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Stroke + Vascular > Stroke diagnosis + classification > Flashcards

Stroke diagnosis + classification Flashcards

1
Q

Define a stroke

A

clinical syndrome characterised by rapidly developing clinical symptoms and/or signs of focal neurological deficit lasting more than 24 hours and thought to be of vascular origin

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2
Q

Describe the onset of a stroke

A

Sudden
haemorrhagic stroke can cause gradual worsening of symptoms but initial onset is still sudden

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3
Q

Stroke investigations

A

Bloods - FBC, U+E, LFTs, bone, clotting, blood sugar, cholesterol, ESR, antiphospholipid screen, vasculitis screen
ECG
CT head
CXR
+/- CT perfusion scan, MRI
Carotid dopplers/CT angiogram
ECHO + 24 hour tape +/- prolonged cardiac monitoring (to detect AF)

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4
Q

What are the 2 main types of stroke?

A

ischaemic
haemorrhagic

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5
Q

Causes of ischaemic stroke

A

Small deep infarcts (lacunar)
Cardio-embolic
Large artery infarcts
Artery-to-artery embolism
Extracranial occlusion
Poor collaterals
Intracranial atherosclerosis
Arterial dissection (carotids/vertebral)
Arteritis (eg. GCA)
Cryptogenic

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6
Q

Haemorrhagic stroke causes

A

Primary:
- amyloid angiopathy
- hypertensive

Secondary:
- AVM (arteriovenous malformation)
- aneurysm
- coagulopathy (warfarin)

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7
Q

Describe the Bamford (Oxford) classification of stroke

A

Lacunar:
- motor or sensory signs only

Partial anterior circulation (PACS) - 2 of following:
- motor or sensory signs
- cortical signs (eg. dysphasia, neglect)
- hemianopia (homonymous)

Total anterior circulation (TACS) - all of:
- motor or sensory signs
- cortical signs
- hemianopia (homonymous)

Posterior circulation:
- Hemianopia
- brain stem signs
- cerebellar signs

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8
Q

What is hemianopia?

A

loss of half of visual field

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9
Q

Total anterior circulation stroke signs

A

all of:
- motor or sensory loss
- cortical eg. dysphasia, neglect
- homonymous hemianopia

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10
Q

Partial anterior circulation stroke signs

A

2 of following:
- motor or sensory loss
- cortical eg. dysphasia, neglect etc.
- homonymous hemianopia

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11
Q

lacunar stroke signs

A

pure motor (internal capsule, pons)
pure sensory (thalamus)
sensorimotor
ataxic hemiparesis (pons)
movement disorders

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12
Q

Posterior circulation stroke signs

A

isolated hemianopia
brain stem signs
cerebellar ataxia
hemiparesis
hemisensory loss
vertigo, vomiting
diplopia (double vision)
facial weakness/numbness
dysphagia
respiratory failure
coma + death (locked in syndrome)

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13
Q

What is a TIA?

A

transient ischaemic attack
neurological signs that are consistent with a stroke that lasts for less than 24 hours
no damage on CT, may see some on MRI

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14
Q

What is the ABCD2 score used for and what are the components?

A

the risk of stroke in the 7 days following a TIA

Age>59 =1
BP systolic >140 and/or diastolic >90 =1
Clinical presentation:
- unilateral weakness =2
- speech disturbance =1
- other =1
Duration>59=2
10-59=1
0-9=0
Diabetes =1

Max score = 7
Score 4-5 = seven day risk >12%
Score 6-7 = seven day risk >30%

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15
Q

Name some stroke mimics

A

migraine
tumour
abscess
subarachnoid
subdural
cerebral vein thrombosis
epilepsy + Todd’s palsy
multiple sclerosis
myasthenia gravis
Bell’s palsy
functional
hypoglycaemia/other metabolic disorder
hypothermia
sepsis
old strokes who are unwell
dementia

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16
Q

If stroke onset is unknown what scan could you do to enable treatment?

A

CT perfusion scan

17
Q

Thrombolysis risks

A

bleeding (into infarct, elsewhere in brain, rest of body)
anaphylactoid reaction om side of stroke

18
Q

Haemorrhagic stroke risk factors

A

hypertension (long-term)
anticoagulants
liver failure (reduced clotting factor production)
arteriovenous malformation

19
Q

Investigations to look for causes of ischaemic stroke

A

Echo (bubble echo?)
Carotid doppler
ECG
APLS antibodies (anticardiolipin, lupus anticoagulant)
Vasculitic screen
Fabry’s test (if pt young)

20
Q

Name 2 investigations for haemorrhagic stroke

A

MRI (6 weeks post-haemorrhage)
CT angiogram

21
Q

Complications of stroke

A

Aspiration pneumonia
DVT/PE
Pressure sores/ulcers
Seizures (more common in haemorrhagic)
Spasticity
Contractures

22
Q

What is the driving advice after a stroke/TIA?

A

cannot drive for 1 month
recurrent TIAs = 3 months
HGV licence = 1 year TIA and stroke free
Seizures = 1 year (sometimes 6 months if only 1)

Must be physically fit to drive
no homonymous hemianopia
no neglect
no visual inattention

23
Q

What is visual inattention?

A

failure of brain to pay attention to visual stimuli
they can see both sides of them but brain will only pay attention to one side at once

24
Q

What is neglect?

A

loss of awareness of one side of body

Stroke + Vascular (17 decks)

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