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ʏear 3 ɴeurological Core Conditions > Stroke part 2 > Flashcards

Stroke part 2 Flashcards

1
Q

what does ischaemic vs haemorrhagic stroke look like on CT?

A
  • infarct = dark

- fresh blood = white

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2
Q

what are lacunes?

A

small infarcts caused by occlusion of small penetrating aterial branches

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3
Q

How could a bone fracture cause a stroke?

A

a fat emboli after a long bone fracture could cause vessel occlusion —> infarct

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4
Q

What accounts for 1 in 5 strokes below the age of 40?

A

dissection of carotid or vertebral artery.

can follow trivial neck trauma or hyperextension e.g. whiplash, exercise

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5
Q

Apart from trivial neck trauma or hyperextension, what could be the cause of artery dissection in patient s under the age of 40 leading to stroke?

A

connective tissue disorders e.g. marfan’s syndrome

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6
Q

how does carotid or vertebral artery dissection lead to stroke?

A
  • blood penetrates the subintimal vessal wall
  • forms a false lumen
  • THROMBOSIS within the TRUE lumen due to thromboplastin release —–> EMBOLUS from site of dissection —–> stroke
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7
Q

What symptoms / signs could indicate carotid / vertebral artery dissection as cause of stroke?

A
  • pain in neck / face
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8
Q

1% of strokes are venous. What increased the risk of thrombosis in the intracranial venous sinuses?

A
  • pregnancy
  • dehydration
  • malignancy
  • hypercoagulable state
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9
Q

What is the result of thrombosis in the intracranial venous sinuses?

A
  • cortical infarction
  • seizures
  • raised ICP
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10
Q

TIAs are usually caused by microemboli - what are the sources for these emboli?

A

1) Cardiac (AF, MI, Valve disease)

2) Thrombi - aortic arch, carotid, vertebral

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11
Q

What could be the cause of a fall in cerebral perfusion leading to TIA?

A
  • Cardia dysarrhythmias
  • postural hypotension
  • decreased flow through atheromatous arteries
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12
Q

What are the major risk factors for stroke/

A

1) hypertension **
2) smoking **
3) alcohol
4) high cholesterol **
5) Atrial fibrillation ***
6) Obesity
7) diabetes
8) severe carotid stenosis **

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13
Q

What intervention results in the greatest stroke risk reduction ?

A

Anticoagulation for Atrial fibrillation

hypertension control

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14
Q

what are the most common clinical features of TIAs?

A
  • Hemiparesis (weakness on one side of the body)

- Aphasia
inability to comprehend and formulate language

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15
Q

What is often the first sign of internal carotid artery stenosis?

A

TIA causing Amaurosis Fugax

(sudden transient loss of vision in one eye)

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16
Q

True or false :

-consciousness is preserved in TIA

A

True

17
Q

How would you distinguish focal epilepsy from TIA?

A

Positive features of epilepsy:

  • limb shaking
  • loss of consciousness
  • tongue biting
  • urinary incontinence
18
Q

What is limb shaking TIA a sign of?

A

Severe carotid stenosis causing transient focal cerebral hypoperfusion.

19
Q

How can you differentiate between a migraine aura and a TIA in elderly people?

A

Migraine aura can occur on its own causing:
- speech, visual disturbances and ataxia.

  • Headache is common in migraine but rare in TIA.
  • postive visual phenomena such as shimmering are typical of migraine but not seen in TIA.
  • onset of symptoms slower in migraine aura than TIA
  • limb weakness is rarely due to migraine
20
Q

What is used to stratify stroke risk in the first 2 days of a TIA?

A

ABCD2 score

  • Age >60
  • BP >140 / 90
  • Clinical features (unilateral weakness, isolated speech disturbance, other)
  • Duration of symptoms > 60mins, 10-9 mins or less than 10 mins.
  • Diabetes?

***score of <4 is minimal risk, score of >6 is high risk within 7 days of TIA

21
Q

What investigations are done for TIA?

