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Stroke: Cerebrovasular Disease Flashcards

1
Q

what are the three different types of stroke?

A

haemorrhage
subarachnoid haemorrhage
infarct (ischaemic)

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2
Q

what are the three causes of haemorrhagic stroke?

A

structural abnormality

hypertensive

amyloid angiopathy

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3
Q

what are the three causes of haemorrhagic stroke?

A

cardioembolic

small vessel

atheroembolic

other

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4
Q

how do you tell what type of stroke has occured?

A

CT (computed tomography)

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5
Q

what are features of total anterior circulation syndrome (TACs)?

A

hemiplegia involving at least two of face, arm and leg +/- hemisensory loss

homonymous hemianopia

cortical signs (dysphasia, neglect etc)

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6
Q

total anterior circulation syndrome (TACS) is the least severe type of stroke - true or false?

A

false - it is the most severe type with only about 5% of patients being alive and independent at 1 year

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7
Q

what are the features of partial anterior circulation syndrome (PACS)?

A

2 or 3 of features present in TACS

or isolated cortical dysfunction such as dysphasia

or pure motor / sensory signs less severe than in lacunar syndromes (eg monoparesis)

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8
Q

what % of patients are alive and independent at 1 year?

A

55%

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9
Q

what are lacunar infarcts (LACS)?

A

small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in brain stem

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10
Q

LACS is caused by occlusion of what type of artery?

A

single deep penetrating artery

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11
Q

what parts of body does LACS affect?

A

any 2 of face, arm and leg

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12
Q

LACS has best prognosis of all strokes - true or false?

A

true - 60% of patients alive and independent at 1 year

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13
Q

what are the features of posterior circulation syndrome (POCS)?

A

cranial nerve palsies

bilateral motor and/or sensory deficits

conjugate eye movement disorders

isolated homonymous hemianopia

cortical blindness

cerebellar deficits without ipsilateral motor / sensory signs

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14
Q

what is the overall one year survival to independence?

A

good - about 60%

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15
Q

what does right side of brain control?

A 
left side of body 
creativity 
music 
spatial orientation 
artistic awareness
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16
Q

what does left side of brain control?

A 
right side of body 
spoken language 
reasoning 
number skills 
written language
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17
Q

what is the main thing affected by dominant hemisphere (left) cortical events?

A

language

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18
Q

what is the main thing affected by non-dominant hemisphere (right) cortical events?

A

spatial awareness - causes hemispatial neglect

19
Q

where can clots originate from to cause stroke?

A

atherothromboembolic (carotid / larger vessels)

cardioembolic (AF)

small vessel disease (clot forms in small vessel itself)

20
Q

describe the difference in appearance and treatment of clots which have formed in the carotids compared to cardioembolic clots?

A

carotid = white and platelet rich (tx = antiplatelets)

cardioembolic = red and protein rich (tx = anticoagulants)

21
Q

what investigations can be used to visualise atherothromboembolic disease in carotid?

A

US (doppler)

CT/MRI angiogram (often more visible)

22
Q

what are the possible contributors to small vessel disease?

A

arteriosclerotic (age / risk factor related)

genetic (related to cerebral amyloid angiopathy)

inflammatory / immunologically mediated (eg eosinophillic granulomatosis / GPA)

23
Q

what signs on MRI indicate small vessel disease?

A

white matter hyperintensities
lacunes
microbleeds

24
Q

what is the CT expression of white matter disease known as?

A

leukoaraiosis

25
Q

AF is associated with how much of an increase in risk of stroke?

A

5 fold (1 in 6 strokes are due to AF)

26
Q

what heart defect can also predispose to stroke?

A

patent foramen ovale

27
Q

what causes a primary intracerebral haemorrhage?

A

hypertension

amyloid angiopathy

28
Q

what causes a secondary intracerebral haemorrhage?

A

arteriovenous malformation
aneurysm
tumour
etc

29
Q

where is haemorrhage more likely to be seen on MRI if it is caused by cerebral amyloid angiopathy?

A

lobar

30
Q

where is haemorrhage more likely to be seen on MRI if it is caused by effects of blood pressure?

A

deep

31
Q

what is the pathophysiology behind ICH early haematoma expansion?

A

continued arterial bleeding

secondary bleeding into perilesional tissue

subsequent perilesional oedema

32
Q

what is the “ABCDD” of medical stroke prevention?

A

antithrombotic therapy - anti platelet or anti coagulation

blood pressure

cholesterol

diabetes

dont smoke

33
Q

what is used to determine risk of AF patient having a stroke?

A

CHA2DS2VASc score

34
Q

what score is used to determine bleeding risk?

A

HAS-BLED

35
Q

how many times would patient need to fall for risk of bleeding to outweigh benefit of anticoagulation?

A

300

36
Q

what must you not use to treat cardioembolic stroke?

A

aspirin

37
Q

what drug has underwent studies to see its effectiveness against preventing strokes?

A

perindopril

38
Q

is there a relationship between increasing cholesterol and increasing stroke?

A

yes but weak

39
Q

low cholesterol is associated with increased risk of what kind of stroke?

A

haemorrhagic

40
Q

what is a carotid endarterectomy?

A

surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery

41
Q

how effective is carotid endarterectomy?

A

65% reduction in recurrent stroke at 2 years

absolute risk reduction - 15.9%

42
Q

how must dysphagia be managed following stroke?

A

initial swallow screen

if abnormal -> assessment by speech and language

may need NG tube placement or textured diet and thickened fluids depending on swallow

43
Q

what must patients with acute stroke be screen for risk of on admission and at least weekly thereafter?

A

malnutrition

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