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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
Q

What can cause haemorrhagic stroke?

A
  • Primary intracerebral haemorrhage
  • Subarachnoid haemorrhage
  • Arteriovenous malformation
26
Q

What happens in ischaemic stroke?

A

Clot stops blood supply to an area of the brain

27
Q

What happens in haemorrhagic stroke?

A

Haemorrhage/ blood leaks into brain tissue

28
Q

What is the most common cause of cardioembolic stroke/

A

Atrial fibrillation

29
Q

What is another name for small vessel stroke?

A

Lacunar

30
Q

What can cause carotid dissection?

A

Idiopathic or trauma

31
Q

What must you determine when investigating what part of the brain is affected?

A
  • Left or right
  • Carotid territory or vertebrobasilar territory
  • Cerebral hemispheres or brainstem
  • Cortex or deep white matter
  • Blood vessels involved
32
Q

Why do you need to know where a stroke is located?

A
  • Confirms the diagnosis
  • Allows better selection of imaging
  • Gives an indication of cause
  • Gives an indication of prognosis
33
Q

Stroke subtypes

A
  • TACS: total anterior circulation stroke
  • PACS: partial anterior circulation stroke
  • LACS: lacunar stroke
  • POCS: posterior circulation stroke
34
Q

What type of lesion would cause unilateral field loss?

A

Optic nerve compression

35
Q

What type of lesion would cause bitemporal hemianopia?

A

Chiasmal compression from pituitary tumour

36
Q

What type of lesion would cause homonymous hemianopia?

A

Left cerebrovascular event

37
Q

What is usually the cause of TACS?

A

Occlusion of proximal MCA or ICA

38
Q

What does TACS cause?

A
  • Weakness
  • Sensory deficit
  • Homonymous hemianopia (loss of vision)
  • Higher cerebral dysfunction (dysphasia, dysphagia)
39
Q

What causes PACS?

A

More restricted cortical infarcts by occlusion of branches of MCA

40
Q

How does TACS present?

A

2 of 3 of TACS criteria or restricted motor/ sensory deficit

41
Q

What are the types of LACS?

A
  • Pure motor
  • Purre sensory
  • Sensorimotor
  • Ataxix hemiparesis
42
Q

Pure motor LACS.

A

Complete or incomplete weakness of 1 side, involving the whole of 2 or 3 body areas

43
Q

Pure sensory LACS

A

Sensory symptoms and/or signs

44
Q

Sensorimotor LACS

A

Combination of pure motor and pure sensory

45
Q

Ataxix hemiparesis LACS

A
  • Hemiparesis and ipsilateral cerebellar ataxia.
  • Small infarcts in basal ganglia or pons
  • Intrinsic disease of single basal perforating artery
46
Q

What do POCS affect?

A

Brainstem, cerebellar or occipital lobes

47
Q

What may the variable, frequently complex presentation of POCS include?

A
  • 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
Q

Strokes subtype by mortality @1 yr (highest at top)

A
  • TACS
  • POCS
  • PACS
  • LACS
49
Q

Strokes subrtype by recurrence rate @ 1 yr(highest at top)

A
  • POCS
  • PACS
  • LACS
  • TACS
50
Q

What are the modifiable risk factors for stroke?

A
  • Hypertension

- Atrial fibrillation

51
Q

What are the non-modifiable risk factors for stroke?

A
  • Age
  • Race
  • Family history
52
Q

What are the investigations for stroke?

A
  • FBC
  • Lipids
  • ECG
  • CT
  • MRI
  • Carotid Doppler
  • Sometimes an ECHO can identify clots in the heart
53
Q

What are the advantages of CT?

A
  • Quick

- Shows up blood

54
Q

What are the advantages of MRI?

A

Shows up ischaemic stroke better than CT

55
Q

What are the disadvantages of MRI?

A
  • Takes up to 30 minutes

- Claustrophobic

Systems: Cardiovascualar AB (42 decks)

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