A
  • Doppler of internal carotid arteries
  • Cardiac Echo
  • ECG + 24tape
  • MRI brain
  • MR or CT angiography
22
Q

What is the treatment for TIA?

A
  • if CT excludes haemorrhage give immediate thrombolytic therapy. e.g. Tissue Plasminogen Activator
  • surgery - stenting of high grade carotid stenosis.
23
Q

What does complete MCA occlusion result in?

A
  • contralateral hemiplegia
  • contralateral facial weakness
  • hemisensory loss
  • eye deviated to affected side
  • aphasia
  • hemianopia
24
Q

What is the consequence of occlusion of lenticulostriate perforating arteries?

A

infarction of deep sub-cortical structures e.g internal capsule —> hemiplegia and hemisensory loss

25
Q

What infarct leads to hemiparesis affecting the leg more than the arm and frontal lobe deficits such as apathy (loss of interest) and apraxia (inability to perform planned actions)

A

Anterior cerebral artery infarct

26
Q

What are the features of brainstem infarcts?

A
  • hemiparesis or tetraparesis
  • sensory loss
  • diplopia
  • facial numbness
  • facial weakness
  • nystagmus, vertigo
  • dysphagia (difficulty swallowing)
  • dysarthria (difficulty speaking)
  • ataxia, hiccups and vomiting
  • horner syndrome
  • coma, altered consciousness
27
Q

Infarct in what region leads to

  • right sided weakness
  • involving face and arms more than legs?
A
  • Left middle cerebral artery
28
Q

Infarct of what region leads to left sided weakness involving face and arms more than legs.

  • visual and/or sensory neglect
  • denial of disability?
A

Right middle cerebral artery

29
Q
  • Homonymous hemianopia
  • confudion
  • memory impairment
A

Posterial cerebral artery

30
Q

When should a CT scan be done within 1 hour for a stroke patient?

A
  • if considering thrombolysis or patient is on anticaogulants or has a reduced conscious level.
31
Q

What are the immediate invx for stroke?

A
  • CT brain scan
  • FBC
  • Glucose
  • clotting
32
Q

What investiagtions are done within 24hrs for stroke?

A
  • Routine blood tests e.g. FBC, ESR, glucose, clotting, lipids
  • ECG and 24hr ECG (Atrial fibrillation)
  • carotid doppler studies to identify high grade carotid stenosis that requires stenting (in anterior circulation stroke ie. ACA, MCA)
  • CT / MRI to identify stenosis in posterior circulation.
33
Q

What imaging is more sensitive for early changes of infarction?

A
  • MRI (infarct)

- CT (haemorrhage)

34
Q

Paramedics and members of the public are encouraged to make diagnosis of stroke using FAST - what does this stand for?

A

Face - sudden weakness of the face.

Arms - sudden weakness of one or both arms.

Speech - difficulty speaking, slurred speech.

Time - sooner the treament can be started the better.

35
Q

When seeing to a stroke patient - what are the first steps you take ? hint RAAPID style

A

1) Airways : ensure pantency
2) Breathing : RR, O2 Sats —> Oxygen
3) Circulation: PR, BP, Cap refil —-> monitor BP

36
Q

Why is thrombolysis of stroke patients important?

A

Thrombolysis within 4.5 hour time window significantly improves outcome - sifnificantly reduces chance of disability.

37
Q

Thrombolysis in acute non haemorrhagic stroke?

A
  • IV Recombinant tissue plasminogen activator
    ( ALTEPLASE 0.9mg/Kg over 1 h)

OR

  • 300g/day aspirin if thrombolytic therapy contraindicated.
38
Q

When is anticoagulation started for stroke?

A

Once haemorrhage excluded :
- 24hr after thrombolysis start 300mg aspririn for 2 weeks then switch to clopidogrel.

  • atrial fibrillation
  • sinus venous thrombosis

ʏear 3 ɴeurological Core Conditions (10 decks)

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