Stroke - Presentation & Investigation Flashcards
What is the commonest cause of long term illness in the UK?
Stroke
What percentage of NHS beds do patients who have had a stroke occupy?
20%
How much does stroke cost the UK per year?
Over £5 billion
What is the age of most stroke patients?
More than half are over 70
What is a stroke?
The sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain
What is the the sudden death of brain cells due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain called?
Stroke
What is stroke caused by?
Blockage of blood flow or supture of an artery to the brain
What are key things for it to be stroke?
Of sudden onset
Lasting more than 24 hours
Of vascular origin
What is the difference between stroke and transient ischaemic attack?
Stroke lasts for longer than 24 hours, transient ischaemic attack lasts for less
What is transient ischaemic attack?
A brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain
What is a brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain called?
Transient ischaemic attack
What are symptoms of stroke?
Loss of power
Loss of sensation
Loss of speach
Loss of vision
Loss of coordination
What does the neurological history/examination for stroke involve?
Motor (clumsy or weak limbs)
Sensory (loss of feeling)
Speech (dysarthria/dysphasia)
Neglect/visuospatial problems
Vision (loss in one eye or hemianopia)
Gaze pulsy
Ataxia/vertigo/incoorination/nystagmus
What is dysarthria?
Difficult or unclear articulation of speech that is otherwise normal
What is difficult or unclear articulation of speech that is otherwise normal called?
Dysarthria
What is gaze pulsy?
Symmetric limitation of the movement in direction of both eyes
What is symmetric limitation of the movement in direction of both eyes
Gaze pulsy
What is ataxia?
Disorder that affects balance
What is a disorder that affects balance?
Ataxia
What does the anatomy of blood circulation of the brain involve?
Anterior circulation
Posterior circulation
Circle of Willis
What will a small stroke in the deep white matter result in?
Major deficit as the fibres are packed closely together
What are some of the causes of stroke?
Blockage of a vessel with a thrombus or clot
Disease of the vessel wall
Disturbance of normal properties of blood
Rupture of the vessel wall
What is rupture of the vessel wall called?
Haemorrhage
Are most strokes due to infarction or haemorrhage?
Infarction
What percentage of stroke is due to infarction?
85%
What percentage of stroke is due to haemorrhage?
15%
What is ischaemic stroke due to?
Large artery atherosclerosis (such as carotid)
Cardioembolic (such as atrial fibrillation)
Small artery occlusion (such as lucunar)
Undetermined
Arterial dissection (rare cause)
Venous sinus thrombosis (rare cause)
What is haemorrhage stroke due to?
Primary intracerebral haemorrhage
Secondary haemorrhage
What are examples of secondary haemorrhages that leads to stroke?
Subarachnoid haemorrhage
Arteriovenous malformation
What are different parts of the brain that can be affected by stroke?
Left or right
Carotid territory or vertebrobasilar territory
Cerebral hemispheres or brainstem
Cortex or deep white matter
From the symptoms and signs of stroke, what can you tell?
What side of the brain is affected
Whether the lesion is in the brainstem
Whether the cortex is involved (such as cortical stroke)
If lesion is in deep white matter (such as lacunar stroke)
What blood vessel is involved
What is an example of a stroke where the cortex is involved?
Cortex stroke
What is an example of a stroke where the lesion is in the deep white matter?
Lacunar stroke
Why is localisation important when diagnosing stroke?
Confirms the diagnosis of stroke
Allows better selection of imaging
Gives an indication of cause
Gives an indication of prognosis
What are examples of different stroke subtypes?
Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar stroke (LACS)
Posterior circulation stroke (POCS)
What percentage of strokes are total anterior circulation strokes (TACS)?
20%
What symptoms are associated with total anterior circulation strokes (TACS)?
Weakness
Sensory deficit
Homonymous hemianopia
Higher cerebral dysfunction
What is homonymous hemianopia?
Loss of vision
What is total anterior circulation stroke (TACS) normally due to?
Occlusion of proximal middle cerebral artery or internal carotid artery
What percentage of strokes are partial anterior circulation strokes (PACS)?
35%
What is the criteria for a partial anterior circulation stroke (PACS)?
2/3 of TACS criteria
What is partial anterior circulation stroke (PACS) usually due to?
More restricted cortical infarcts such as occlusion of branches of middle cerebral artery
What percentage of strokes are lacunar strokes (LACS)?
20%
What are different kinds of lacunar stroke (LACS)?
Pure motor
Pure sensory
Sensorimotor
What kind of lacunar stroke (LACS) is the commonest?
Pure motor
What is the criteria for pure motor lacunar stroke?
Complete or incomplete weakness of 1 side, involving the whole of 2 of 3 body areas (face/arm/legs)
What is the criteria of pure sensory lacunar stroke?
Sensory symptoms and/or signs, same distribution
What is the criteria for sensorimotor lacunar stroke?
Combination of that for pure motor and pure sensory lacunar stroke
What can be said about the manifestation of lacunar stroke (LACS)?
Often silent
Underdiagnosed
What percentage of strokes are posterior circulation stroke (POCS)?
25%
What does posterior circulation stroke affect?
Brainstem, cerebellar or occipital lobes
What may the presentation of posterior circulation stroke include?
Bilateral motor/sensory deficit
Disordered conjugate eye movement
Isolate homonymous hemianopia
Ispilateral cranial nerve palsy with contralateral motor/sensory deficity
Coma
Disordered breathing
Tinnitus
Vertigo
Horner’s
What stroke subtype is the most common?
Partial anterior circulation stroke (at 35%)
What is the mortality of the different subtypes of strokes within 1 year, going from most fatal to least?
TACS
POCS
PACS
LACS
What must be remembered for the diagnosis to be stroke?
Symptoms come on rapidly
Symptoms depend on which part of the brain is affected
What are some risk factors for stroke?
High blood pressure
Atrial fibrillation
Age
Race
Family history
