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Neuro and SS > Stroke Medicine > Flashcards

Stroke Medicine Flashcards

1
Q

What is a stroke?

A

Infarction or bleeding into brain manifests with sudden onset focal CNS signs due to hypoperfusion and action potential arrest

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2
Q

What are the types of stroke?

A

Ischaemic (85%), haemorrhagic (15%)

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3
Q

What are some causes of stroke?

A

Small vessel occlusion or thrombosis in situ
Cardiac emboli (AF, endocarditis, MI)
Atherothromboembolism
CNS bleeds

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4
Q

What are some risk factors for stroke?

A

HTN, smoking, DM, heart disease, peripheral vascular disease, carotid bruit
COCP, hyperlipidaemia, alcohol excess, ↑clotting

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5
Q

Describe the features of signs seen in stroke:

A

Worst at onset

Sudden, focal, predominantly negative

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6
Q

What scale can be used to assess the severity of a stroke?

A

NIH stroke scale

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7
Q

What conditions would be suggested by stereotyped stroke symptoms?

A

Capsular warning syndrome (intermittent hypoperfusion of lenticulostriate end arteries when MCA flow reduced)
Intracranial stenosis

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8
Q

What is the OCSP classification?

A 
Classifies stroke into 4 syndromes:
Total Anterior Circulation Syndrome
Partial Anterior Circulation Syndrome
Posterior Circulation Syndrome
Lacunar Syndrome
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9
Q

What are the features of a TACS?

A

Hemiparesis AND higher cortical dysfunction AND homonymous hemianopia

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10
Q

What are the features of a PACS?

A

Isolated higher cortical dysfunction OR

any two of: hemiparesis, higher cortical dysfunction, hemianopia

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11
Q

What are the features of a POCS?

A

Isolated hemianopia, brainstem or cerebellar syndromes

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12
Q

What are types of lacunar stroke?

A 
Pure motor
Pure sensory
Sensorimotor
Ataxic hemiparesis
Clumsy hand dysarthria
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13
Q

Which vessels tend to be occluded in TACS?

A

Proximal MCA or ICA

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14
Q

Which vessel tends to be occluded in PACS?

A

Branch MCA

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15
Q

Which vessels tend to be occluded in POCS?

A

Vertebral, basilar, cerebellar or PCA

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16
Q

Which vessels tend to be occluded in LACS?

A

Small penetrating arteries (usually lenticulostriate)

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17
Q

What is the acute management for stroke (scan, meds etc.)?

A

Protect airway
Screen swallow
Non contrast CT head or MRI head within 1hr
Aspirin 300mg once haemorrhagic stroke is excluded (continue for 2w)

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18
Q

Describe thrombolysis treatment and the indications:

A

Alteplase
Consider as soon as haemorrhage has been excluded and providing onset of symptoms was <4.5 hours ago
Best results within 90 mins

19
Q

What should be done 24h after thrombolysis?

A

CT to identify bleeds

20
Q

What are the complications of thrombolysis?

A

ICH, anaphylaxis, GI bleed

21
Q

What are some contraindications to thrombolysis?

A

Haemorrhage, recent surgery or trauma, previous CNS bleed, aneurysm, stroke in past 3m, known clotting disorder, anticoagulants or INR > 1.7, BP > 180/105, intracranial neoplasm, LP in last 7d

22
Q

How should intracerebral haemorrhage be managed?

A

BP control, correcting clotting derangement

Consider neurosurgery

23
Q

What is act FAST?

A

Facial asymmetry, Arm/leg weakness, Speech difficult, Time to call 999

24
Q

What are some examples of stroke mimics?

A

Subdural haematomas, brain tumours, MS

Migraine with aura, focal seizures, transient global amnesia, hypoglycaemia, sepsis, dehydration

25
Q

What are some examples of stroke chameleons?

A

Venous infarcts, limb shaking TIA, occipital stroke

26
Q

What are some post-stroke complications?

A 
Recurrent stroke
Immobility
RICP 
Infections
Mood and other cognitive issues
Post stroke fatigue and pain
27
Q

What is primordial prevention in regards to stroke?

A

Prevent onset of rf in general pop. e.g. stop smoking campaigns

28
Q

What is primary prevention in regards to stroke?

A

Control rf in at risk groups
Look for and treat HTN, DM, hyperlipidaemia, cardiac disease, anticoagulation in AF
Help quit smoking, ↑exercise

29
Q

What is secondary prevention in regards to stroke?

A

Control rf, lower BP and cholesterol (even if not
particularly raised)
Antiplatelets after stroke - 2w aspirin, then long term
clopidogrel

30
Q

What is the MoA of aspirin?

A

COX1 inhibitor, suppressing prostaglandin and thromboxane synthesis

31
Q

What is the MoA of clopidogrel?

A

Inhibits platelet aggregation by modifying platelet ADP receptors

32
Q

What is the MoA of dipyradimole?

A

↑cAMP and ↓thromboxane A2

33
Q

What is the target BP in stroke prevention?

A

130/80

34
Q

How should carotid artery stenosis be investigated and when should pts have surgery?

A

Carotid Doppler US

If stenosis >70% (ECST) or >50% (NASCET), likely need carotid endarterectomy

35
Q

What is the target HbA1c in stroke prevention?

A

<7%

36
Q

What is the target total cholesterol in stroke prevention?

A

<3.5mmol/L

37
Q

If cardiac source of emboli is suspected in stroke, what investigations can be done?

A

24h ECG for AF, echo

38
Q

What score can be used to guide whether anti-coagulation is needed in AF patients due to risk of stroke?

A

CHA2DS2 VASc

39
Q

What is a transient ischemic attack?

A

An ischaemic (usually embolic) neurological event with symptoms lasting <24h and without acute infarction

40
Q

What are some causes of TIA?

A

Atherothromboembolism from carotid (primary causes)
Cardioembolism: mural thrombus, post MI, AF, valves
Hyperviscosity: polycythaemia, sickle cell
Vasculitis

41
Q

What investigations should be performed in suspected TIA?

A

FBC, U+Es, glucose, lipids, CXR, ECG, carotid Doppler, CT/MRI, echo

42
Q

What is the management for a TIA?

A

Control CV rf: HTN, lipids, DM, smoking
300mg aspirin for 2w then 75mg clopidogrel
Anticoagulation if cardioembolism
Carotid endarterectomy: within 2w if >70% stenosis
No driving for at least 1m

43
Q

When can thrombectomy be used?

A

Within 6 hours of onset

Large artery occlusion in proximal anterior circulation

Neuro and SS (5 decks)

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