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Systems: Cardiovascualar AB > Stroke: Presentation and Investigation > Flashcards

Stroke: Presentation and Investigation Flashcards

1
Q

Stroke

A

Neurological deficit causing loss of function:

  • of sudden onset
  • lasting more than 24 hrs
  • of vascular origin
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2
Q

Transient ischaemic attack

A

Lasts less than 24 hrs

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3
Q

Symptoms of stroke

A
  • Loss of power
  • Loss of sensation
  • Loss of speech
  • Loss of vision
  • Loss of coordination
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4
Q

What may included in the history of the complaint?

A
  • Time of onset
  • Witnesses
  • Headache/ vomting/ neck stiffness/ photophobia
  • Loss of consciousness
  • Fit
  • Incontinence
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5
Q

What may be found on neurological examination?

A
  • Motor: clumsy or weak limbs
  • Sensory: loss of feeling
  • Speech: dysarthria/ dysphasia
  • Neglect/ visuospatial problems
  • Vision: loss in one eye/hemianopia
  • Gaze palsy
  • Ataxia/vertigo/incoordination/nystagmus
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6
Q

What is a stroke?

A

Damage to part if the brain due to blockage of a blood vessel by thrombus or embolus or due to haemorrhage from rupture of a blood vessel

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7
Q

What are the 2 kinds of stroke?

A
  • Ischaemic

- Haemorrhagic

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8
Q

What does the carotid system supply?

A

Most of the hemispheres and cortical deep white matter

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9
Q

What does the vertebra-basilar system supply?

A

The brain stem, cerebellum and occipital lobes

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10
Q

Motor cortex

A

Movement

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11
Q

Sensory cortex

A

Pain, heat and other sensations

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12
Q

Parietal lobe

A

Comprehension of language

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13
Q

Temporal lobe

A

Hearing

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14
Q

Occipital lobe

A

Primary visual area

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15
Q

Wernicke’s area

A

Speech comprehension

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16
Q

Cerebellum

A

Coordination

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17
Q

Brainstem

A

Swallowing, breathing, heartbeat, wakefulness centre and other involuntary functions

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18
Q

Temporal lobe

A

Intellectual and emotional functions

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19
Q

Frontal lobe

A
  • Smell

- Judgement, foresight and voluntary movement

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20
Q

Broca’s area

A

Speech

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21
Q

Why does a small stroke in the pons or near the centre of the brain result in major deficit?

A

The fibres are packed close together

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22
Q

Causes of stroke

A
  • Blockage of a vessel with thrombus or clot
  • Disease of vessel wall
  • Disturbance of normal properties of blood
  • Rupture of vessel wall
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23
Q

What are most strokes caused by?

A

Infarction

24
Q

What can cause ischaemic stroke?

A
  • Large artery atheroscleorosis
  • Cardioembolic
  • Small artery occlusion
  • Undetermined/cryptogenic
  • Atrial dissection
  • Venous sinus thrombosis
25
What can cause haemorrhagic stroke?
- Primary intracerebral haemorrhage - Subarachnoid haemorrhage - Arteriovenous malformation
26
What happens in ischaemic stroke?
Clot stops blood supply to an area of the brain
27
What happens in haemorrhagic stroke?
Haemorrhage/ blood leaks into brain tissue
28
What is the most common cause of cardioembolic stroke/
Atrial fibrillation
29
What is another name for small vessel stroke?
Lacunar
30
What can cause carotid dissection?
Idiopathic or trauma
31
What must you determine when investigating what part of the brain is affected?
- Left or right - Carotid territory or vertebrobasilar territory - Cerebral hemispheres or brainstem - Cortex or deep white matter - Blood vessels involved
32
Why do you need to know where a stroke is located?
- Confirms the diagnosis - Allows better selection of imaging - Gives an indication of cause - Gives an indication of prognosis
33
Stroke subtypes
- TACS: total anterior circulation stroke - PACS: partial anterior circulation stroke - LACS: lacunar stroke - POCS: posterior circulation stroke
34
What type of lesion would cause unilateral field loss?
Optic nerve compression
35
What type of lesion would cause bitemporal hemianopia?
Chiasmal compression from pituitary tumour
36
What type of lesion would cause homonymous hemianopia?
Left cerebrovascular event
37
What is usually the cause of TACS?
Occlusion of proximal MCA or ICA
38
What does TACS cause?
- Weakness - Sensory deficit - Homonymous hemianopia (loss of vision) - Higher cerebral dysfunction (dysphasia, dysphagia)
39
What causes PACS?
More restricted cortical infarcts by occlusion of branches of MCA
40
How does TACS present?
2 of 3 of TACS criteria or restricted motor/ sensory deficit
41
What are the types of LACS?
- Pure motor - Purre sensory - Sensorimotor - Ataxix hemiparesis
42
Pure motor LACS.
Complete or incomplete weakness of 1 side, involving the whole of 2 or 3 body areas
43
Pure sensory LACS
Sensory symptoms and/or signs
44
Sensorimotor LACS
Combination of pure motor and pure sensory
45
Ataxix hemiparesis LACS
- Hemiparesis and ipsilateral cerebellar ataxia. - Small infarcts in basal ganglia or pons - Intrinsic disease of single basal perforating artery
46
What do POCS affect?
Brainstem, cerebellar or occipital lobes
47
What may the variable, frequently complex presentation of POCS include?
- Bilateral motor/sensory deficit - Disordered conjugate eye movement - Isolated homonymous hemianopia - Ipsilateral cranial nerve palsy with contralateral motor/ sensory deficit - Coma - Disordered breathing - Tinnitus - Vertigo - Horner's
48
Strokes subtype by mortality @1 yr (highest at top)
- TACS - POCS - PACS - LACS
49
Strokes subrtype by recurrence rate @ 1 yr(highest at top)
- POCS - PACS - LACS - TACS
50
What are the modifiable risk factors for stroke?
- Hypertension | - Atrial fibrillation
51
What are the non-modifiable risk factors for stroke?
- Age - Race - Family history
52
What are the investigations for stroke?
- FBC - Lipids - ECG - CT - MRI - Carotid Doppler - Sometimes an ECHO can identify clots in the heart
53
What are the advantages of CT?
- Quick | - Shows up blood
54
What are the advantages of MRI?
Shows up ischaemic stroke better than CT
55
What are the disadvantages of MRI?
- Takes up to 30 minutes | - Claustrophobic

Systems: Cardiovascualar AB (42 decks)

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