Stroke (Ischemic and hemorrhagic) Flashcards
Define stroke
Rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours or leading to death with vascular origin.
What is the aetiology of ischaemic stroke?
Blood supply to cerebral vascular territory is critically reduced due to occlusion or stenosis of cerebral artery .
How can ischaemic be classified?
Primary vascular pathology - atherosclerosis, dissection, vasculitis, embolism. (Reduce cerebral perfusion)
Cardiac pathologies - AF, MI, patent foramen ovale (these lead to occlusion due to embolism)
Haem pathologies - Prothrombotic hypercoagulable states precipitating embolism
What are modifiable risk factors of stroke?
BP, smoking, DM, heart disease, peripheral vascular disease, combined OCP, alcohol
What are some differentials for stroke?
head injury
hypo/hyperG
Subdural haemorrhage
Intracranial tumour
Hemiplegic migraine
What are some key signs of stroke?
Unilateral weakness or paralysis in face/arm/leg
Dysphasia
Ataxia - points to cerebellar involvement
Visual disturbance
What will you get for sure if it is middle cerebral affected?
Hemiparesis
What are posterior circulation strokes typically associated with
Difficulty with fine motor coordination and gait.
Diplopia also.
What is dysarthria?
Trouble speaking because muscles are weak
What is epidemiology of stroke?
1 every 3.5 mins
1 in 4 die in a year
half of survivors have a perm disability/
What is the acute management of stroke?
Protect the airway
Maintain haemostasis - BMs, if hypertensive crisis treat
Screen swallow - NBM
CT/MRI within 1hr, (headache, consciousness, signs of ICP can point to bleed)
Aspirin 300mg once haemorrhage excluded 2 weeks
Alteplase if within 4.5hrs of symptoms
Thrombectomy if visualized
Where should stroke patients be admitted?
Acute stroke unit
What gives you idea brainstem involvement/
Quadriplegia
Gaze disturbance and vision
Locked in syndrome
What are secondary prevention measures?
Control modifiable risk factors
long term clopidogrel monotherapy after 2 weeks of aspirin
Statin therapy
Antihypertensive.
What is prognosis of stroke?
Overall mortality of 60k a year
20% at 1 month and then 10% at year
Less than 40% recovery fully
Drowsy = poor prognosis.
What are some imperatives for re-enablement after stroke?
Swallowing - speech therapist should assess if struggles with a sip of water
Minimise fall risk
Ensure good bladder and bowel care - catheter can prevent continence
Prompt physiotherapy to avoid spasticity
Monitor mood
What are some complications of stroke?
DVT
Haemorrhagic transformation
Depression
Fatigue
Aspiration pneumonia
Anterior cerebral artery stroke
Contralateral hemiparesis and sensory loss, lower extremity > upper
Middle cerebral artery
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
Posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome)
Symptoms are similar to Wallenberg’s (see above), but:
Ipsilateral: facial paralysis and deafness
Retinal/ophthalmic artery
Amaurosis fugax
Basilar artery
‘Locked-in’ syndrome
Lacunar strokes
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Association with hypertension
basal ganglia, thalamus and internal capsule are common sites
Quadriplegia
Pontine haemorrhage
What is wernicke’s dysphasia
Speech fluent, comprehension abnormal and repetition impaired
Brocas dysphasia
Non fluent speech, poor repetition, normal comprehension
Conductive dysphasia
Word finding difficulties and difficulty repeating phrases
