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Neuro > Stroke and cerebrovascular disease > Flashcards

Stroke and cerebrovascular disease Flashcards

1
Q

most treatable stroke risk factor

A

HTN

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2
Q

FAST

A

face
arm
speech
time

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3
Q

what is a stroke

A

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)

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4
Q

TIA

A

transient ischaemic attack (TIA)
a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia without acute infarction

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5
Q

pathogenesis stroke

A

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

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6
Q

where do emboli arise from in stroke

A

atheromatous plaques in the carotid or vertebrobasilar arteries
cardiac mural thrombi (eg following MI)
left atrium in atrial fibrillation

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7
Q

pathogenesis TIA

A

microemboli from atheromatous plaques or cardiac mural thrombi
temporary drop in cerebral perfusion

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8
Q

risk factors TIA and stroke

A 
HTN
DM
oestrogen contraceptives
XS alcohol
polycythaemia
atrial fibrillation
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9
Q

TIA presentation

A

sudden onset
focal neurological deficit
maximal at onset and lasts 5-15min

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10
Q

TIA symptoms if in carotid

A 
aphasia
hemiparesis
hemisensory loss
hemianopic visual loss
amaurosis fugax
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11
Q

TIA symptoms if vertebrobasilar territory

A 
diplopia, vertigo, vomiting
choking
ataxia - loss of control of body movements
hemisensory loss
hemianopic or bilateral visual loss
tetraparesis
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12
Q

what is amaurosis fugax

A

painless transient monocular blindness as a result of the passage of emboli through the retinal arteries

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13
Q

investigations TIA

A
  • 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
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14
Q

ABCD2 risk of stroke after TIA

A

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

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15
Q

TIA rx

A

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

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16
Q

most common symptom of cerebral stroke

A

hemiplegia caused by infarction of the internal capsule following occlusion of a branch of the middle cerebral artery

17
Q

3 types of stroke

A

cerebral hemisphere infarcts
brainstem infarction
multi infarct

18
Q

cerebral stroke signs

A

contralateral to the lesion
hemiplegia (arm > leg) (hypotonic then spastic)
hemisensory loss
UMN facial weakness and hemianopia

19
Q

most common syndrome relating to brainstem infarction

A

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

20
Q

multi infarct dementia

A

a syndrome caused by multiple small cortical infarcts = generalised intellectual loss
final picture: dementia, shuffling gait resembling parkisons

21
Q

investigations stroke

A

emergency
brain CT or MRI - site, ischaemic/haemorrhagic, conds mimicking stroke
bloods
ECG if AF/ MI

22
Q

immediate rx stroke

A

aspirin ASAP
thrombolysis - IV alteplase if given within 4.5hrs of onset of symptoms (CI haemorrhage)
HTN - BP lowered in acute phase

23
Q

supportive care stroke

A

stroke unit
swallowing and feeding dysphagia - aspiration = pneumonia
internal carotid stent / endarterectomy
physio and occupational therapist

24
Q

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

A

Polycystic kidney disease, autosomal dominant, predisposes to berry aneurysms

Neuro (15 decks)

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