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w206 stroke > stroke catchall > Flashcards

stroke catchall Flashcards

(45 cards)

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1
Q

What is the definition of stroke?

A

A rapid onset of neurological deficit (usually focal) which is the result of a vascular liesion and associated with an infarction of central nervous tissue.

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2
Q

What is a stroke in evolution?

A

A stroke in evolution is when the symptom and signs get worse usually within 24hrs of onset

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3
Q

What is the definition of a minor stroke?

A

This is a stroke where the patient recovers without a significant neurological deficit usually over the period of about a week

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4
Q

What is a TIA?

A

A TIA is a transient episode of neurological deficit which is caused by a focal brain, spinal cord or retinal ischaemia WITHOUT acute infarction.

They usually reoccur and can herald thrombo embolic stroke.

They can also herald MI

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5
Q

Roughly what % of strokes are Hemorrhagic in nature?

A

15%

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6
Q

Roughly what % of strokes are Ischaemic in nature?

A

85%

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7
Q

A young person presents with neck pain, trauma, or neck manipulation. What must be considered?

A

Dissection of the carotid or vertebral arteries.

In young people1/5th of strokes are due to dissection.

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8
Q

What is amaurosis fugax?

A

Painless monocular temporary loss of vision. “like a curtain coming down across the eye”.

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9
Q

How long does a TIA last?

A

Normally 10-15 mins but defined as less than 24hrs.

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10
Q

What is the test to assess the severity of a TIA?

A

ABCD2

A = age
B = B/P
C = clinical features
D = duration of symptoms
D = diabetes
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11
Q

What is a crescendo TIA?

A

More than 2 in a week.

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12
Q

What are the causes of TIA?

A
  • Artherothromboembolism → Chiefly from the carotid.
  • Cardioembolism → post MI or due to AF
  • Hyperviscosity
  • Vasculitis
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13
Q

What symptoms are associated with a carotid territory TIA?

A
  • Amaurosis fugax
  • Aphasia
  • Hemiparesis
  • Hemisensory loss
  • Hemianopic visual loss
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14
Q

What symptoms are associated with vertebro-basilar territory TIA?

A
  • Diplopia, vertigo, vomiting
  • Choking dysarthria
  • Ataxia
  • Hemisensory loss
  • Hemianopic or bilateral sensory loss
  • Tetraparesis
  • LOC
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15
Q

What are the tests for TIA?

A

Aim to find cause and define vascular risks.

→ FBC, ESR, U&Es, Glucose, Lipids,CXR, ECG

→ Carotid doppler +/- Angiography

→ CT or diffusion weighted MRI

→ Echocardiogram

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16
Q

Why should you treat an TIA quickly?

A

If treated within 72hrs risk of stroke = 2%

If treated within 3 weeks risk = 10%

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17
Q

Treatment for TIA?

A
  • Treat Hypertension bp <140/90
  • Antiplatelet drugs → Clopidogrel or aspirin
  • AF →warfarin (cardiac embolii)
  • Carotid endarterectomy → If sentosis is >70% and there is good prognosis
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18
Q

What are the 4 pillars of stroke?

A
  • Acute onset
  • Focal neurological decficit
  • due to an atraumatic event
  • Lasting for aduration >2hrs (24hrs)
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19
Q

How long do you have to thromobolyse after the onset of a stroke?

20
Q

What do you do if a patient arrives and it is more than 4.5hrs since the onset of the stroke?

Study These Flashcards
A

Give 300mg aspirin and monitor

21
Q

What is the PC/PMH that points to an ischaemic stroke?

Study These Flashcards
A
  • Carotid bruit
  • AF
  • Past TIA
  • Ischaemic heart disease (IHD)
22
Q

What is the PC/PMH that points to haemorrhagic stroke?

Study These Flashcards
A
  • Meningism
  • Sever headache (Thunderclap)
  • Coma within hours
23
Q

What causes a cerebral infarction?

Study These Flashcards
A
  • Vessel occlusion causes brain ischaemia followed by infarction.
  • The infarcted area is then surrounded by a swollen area which can regain use later on.
24
Q

What drug is used to thrombolyse?

25
What are the 5 types of emboli?
* Thrombus * Fat * Air * Septic * Fluid
26
What are the 3 main types of cerebral infarction?
* cerebral hemisphere infarction * Brain stem infarction * Multi infarct dementia
27
What are the 4 main types of primary inter-cranial haemorrhage?
* Sub-arachnoid haemorrhage * Sub-dural haemorrhage * Extra-dural haemorrhage * Intercranial Venous thrombosis
28
What are the key features of a sub-arachnoid haemorrhage?
* Thunder clap Headache * Meningism * +/- * Often accompanied by nausea and vomitting
29
Where do aneurysms normally form?
Berry aneurysms (70% of aneurysms) normally form at: * Junction of the posterior communicating and carotid * Anterior communicating and ACA * Bifurcation of the MCA
30
What are the tests for aneurysm?
* CT head picks up 90% of cases * Lumbar puncture if CT head -ve if there are no contraindications. → SAH blood in LP is red in the first few hours and becomes yellow (xanthochromic) as bilirubin is broken down.
31
What is the management of a sub-arachnoid haemorrhage?
* Refer to neurosurgeons immediately * Rexamine CNS often →check pupils and GCS * maintain cerebral pefusion with hydration * administer nimodipine (ca+2 agonist). ↓ vasospasm
32
What is a sub-dural haemorrhage?
A collection of blood in the sub dural space normally caused by the rupture of a vein running from the hemisphere of the sagital sinus.
33
What are the symptoms of a subdural haemorrhage?
* fluctuating lvl of consciousness +/- insidious loss of physical of intellectual capacity * slowing, unsteadiness * sleepiness * Headache * Personailty change
34
What are the tests for a Subdural?
CT/MRI looking for clot +/- midline shift
35
What is the treatment for a subdural haemorrhage?
irrigation/evacuation → surgical. craniostomy/craniotomy.
36
What is an extradural haemorrhage?
Extramdural haemorrhages are an arterial bleed outside the dura but under the skull.
37
what is the normal cause of an extradural bleed?
Trauma to the temporal bone of the skull damaging the middle menegeal artery.
38
What are the symptoms of an extradural haemorrhage?
* Initial lucidity followed by delayed loss of conciousness and ↓GCS. * HA, vomiting, nausea + fits * raised inter cranial pressure → papiloedema * hemiparesis with brisk reflexes and upgoing plantar reflex.
39
What are the tests for Extradural haemorrhage?
* CT head | * LP is contraindicated as raised intracranial pressure can cause coning.
40
What is the treatment of an extradural bleed?
•Surgical excision.
41
What is Intravenous Cranial thrombosis?
ICT is thombosis of the cranial sinus.
42
What are the common causes of Intercranial venous thrombosis
* Pregnancy/puerperium * Oral contreceptive pill * head injury * dehydration * intercranial malignancy and blood disorders * Recent Lumbar puncture * INFECTION
43
What tests do you do for intercranial venous thrombosis?
CT/MRI venogram
44
What are the symptoms of intercranial venous thrombosis?
* Headache !!!! * Vomitting, siezures * Raised intercranial pressure → papiloedema
45
What is the treatment for intercranial venous thrombosis?
•Heperinise + seek help

w206 stroke (2 decks)

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