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Neurology > Stroke + TIA > Flashcards

Stroke + TIA Flashcards

1
Q

S+S brainstem stroke

A

Quadriplegia

Locked in

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2
Q

S+S lacunar stroke + what is it

A

Occurs secondary to small vessel disease (atherosclerosis), involves subcortical stroke:

Pure motor

Pure sensory

Ataxic hemiparesis

Usually associated with HTN

Small infarcts around basal ganglia, internal capsule, thalamus + pons

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3
Q

S+S total + partial anterior circulation infarct

A

All 3 = TACS, 2 = PACS:

Unilateral weakness and/ or sensory disturbance of face, arm + leg

Homonymous hemianopia

High cerebral dysfunction eg dysphasia, visuospatial disorder

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4
Q

Posterior circulation syndrome S+S

A

1 present to be POCS:

Cranial nerve palsy + contralateral deficit

Bilateral motor/ sensory deficit

Conjugate eye movement disorder (horizontal gaze palsy)

Cerebellar dysfunction: ataxia, vertigo, nystagmus Isolated

homonymous hemianopia

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5
Q

Investigation + management of stroke (acute)

A

CT head within 4 hours to exclude haemorrhage

If no evidence of haemorrhage, given alteplase within 4.5 hrs. If over 4.5 hrs, 300mg aspirin (rectal if NBM)

Repeat CT head at 24 - 48 hrs

Bloods, BM, MRI (24 - 48 hrs later), carotid Duplex USS (for ischaemic strokes)

Keep BP (IV infusion of GTN or labetaolol), BM + O2 controlled

Sip test - spoon of water, then cup, then add thickener - if not, NBM + NG tube

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6
Q

S+S carotid TIA

A

Unilateral motor/ speech difficulty

Loss of vision

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7
Q

S+S vertebrobasilar TIA

A

Bilateral visual defects

Vomiting

Vertigo

Dysphagia

ataxia

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8
Q

Investigations and treatment of TIA (long term)

A

ECG, echo, carotid USS, CT within a week

Aspirin 300mg then clopidogrel + statin

HTN management

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9
Q

Types of ischaemic stroke

A

Embolism

Thrombosis - blood clot forming locally

Systemic hypoperfusion due to hypotension

Cerebral venous sinus thrombosis

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10
Q

Types of haemorrhagic stroke

A

Intracerebral haemorrhage, intraventricular, SAH

Extradural - egg shaped

Subdural - slithers around the side like a snake

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11
Q

What is the Bamford classification?

A

Classification for ischaemic strokes

Also called Oxford system

TACS, PACS, POCS, LACS

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12
Q

What is the ABCD2 score?

A

Assess risk of stroke in 90 days after TIA

Age >60

BP >140/90

Clinical features of TIA (unilateral weakness = 2, speech disturbance = 1)

Duration >60 mins = 2, 10-59 mins = 1

Diabetes

Score >4 = give aspirin 300mg + specialist assessment within 24 hrs

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13
Q

Management of stroke (long term)

A

Aspirin for first 14 days (300mg) + then switch to clopidogrel 75mg lifelong

Statin

HTN management (ACD rule)

Carotid endarteterecomy

warfarin/ NOAC if AF, + digoxin/ B blocker if needed

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14
Q

What to do with a high INR?

A

>5/6 + any bleed = vit K (oral phytomenodione)

>8 = vit K

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15
Q

Monitoring of warfarin

A

Yearly FBC

Stable INR = checks every 12 weeks

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16
Q

What affects warfarin dose?

A

Alcohol Leafy green veg - cause low INR

Abx, steroids (make INR go up)

17
Q

Monitoring with NOACS

A

FBC, LFTs, coag check + INR baseline

FBC + LFTs yearly

18
Q

RF for ischaemic stroke

A

Carotid stenosis , AF, valve disease, atherosclerosis

CVD RF (smoking, HTN, DM, alcohol (ETOH))

COCP

Polycythaemia vera (production of more Hb + RBC)

19
Q

Comparison of ischaemic vs haemorrhagic stroke on CT scan

A

Haemorrhagic - white blood

Ischaemic = delayed response in brain

20
Q

Causes of extra + subdural haemorrhages + likely patients + presentation?

A

Extradural = usually in young patients, due to head strike. Have lucid interval but then lose consciousness over few hours. Damage to middle meningeal artery or vein

Subdural = due to falls, no obvious cause - commonly in elderly + drunks - venous bleeding so presents slowly. Can be acute, subacute (3-7 days) or chronic (2-3 weeks)

21
Q

What is the circle of willis?

A

Connecting arteries in brain

22
Q

What are the cerebellar signs?

A

DANISH P

Dysdiadokinesis

Ataxia

Nystagmus

Intention tremor

Slurred speech

Homonymous hemianopia

Past pointing

23
Q

SAH presentation + RF

A

Sudden onset thunderclap headache, typically pulsates towards occiput

Can vomit or LOC

RF: berry aneurysms

Star shape on CT

24
Q

What is a carotid endarterectomy?

A

Removing debris if carotid artery is stenosed (50-70% lumen occluded)

25
Q

What is alteplase, what are the CI?

A

t-PA

CI: <18, >80, onset of symptoms >4 hrs, seizures, neuro signs resolved, fully dependant on carers

26
Q

Management of haemorrhagic stroke

A

Neurosurgery - clipping + coiling

Vasospasm is common complication so give nimodepine

Control HTN with infusions

27
Q

Causes of emboli from the heart

A

AF

MI

Endocarditis

Valvular disease

Dilated cardiomyopathy

Left heart myxoma

Prosthetic valves

Neurology (7 decks)

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