Stroke Syndromes Flashcards
Define stroke
An acute neurological deficit caused by a cerebrovascular aetiology
Define ischaemic stroke
An acute neurological deficit caused by a lack of blood perfusion due to occlusion or critical stenosis of a cerebrospinal artery
Define haemorrhagic stroke
An acute neurological deficit caused by a lack of blood perfusion due to rupture of a cerebrospinal artery
Describe the difference between primary and secondary haemorrhagic stroke
Primary: haemorrhage in the absence of vascular malformation or associated disease
Secondary: haemorrhage from an identifiable vascular malformation or from a disease impairing coagulation or promoting vascular rupture
State some causes of ischaemic stroke
Cardioembolism, atherosclerosis, small vessel disease (lacunar stroke), cerebral venous sinus thrombosis, vasculitis, sickle cell anaemia, antiphospholipid syndrome
State some causes of haemorrhagic stroke
Aneurysms, arteriovenous malformations, primary intracerebral haemorrhage, subarachnoid haemorrhage, acute ischaemic stroke, subdural haemorrhage, cavernoma
Which type of strokes does cerebral amyloid angiopathy predispose to?
Primary haemorrhagic lobar strokes
Name 2 drugs which can cause secondary haemorrhagic stroke
Cocaine, amphetamines
State some risk factors for ischaemic stroke
Ageing, family or personal history, hypertension, smoking, diabetes, dyslipidaemia, AF, past MI, carotid artery stenosis, valve disease, sickle cell anaemia
State some risk factors for haemorrhagic stroke
Ageing, male sez, family history, haemophilia, cerebral amyloid angiopathy, hypertension, anticoagulation, cocaine or amphetamine use, vascular malformations
Which type of stroke is more common in women?
Subarachnoid haemorrhage
State the most common cause of non-traumatic subarachnoid haemorrhage
Rupture of intracranial saccular aneurysm
State the 3 most common aneurysm sites in the CNS arteries
Anterior communicating artery and anterior cerebral artery junction, distal internal carotid artery and posterior communicating artery junction, middle cerebral artery bifurcation
State some risk factors for subarachnoid haemorrhage
Hypertension, smoking, family history, autosomal dominant polycystic kidney disease, alcohol use, cocaine use, connective tissue disorders
Describe the typical presentation of an ophthalmic artery stroke
Uniocular loss of vision, transient amaurosis fugax
Describe the typical presentation of an anterior cerebral artery stroke
Leg and trunk weakness, excessive or inappropriate crying or laughing
If bilateral: gait apraxia
Describe the typical presentation of a middle cerebral artery stroke
Contralateral hemiparesis, eye deviation towards infarct, contralateral hemianaporia, contralateral hemianaesthesia, global aphasia, visual neglect
Describe the typical presentation of a posterior cerebral artery stroke with parieto-occipital involvement
Unilateral homonymous hemianopia, Anton syndrome, Balint syndrome
Describe the typical presentation of a posterior cerebral artery stroke with thalamic involvement
Confusion, memory loss, pure hemisensory loss
Describe the typical presentation of a brainstem infarct
Vertigo, nystagmus, diplopia, dysarthria, dysphagia, limb or trunk ataxia, contralateral pain and temperature loss, cranial nerve V-XII involvement
State the 3 components of Virchow’s triad
Stasis, vessel wall injury, hypercoagulability
State some specific causes of venous thrombosis
Surgery, obesity, long-haul flights, reduced circulating blood volume, right-sided heart failure
Name 3 causes of cardiac mural thrombus
Atrial fibrillation, cardiomyopathy, previous myocardial infarction
Where do strokes appear to most commonly occur?
Deep in the white matter of the internal capsule and basal ganglia in the left hemisphere
Which hemisphere is more prone to ‘silent’ strokes?
Right
Why are end arteries most vulnerable to blockage?
They have no collateral arteries to take over blood supply
Describe the typical presentation of a posterior inferior cerebellar artery infarct
Ataxia, Horner’s syndrome, cranial nerve palsies
What is Horner’s syndrome?
Triad of ptosis, miosis, and anhidrosis
State some causes of lacunar infarcts
Hypertension, ageing, diabetes mellitus, renal disease, migraine, CADASIL
State at least 5 features of the acute phase of ischaemic stroke
Decreased blood flow, disturbed ionic homeostasis, increased intracellular calcium, increased glutamate release, cytotoxic oedema, mitochondrial and DNA damage, enzyme dysfunction, necrosis
State at least 5 features of the subacute phase of ischaemic stroke
Apoptosis, inflammation, cytokine production, proteolytic enzyme activation, vasogenic oedema and raised ICP, ROS production, stimulation of neurogenesis and angiogenesis
State at least 5 features of the chronic phase of ischaemic stroke
Removal of necrotic debris, stem cell proliferation and differentiation, angiogenesis, gliosis, circuit reconnection, neurovascular remodelling
