Stroke: Cerebrovasular Disease Flashcards
what are the three different types of stroke?
haemorrhage
subarachnoid haemorrhage
infarct (ischaemic)
what are the three causes of haemorrhagic stroke?
structural abnormality
hypertensive
amyloid angiopathy
what are the three causes of haemorrhagic stroke?
cardioembolic
small vessel
atheroembolic
other
how do you tell what type of stroke has occured?
CT (computed tomography)
what are features of total anterior circulation syndrome (TACs)?
hemiplegia involving at least two of face, arm and leg +/- hemisensory loss
homonymous hemianopia
cortical signs (dysphasia, neglect etc)
total anterior circulation syndrome (TACS) is the least severe type of stroke - true or false?
false - it is the most severe type with only about 5% of patients being alive and independent at 1 year
what are the features of partial anterior circulation syndrome (PACS)?
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)
what % of patients are alive and independent at 1 year?
55%
what are lacunar infarcts (LACS)?
small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in brain stem
LACS is caused by occlusion of what type of artery?
single deep penetrating artery
what parts of body does LACS affect?
any 2 of face, arm and leg
LACS has best prognosis of all strokes - true or false?
true - 60% of patients alive and independent at 1 year
what are the features of posterior circulation syndrome (POCS)?
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
what is the overall one year survival to independence?
good - about 60%
what does right side of brain control?
left side of body creativity music spatial orientation artistic awareness
what does left side of brain control?
right side of body spoken language reasoning number skills written language
what is the main thing affected by dominant hemisphere (left) cortical events?
language
what is the main thing affected by non-dominant hemisphere (right) cortical events?
spatial awareness - causes hemispatial neglect
where can clots originate from to cause stroke?
atherothromboembolic (carotid / larger vessels)
cardioembolic (AF)
small vessel disease (clot forms in small vessel itself)
describe the difference in appearance and treatment of clots which have formed in the carotids compared to cardioembolic clots?
carotid = white and platelet rich (tx = antiplatelets)
cardioembolic = red and protein rich (tx = anticoagulants)
what investigations can be used to visualise atherothromboembolic disease in carotid?
US (doppler)
CT/MRI angiogram (often more visible)
what are the possible contributors to small vessel disease?
arteriosclerotic (age / risk factor related)
genetic (related to cerebral amyloid angiopathy)
inflammatory / immunologically mediated (eg eosinophillic granulomatosis / GPA)
what signs on MRI indicate small vessel disease?
white matter hyperintensities
lacunes
microbleeds
what is the CT expression of white matter disease known as?
leukoaraiosis
AF is associated with how much of an increase in risk of stroke?
5 fold (1 in 6 strokes are due to AF)
what heart defect can also predispose to stroke?
patent foramen ovale
what causes a primary intracerebral haemorrhage?
hypertension
amyloid angiopathy
what causes a secondary intracerebral haemorrhage?
arteriovenous malformation
aneurysm
tumour
etc
where is haemorrhage more likely to be seen on MRI if it is caused by cerebral amyloid angiopathy?
lobar
where is haemorrhage more likely to be seen on MRI if it is caused by effects of blood pressure?
deep
what is the pathophysiology behind ICH early haematoma expansion?
continued arterial bleeding
secondary bleeding into perilesional tissue
subsequent perilesional oedema
what is the “ABCDD” of medical stroke prevention?
antithrombotic therapy - anti platelet or anti coagulation
blood pressure
cholesterol
diabetes
dont smoke
what is used to determine risk of AF patient having a stroke?
CHA2DS2VASc score
what score is used to determine bleeding risk?
HAS-BLED
how many times would patient need to fall for risk of bleeding to outweigh benefit of anticoagulation?
300
what must you not use to treat cardioembolic stroke?
aspirin
what drug has underwent studies to see its effectiveness against preventing strokes?
perindopril
is there a relationship between increasing cholesterol and increasing stroke?
yes but weak
low cholesterol is associated with increased risk of what kind of stroke?
haemorrhagic
what is a carotid endarterectomy?
surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery
how effective is carotid endarterectomy?
65% reduction in recurrent stroke at 2 years
absolute risk reduction - 15.9%
how must dysphagia be managed following stroke?
initial swallow screen
if abnormal -> assessment by speech and language
may need NG tube placement or textured diet and thickened fluids depending on swallow
what must patients with acute stroke be screen for risk of on admission and at least weekly thereafter?
malnutrition
