the oxford stroke classification system based on?

A

1) hemiplegia or hemi-sensory loss in face, arm and leg
2) homonymous hemianopia
3) high cognitive deficit e.g. aphasia

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11
Q

what 3 criteria is the oxford stroke classification system based on?

A

1) unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2) homonymous hemianopia
3) higher cognitive deficit e.g. dyphasia

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12
Q

Total anterior circulation infacts (TACI)

1) involves which cerebral arteries
2) which oxford stroke classification criteria are present?

A

1) middle and anterior

2) all 3

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13
Q

Partial anterior circulation infacts (PACI)

1) involves which cerebral arteries
2) which oxford stroke classification criteria are present?

A

1) small arteries of anterior circulation e.g. upper or lower division of MCA
2) just 2

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14
Q

.

A

.

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15
Q

Lacunar infarcts (LACI)

1) involves which cerebral arteries
2) presents how?

A

1) perforating arteries around internal capsule, thalamus and basal ganglia
2) 1 of:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke
- ataxic hemiparesis

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16
Q

Posterior circulation infarcts (POCI)

1) involves which cerebral arteries
2) which oxford stroke classification criteria are present?

A

1) vertebrobasilar arteries
2) 1 of:
- cerebellar or brainstem syndromes
- LOC
- Isolated homonymous hemianopia

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17
Q

Whilst symptoms alone cannot be used to differentiate haemorrhagic from ischaemic strokes, patients who’ve suffered haemorrhages are more likely to have:

A

decreased LOC

HA, N&V, seizure

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18
Q

why is neuroimaging urgently indicated in stroke?

A

to classify as either ischaemic or haemorrhagic and thereby determine whether thrombolysis can be done

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19
Q

what is the criteria for offering thrombolysis in stroke?

A

must administer within 4.5hrs of onset of symptoms

haemorrhage has been definitively excluded (i.e. imaging)

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20
Q

once haemorrhagic stroke has been excluded patients should be given what medication?

A

300mg aspirin

21
Q

immediate management of TIA?

A

aspirin 300mg (unless contraindicated)

22
Q

referral pathway

1) if patient has had suspected TIA in last 7 days
2) if patient has had suspected ITA more than 1 week previously

A

1) urgent assessment within 24hr by stroke specialist

2) urgent specialist assessment within 7 days

23
Q

T/F: the vast majority of patients with haemorrhagic stroke will undergo surgical intervention

A

false - most not suitable for surgical intervention

24
Q

management of haemorrhagic stroke?

A

supportive

  • stop anticoagulants and antithrombotics e.g. clopidogrel
  • reverse anticoagulation asap
25
Q

what is the ROSIER score used for?

A

to identify symptoms of stroke (exclude hypoglycaemia first)

if >0, stroke is likely

26
Q

1st line radiological investigation for suspected stroke?

A

non-contrast CT head

27
Q

immediate management of acute stroke?

A

aspirin 300mg PO/ PR asap once haemorrhagic stroke excluded

28
Q

T/F: AF should be immediately treated with anticoagulants if identified in a stroke patient

A

False- anticoagulants should not be started until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke

29
Q

thrombolysis agent?

A

alteplase

30
Q

absolute contraindications to thrombolysis?

A

previous haemorrhagic stroke

31
Q

absolute contraindications to thrombolysis?

A
  • Previous IC haemorrhage
  • Seizure at onset of stroke
  • Intracranial neoplasm
  • Suspected SAH
  • Stroke/ traumatic brain injury in preceding 3 months
  • LP in past 7 days
  • GI haemorrhage in preceding 3 weeks
  • Active bleeding
  • Pregnancy
  • Oesophageal varices
  • Uncontrolled hypertension >200/120mmHg
32
Q

Offer thrombectomy as soon as possible and within ___ hours of symptom onset, together with ?what?, to people who have: acute ischaemic stroke and confirmed occlusion of the __ __ circulation demonstrated by what imaging

A

6
IV alteplase (if <4.5 hr)
anterior cerebral
CT/ MR-angiogram

(can be up to 24 hours if imaging shows potential to salvage brain tissue e.g. limited infarct core volume)

33
Q

Offer thrombectomy as soon as possible and within ___ hours of symptom onset, together with ?what?, to people who have: acute ischaemic stroke and confirmed occlusion of the __ __ circulation demonstrated by what imaging

A

6
IV thrombolysis (if <4.5 hr)
proximal anterior
CTA/ MRA

(can be up to 24 hours if imaging shows potential to salvage brain tissue e.g. limited infarct core volume)

34
Q

secondary prevention post stroke?

A

clopidogrel first line

aspirin + MR dipyridamole if clopidogrel not tolerated

35
Q

T/F: hypertensives should be routinely used post stroke

A

false - only in those with HTN

36
Q

T/F: hypertensives should be routinely used post stroke

A 
only if there is a hypertensive emergency:
Hypertensive encephalopathy
Hypertensive nephropathy
Hypertensive HF/ MI
Aortic dissection
Pre-eclampsia/eclampsia
37
Q

T/F: all stroke patients should be started on a statin

A

False- only if cholesterol is > 3.5 mmol/l

Many physicians will delay treatment until 48 hr due to the risk of haemorrhagic transformation

38
Q

what is Wallenberg’s syndrome?

A

aka lateral medullary syndrome

ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss

39
Q

what is Weber’s syndrome?

A 
ipsilateral CN III palsy
contralateral weakness (upper and lower limbs)
40
Q

effects of a stroke affecting anterior cerebral artery?

A

contralateral hemiparesis and sensory loss

lower limb > upper

41
Q

effects of a stroke affecting middle cerebral artery?

A

contralateral hemiparesis and sensory loss
upper limb > lower
contralateral homonymous hemianopia
aphasia

42
Q

effects of a stroke affecting posterior cerebral artery?

A

contralateral homonymous hemianopia with macular sparing

visual agnosia

43
Q

what arteries are affected in weber’s syndrome?

A

branches of the posterior cerebral artery that supply the midbrain

44
Q

which vessels are affected in Wallenberg syndrome?

A

posterior inferior cerebellar artery

45
Q

what kind of visual loss is associated with retinal/ ophthalmic artery occlusion?

A

Amaurosis fugax

46
Q

a lesion in the __ artery can lead to ‘locked in’ syndrome

A

basilar

47
Q

T/F: lacunar strokes have a strong association with hypertension

A

true

48
Q

stroke of ACA affects ___

stroke of MCA affects ____

stroke of PCA affects ____

A

leg

face

vision/ arm

Y4: Neurology (13 decks)

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