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Cardiovascular System > Stroke And TIA (pathology) > Flashcards

Stroke And TIA (pathology) Flashcards

1
Q

What is a stroke?

A

Stroke
A blocked or ruptured blood vessel in the brain causing failure of neuronal function leading (usually) to deficit in brain function (Lasting > 24 hours)

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2
Q

What are different types of strokes (2)?

A

Haemorrhagic stroke (10-15%) due to:

  • Hypertension
  • Amyloid (glass like vessel)
  • Excess alcohol
  • Hypocholesterolaemia
  • Haemorrhagic transformation

Ischaemic stroke- infarction (85-90%)

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3
Q

What are the causes of strokes (8)?

A
  • Carotid stenosis due to clot or atheroma
  • Carotid plaque with arteriogenic emboli
  • Atrial fibrillation (clots in left atrial appendage-> aorta-> cerebral vessels)
  • Penetrating artery disease= Lacunar stroke
  • Carotid dissection
  • Intracranial atherosclerosis
  • Left ventricle emboli
  • Valve disease
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4
Q

How long does a transient ischaemic attack last?

A

<24hrs

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5
Q

What are the TIA sub-types (2)?

A

Carotid system

Vertebrobasilar system

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6
Q

Which arteries are involved in a carotid system TIA?

A

Carotid system

  • Common carotid
  • Internal carotid
  • Middle cerebral artery
    - Lenticulostriate a. (lacunar stroke)
  • Anterior cerebral
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7
Q

Which arteries are involved in a vertebrobasilar system TIA?

A
  • Vertebral artery
  • Basilar artery
  • Cerebellar artery
  • Posterior cerebral artery
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8
Q

What are the stroke subtypes (4)?

A

• TACS: Total anterior circulation stroke-> all MCA – HIGHEST MORTALITY (60%)
• PACS: partial anterior circulation stroke – branches of MCA
• LACS: lacunar stroke
POCS: posterior circulation stroke

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9
Q

What are the risk factors for a stroke (10)?

A
  • High blood pressure (MOST IMPORTANT)
  • AF
  • Diabetes Mellitus
  • Smoking
  • Alcohol
  • Previous stroke
  • Oral contraceptive with high oestrogen
  • Hypercoagulability (malignancy or genetic)
  • Ratio of ApoB to ApoA
  • Cocaine use
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10
Q

What does FAST stand for?

A

Face: unilateral drooping
Arms: weak or numb, unable to lift
Speech: slurred
Time: call 999

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11
Q

What are the symptoms and signs of a stroke (9)?

A
  • Motor (clumsy or weak limb)
  • Sensory (loss of feeling)
  • Speech (Dysarthria=slurred speech, dysphasia=loss of speech)
  • Neglect/visuospatial problems
  • Vision: loss in one eye or Hemianopia (loss of half vision in each eye)
  • Gaze palsy= stuck in 1 direction
  • Ataxia= difficulty with balance, walking, coordination)
  • Nystagmus= repetitive uncontrolled eye movements
  • Vertigo
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12
Q

What are the relevant investigations in a stroke?

A
  • Bloods
  • ECG for AF
  • Echo for structural abnormalities
  • CT head (rule out bleed, tumour, hydrocephalus)
  • Carotid USS:
    • Look at velocity of flow (Poiseuille’s law)
      • Velocity < 125 cm/s= < 50% stenosis
      • > 125 cm/s= 50-69% stenosis
      • > 270 cm/s = 70-79% stenosis
      • End diastolic v > 140 cm/s= 80-99% stenosis
  • Diffusion weighted MRI
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13
Q

What are the relevant examinations for a stroke?

A
  • Neurological examination
  • Cardiac examination
  • Auscultate carotids
  • Listen for murmurs -> endocarditis
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14
Q

What is the goal when examining and investigating a stroke?

A

To distinguish between ischaemic and haemorrhagic stroke

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15
Q

What is the treatment/management for a TIA?

A
  • Assess risk of subsequent stroke (ABCD2)

- Start Aspirin 300 mg

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16
Q

What is the treatment/management for a ischaemic stroke (no haemorrhage)?

A
  • Immediate Thrombolysis - ALTEPLASE (within 4.5 hours of symptoms onset)
  • Clot retrieval - Thrombectomy
17
Q

What is prophylactic surgery? When would this be appropriate?

A

Prophylactic surgery is a Carotid endarterectomy = removal of plaque from carotid artery
- have to take care not to damage vagus or hypoglossal nerves

Surgery appropriate depending on risk of stroke and MI (stenosis):

  • > 70 % stenosis= endarterectomy
  • < 50%= NO endarterectomy
  • Asymptomatic disease= NO surgery- best medical therapy

Risk of subsequent strokes = 2 weeks cut-off for surgery

18
Q

What is the long-term treatment for strokes?

A
  • Antiplatelets
  • Statins
  • Blood pressure management
  • Anticoagulation (APIXABAN, RIVAROXABAN for AF)

Cardiovascular System (37 decks)

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