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w206 stroke > stroke catchall > Flashcards

stroke catchall Flashcards

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?

A

4.5hrs

20
Q

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

A

Give 300mg aspirin and monitor

21
Q

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

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

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

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

What causes a cerebral infarction?

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?

A

Alteplase

25
Q

What are the 5 types of emboli?

A
  • Thrombus
  • Fat
  • Air
  • Septic
  • Fluid
26
Q

What are the 3 main types of cerebral infarction?

A
  • cerebral hemisphere infarction
  • Brain stem infarction
  • Multi infarct dementia
27
Q

What are the 4 main types of primary inter-cranial haemorrhage?

A
  • Sub-arachnoid haemorrhage
  • Sub-dural haemorrhage
  • Extra-dural haemorrhage
  • Intercranial Venous thrombosis
28
Q

What are the key features of a sub-arachnoid haemorrhage?

A
  • Thunder clap Headache
  • Meningism
  • +/-
  • Often accompanied by nausea and vomitting
29
Q

Where do aneurysms normally form?

A

Berry aneurysms (70% of aneurysms) normally form at:

  • Junction of the posterior communicating and carotid
  • Anterior communicating and ACA
  • Bifurcation of the MCA
30
Q

What are the tests for aneurysm?

A
  • 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
Q

What is the management of a sub-arachnoid haemorrhage?

A
  • Refer to neurosurgeons immediately
  • Rexamine CNS often →check pupils and GCS
  • maintain cerebral pefusion with hydration
  • administer nimodipine (ca+2 agonist). ↓ vasospasm
32
Q

What is a sub-dural haemorrhage?

A

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
Q

What are the symptoms of a subdural haemorrhage?

A
  • fluctuating lvl of consciousness +/- insidious loss of physical of intellectual capacity
  • slowing, unsteadiness
  • sleepiness
  • Headache
  • Personailty change
34
Q

What are the tests for a Subdural?

A

CT/MRI looking for clot +/- midline shift

35
Q

What is the treatment for a subdural haemorrhage?

A

irrigation/evacuation → surgical. craniostomy/craniotomy.

36
Q

What is an extradural haemorrhage?

A

Extramdural haemorrhages are an arterial bleed outside the dura but under the skull.

37
Q

what is the normal cause of an extradural bleed?

A

Trauma to the temporal bone of the skull damaging the middle menegeal artery.

38
Q

What are the symptoms of an extradural haemorrhage?

A
  • 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
Q

What are the tests for Extradural haemorrhage?

A
  • CT head

* LP is contraindicated as raised intracranial pressure can cause coning.

40
Q

What is the treatment of an extradural bleed?

A

•Surgical excision.

41
Q

What is Intravenous Cranial thrombosis?

A

ICT is thombosis of the cranial sinus.

42
Q

What are the common causes of Intercranial venous thrombosis

A
  • Pregnancy/puerperium
  • Oral contreceptive pill
  • head injury
  • dehydration
  • intercranial malignancy and blood disorders
  • Recent Lumbar puncture
  • INFECTION
43
Q

What tests do you do for intercranial venous thrombosis?

A

CT/MRI venogram

44
Q

What are the symptoms of intercranial venous thrombosis?

A
  • Headache !!!!
  • Vomitting, siezures
  • Raised intercranial pressure → papiloedema
45
Q

What is the treatment for intercranial venous thrombosis?

A

•Heperinise + seek help

w206 stroke (2 decks)

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