Stroke - Presentation & Investigation Flashcards by Becca M

What is the commonest cause of long term illness in the UK?

Stroke

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What percentage of NHS beds do patients who have had a stroke occupy?

20%

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How much does stroke cost the UK per year?

Over £5 billion

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What is the age of most stroke patients?

More than half are over 70

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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

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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

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What is stroke caused by?

Blockage of blood flow or supture of an artery to the brain

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What are key things for it to be stroke?

Of sudden onset

Lasting more than 24 hours

Of vascular origin

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What is the difference between stroke and transient ischaemic attack?

Stroke lasts for longer than 24 hours, transient ischaemic attack lasts for less

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What is transient ischaemic attack?

A brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain

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What is a brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain called?

Transient ischaemic attack

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What are symptoms of stroke?

Loss of power

Loss of sensation

Loss of speach

Loss of vision

Loss of coordination

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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

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What is dysarthria?

Difficult or unclear articulation of speech that is otherwise normal

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What is difficult or unclear articulation of speech that is otherwise normal called?

Dysarthria

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What is gaze pulsy?

Symmetric limitation of the movement in direction of both eyes

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What is symmetric limitation of the movement in direction of both eyes

Gaze pulsy

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What is ataxia?

Disorder that affects balance

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What is a disorder that affects balance?

Ataxia

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What does the anatomy of blood circulation of the brain involve?

Anterior circulation

Posterior circulation

Circle of Willis

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What will a small stroke in the deep white matter result in?

Major deficit as the fibres are packed closely together

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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

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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