Stroke - Presentation and Investigation Flashcards
What is a stroke?
Neurological deficit of sudden onset lasting more than 24hrs
What are the symptoms of stroke?
Loss of power Loss of sensaation Loss of speech Loss of vision Loss of coordination Headache Vomiting Neck stiffness Photophobia
What causes a stroke?
Blockage of a vessel with thrombus or clot
Disease of vessel wall
Disturbance of normal properties of blood
Rupture of vessel wall - haemorrhage
What are the three types of blood supply to the brain?
Anterior circulation
Posterior circulation
Circle of Willis
How much of stroke is caused by infarction or haemorrhage?
85% infarction
15% haemorrhage
What are some causes of ischaemic stroke?
Large artery atherosclerosis Cardioembolic Small artery occlusion Cryptogenic Arterial dissection Venous sinus thrombosis
What are the causes of haemorrhage stroke?
Primary intracerebral haemorrhage
Secondary haemorrhage
What are some types of secondary haemorrhage?
Subarachnoid haemorrhage
Arteriovenous malformation
What is the commonest cause of cardioembolic stroke?
Atrial fibrillation because clot forms in the heart which then moves up to the brain
What is a carotid dissection?
When the wall of the carotid artery tears and a clot forms. The clot then breaks off and moves to block a vessel in the brain
What are the 4 stroke subtypes?
Total anterior circulation stroke
Partial anterior circulation stroke
Lacunar stroke
Posterior circulation stroke
Why does a TACS take place?
Usually due to occlusion of the proximal middle cerebral artery or the internal cerebral artery
What is the affect of a TACS?
Weakness
Sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction
Why does a PACS take place?
Occlusion of branches of the middle cerebral artery
What is the affect of a PACS?
Restricted motor and sensory deficit, for example one limb, face and hand dysfunction or higher cerebral dysfunction
What is the affect of a LACS?
Pure motor dysfunction - complete or incomplete weakness of 2 side
Pure sensory dysfunction
Sensorimotor dysfunction
Ataxic hemiparesis
Where does a POCS affect?
Brainstem
Cerebellum
Occipital lobes
What is the affect of a POCS?
Bilateral motor/ sensory deficit Isolated homonymous hemianopia Ipsilateral cranial nerve palsy Coma Disordered breathing Tinnitus Vertigo Horner's
What has to be done to investigate for stroke?
Full blood count ECG CT MRI Carotid doppler Echocardiogram
What does MRI show better than CT?
Ischaemic stroke
How can you harm someone with a stroke?
Cause unexpected bleeding if tissue has established damage
Cause bleeding elsewhere
What is the difference between a stroke and a transient ischaemic attack?
The transient ischaemic attack lasts less than 24 hours
What do the types of symptoms of a stroke victim tell you about their condition?
Where the blood clot is
What is carotid stenosis?
Narrowing or constriction of the inner surface of the carotid artery, usually caused by atherosclerosis.
What type of stroke has the highest mortality rate?
Total anterior circulation stroke
What are the risk factors for stroke?
High blood pressure Atrial fibrillation Age Race Family history
What is thrombolysis?
Breaking down a thrombus
What should not be used when treating the acute phase of stroke?
Streptokinase
When can thrombolysis not be done?
When a person is older than 80
Usually when a person is younger than 16
What are the acute stroke treatments available?
Stroke unit
Thrombolysis
Aspirin
Hemicraniectomy
Who is at most risk of having a stroke?
Patients that have already had a stroke previously
What is the most important thing to do to prevent secondary strokes from TIA or minor strokes?
Evaluation and initiation of treatment in a specialised outpatient clinic
What medication can be used as secondary prevention for stroke?
Clopidogrel
Aspirin and dipyridamole
Statin
Blood pressure drugs
What is a carotid endarterectomy and why is it done?
It is a surgical procedure that corrects stenosis and is done to prevent strokes from happening
