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NEURO > STROKE + SAH > Flashcards

STROKE + SAH Flashcards

0
Q

What are the types of haemorrhagic stroke? What percentage of strokes are they?

A

Due to rupture of BV within the brain.

2/3 SAH
1/3 intra cerebral dt HTN

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1
Q

What is a stroke? What is a TIA?

A

A stroke is focal neurological deficit that lasts for greater than 24 hours.

TIA < 24 hours

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2
Q

What are the types of ischemic stroke? What percentage of strokes are they?

A

85%

Usually due to:

  • thrombosis
  • emboli
  • global ischemia
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3
Q

When would you consider haematological causes? What are the causes?

A

Patients < 45
Cryptogenic stroke (unknown cause)
Hx of hypercoagulable state

Causes:
Myeloproliferative
- polycythemia Vera
- essential thrombocytosis
Hypercoagulable state
Thrombocytopenia with thrombosis 
Sickle cell anemia
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4
Q

What are potential sources of emboli?

A 
Cardiogenic
Rhythmic 
- AF
- SSS
- sustained atrial flutter

Valvular

  • RHD: mitral/aortic
  • prosthetic
  • IE
  • fibrous endocarditis e.g. SLE

Myocardium

  • mural thrombus
  • MI
  • CHF with EF < 30%
  • dilated cardiomyopathy

Non-cardiogenic

  • atherosclerotic emboli
  • fat emboli
  • air emboli (iatrogenic)
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5
Q

Causes of ICH?

A 
HTN
Trauma
Bleeding diatheses 
Amyloid angiopathy
Illicit drugs: amphetamines, cocaine
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6
Q

Causes of SAH?

A

Ruptured berry aneurysm
Vascular malformation (AVM)
Trauma

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7
Q

Risk factors for stroke?

A 
FHx
Cerebral 
- cerebrovascular disease
- berry aneurysm 
CVS
- HTN
- smoking (X2)
- hyperlipidaemia 
- AF
- MI
- IHD 
Haematological 
- hypercoagulable state
- polycythemia
- warfarin (haemorrhage) 
- thrombolysis
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8
Q

S + S of stroke?

A 
Focal neurological deficit
- hemiparesis
- aphasia
- loss of vision 
- dysphagia
- dizziness, loss of balance
HEADACHE
SEIZURES (in haemorrhagic)
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9
Q

If sudden onset focal deficit, what are you thinking? If deficit goes hours - days?

Sudden LOC without focal neurological deficit.

A

Embolism
ICH

Small vessel disease

Potential SAH

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10
Q

If a stroke causes purely motor think? If pure sensory think? If hand only?

A

Internal capsule or pons

Thalamus

Cortex or peripheral neuropathy

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11
Q

If isolated ACA?
If MCA?
If PCA?

A

ACA - contralateral hemiparesis + sensory loss, mostly in leg

MCA - contralateral weakness + sensory loss of face and arm while sparing arm.

  • homonymous hemianopia ipsilateral
  • if superior branch -> broca’s
  • if inferior branch -> wernickes

PCA

  • contralateral homonymous hemianopia
  • superior quadrantopia
  • memory impairment
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12
Q

What is a lacunar INFARCT? What are features?

A

Occlusion in one penetrating artery.

Pure motor stroke/hemiparesis (posterior limbinternal capsule)
Pure sensory loss (thalamus)
Ataxic hemiparesis (ant. Limb of internal capsule)
Dysarthria - clumsy hand
Mixed sensorimotor - thalamus and posterior internal capsule

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13
Q

What LAB investigations?

A

CBE EUC LFT CRP BGL URINALYSIS

COAGS: INR if warfarin, PT

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14
Q

Radiological Ix acutely?

A

Non contrast CT head: ischemic vs haemorrhagic

  • looking for SAH vs ICH
  • ischemic may show up later than 3-24 hours after deficit

Head MRI if brainstem/cerebral stroke suspected

If CT normal but high suspicion of SAH -> lumbar puncture

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15
Q

To determine cause later Ix?

A

Ischemic

  • ECG for MI
  • echo for valvular disease
  • carotid US

Haemorrhagic
- cerebral angiography to identify source of SAH

16
Q

How do you diagnose strokes?

A

Clinically

If TIA do ABCD2 for risk of future stroke over next 7 days.

17
Q

Management for ischemic stroke?

A

Thrombolysis within 4.5 hours
Aspirin within 48 hours
Hemicraniectomy if massive stroke and <60 years
Admit to stroke unit

Control

  • BP
  • fever
  • Glucose
18
Q

Contraindications to thrombolysis?

A 
Active bleeding
Haemorrhagic stroke
Recent head trauma
History of intracranial haemorrhage 
BP high unresponsive to medication
19
Q

What do you do acutely if thrombolysis contraindicated?

A

Aspirin (rule out haemorrhagic)
If aspirin contraindicated -> clopidogrel

Control

  • Sa02
  • BP
  • fever
  • BGL

VTE prophylaxis

20
Q

Long term management of ischemic stroke?

A 
Secondary prevention by
Treat rf 
Anti platelet therapy if ischemic -> clopidogrel or (aspirin + dipyridamole) 
Educate 
Allied health
Rehab
21
Q

Management of haemorrhagic stroke?

A

Prevention mainstay

Clip aneurysm
Treat complications
Nimlodopine

NEURO (13 decks)

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