Stroke and cerebrovascular disease Flashcards
most treatable stroke risk factor
HTN
FAST
face
arm
speech
time
what is a stroke
Rapid onset of neurological deficit which is the result of vascular lesion & associated with infarction of central nervous tissue. A completed stroke is when the neurological deficit has reached its maximum (usually within 6 hrs)
TIA
transient ischaemic attack (TIA)
a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction
pathogenesis stroke
85% arterial embolism or thrombosis in carotid, vertebral or cerebral arteries
15% intracranial or subarachnoid haemorrhage
less common - venous thrombosis, MS relapse, tumour or abscess, carotid/vertebral dissection
where do emboli arise from in stroke
atheromatous plaques in the carotid or vertebrobasilar arteries
cardiac mural thrombi (eg following MI)
left atrium in atrial fibrillation
pathogenesis TIA
microemboli from atheromatous plaques or cardiac mural thrombi
temporary drop in cerebral perfusion
risk factors TIA and stroke
HTN DM oestrogen contraceptives XS alcohol polycythaemia atrial fibrillation
TIA presentation
sudden onset
focal neurological deficit
maximal at onset and lasts 5-15min
TIA symptoms if in carotid
aphasia hemiparesis hemisensory loss hemianopic visual loss amaurosis fugax
TIA symptoms if vertebrobasilar territory
diplopia, vertigo, vomiting choking ataxia - loss of control of body movements hemisensory loss hemianopic or bilateral visual loss tetraparesis
what is amaurosis fugax
painless transient monocular blindness as a result of the passage of emboli through the retinal arteries
investigations TIA
- diagnosis is clinical
- MRI of brain and specialist review within 24h if ABCD2 score >= 4 or if crescendo TIAs
- carotid artery imaging to look for atheroma and stenosis
- bloods
ABCD2 risk of stroke after TIA
A - age >60 (1)
B- BP >140s or 90d (1)
C- clinical features: unilateral weakness (2), speech disturbance without weakness (1)
D - duration of TIA: > 60 min (2), 10-59 min (1), presence of DM (1)
2 - 2 day risk of stroke is 4.1% with a score of 4-5, and 8.1% with a score 6-7
TIA rx
anti-thombotic - aspirin immediately and long term
LT anticoagulation w warfarin in pts in AF/ vavlular lesions / dilated cardiomyopathy
control HTN
Statin if cholesterol > 3.5
carotid endarterectomy
most common symptom of cerebral stroke
hemiplegia caused by infarction of the internal capsule following occlusion of a branch of the middle cerebral artery
3 types of stroke
cerebral hemisphere infarcts
brainstem infarction
multi infarct
cerebral stroke signs
contralateral to the lesion
hemiplegia (arm > leg) (hypotonic then spastic)
hemisensory loss
UMN facial weakness and hemianopia
most common syndrome relating to brainstem infarction
the lateral medullary syndrome caused by occlusion of the posterior inferior cerebellar artery
sudden vomiting and vertigo
facial numbness
opp side to lesion = loss of pain and temp sensation
multi infarct dementia
a syndrome caused by multiple small cortical infarcts = generalised intellectual loss
final picture: dementia, shuffling gait resembling parkisons
investigations stroke
emergency
brain CT or MRI - site, ischaemic/haemorrhagic, conds mimicking stroke
bloods
ECG if AF/ MI
immediate rx stroke
aspirin ASAP
thrombolysis - IV alteplase if given within 4.5hrs of onset of symptoms (CI haemorrhage)
HTN - BP lowered in acute phase
supportive care stroke
stroke unit
swallowing and feeding dysphagia - aspiration = pneumonia
internal carotid stent / endarterectomy
physio and occupational therapist
There is an important genetic condition which predisposes people to subarachnoid hemorrhage, give me the name of the condition, its pattern of inheritance and how it causes SAH
Polycystic kidney disease, autosomal dominant, predisposes to berry aneurysms
