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Neurology/Neurosurgery > Stroke Tutorials > Flashcards

Stroke Tutorials Flashcards

1
Q

What % of strokes occur in those >65?

A

75%

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2
Q

What % of people will die in the first year after a stroke?

A

1/3rd

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3
Q

What % of people will remain dependent on others after surviving a stroke?

A

50%

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4
Q

What is the WHO definition of stroke?

A

Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting =>24h or leading to death with no apparent cause other than vascular

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5
Q

Define TIA

A

Brief episode of neurological dysfunction caused by focal brain or retinal ischaemia with clinical symptoms typically lasting less than 1h and without evidence of acute infarction

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6
Q

In which period of time do the majority of TIAs resolve in?

A

60 minutes

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7
Q

How does the length of a TIA correlate with symptom resolution?

A

<15% chance of complete resolution of symptoms if TIA lasts >1h

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8
Q

What are the two major categories of stroke? What is their prevalence?

A

Ischaemic - 85%
Haemorrhagic - 15%
- 70% primary ICH
- 30% secondary haemorrhage, e.g. SAH, AVM

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9
Q

What sort of things may cause a stroke?

A 
Intracranial atherosclerosis
Carotid plaque with atherogenic emboli
Aortic arch plaque
Cardiogenic emboli 
AF
Valve disease
Penetrating artery disease (lacunar stroke)
Flow reducing carotid stenosis
Carotid dissection
Left ventricle thrombi
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10
Q

Where do the carotids mostly supply?

A

Most of the hemispheres and cortical deep white matter

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11
Q

Where does the vertebro-basilar system supply?

A

Brainstem, cerebellum, occipital lobe

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12
Q

What are the functions of the temporal lobe?

A

Primary auditory receptive area
Comprehension of speech (dominant) - Wernicke’s area
Visual, auditory and olfactory perception
Important role in learning, memory and emotions

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13
Q

What are the functions of the frontal lobe?

A 
High level cognitive functions, e.g. abstraction, concentration reasoning
Memory
Control of voluntary eye movement
Motor control of speech in dominant hemisphere
Motor cortex
Urinary continence
Emotion and personality
Broca's area
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14
Q

What are the functions of the parietal lobe?

A 
Sensory cortex
Sensation (touch, pressure, position)
Awareness of parts of body
Spatial orientation + visuospatial information (non-dominant hemisphere)
Ability to perform learned motor tasks
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15
Q

What are the functions of the occipital lobe?

A

Primary visual cortex
Visual perception
Involuntary eye movement

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16
Q

What is the main function of the cerebellum?

A

Balance and coordination

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17
Q

What are the functions of the brainstem?

A

Swallowing, breathing, heartbeat, wakefulness

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18
Q

What is Broca’s area essential for?

A

Language pronunciation, production and articulation

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19
Q

Why are small strokes in the deep white matter so bad?

A

All the fibres are packed closely together so small strokes can result in large deficits

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20
Q

What is the brainstem composed of?

A

Midbrain, pons, medulla

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21
Q

What are some clinical presentations of stroke?

A

Sudden onset loss of function:

  • Motor (clumsy/weak)
  • Sensory
  • Speech (dysarthria/dysphagia)
  • Neglect/visuospatial problems
  • Vision (loss in one eye (amaurosis fugax) or hemianopia)
  • Gaze palsy

Ataxia, vertigo, incoordination, nystagmus

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22
Q

What are some key things to remember about the symptoms of stroke?

A

Symptoms come on rapidly
Symptoms depend on area of brain affected
Abnormal movements after stroke are unusual
Positive visual phenomena probably = migraine
Severe headache after stroke unusual

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23
Q

What is the most commonly used clinical classification of strokes?

A

Oxford community stroke project classification

24
Q

What causes a TACS?

A

Total anterior circulation syndrome

Caused by blockage/bleed from main artery to one of the hemispheres

25
Q

What symptoms do you get in TACS?

A

3/3 of:

  • Complete hemiparesis/numbness
  • Hemianopia (loss of vision on one side)
  • Loss of awareness on one side (inattention) if non-dominant OR dysphagia if dominant
26
Q

What causes a PACS?

A

Partial anterior circulation syndrome

Caused by bleed/blockage to a branch of a main artery

27
Q

What are the symptoms of a PACS?

A

2/3 of TACS criteria or
- one higher cortical deficit, e.g. inattention or dysphagia
or
- monoparesis

28
Q

What causes a LACS?

A

Lacunar syndrome
Blockage/bleed from a small perforating artery

Tends to affect movement/sensation pathways

29
Q

What are the symptoms of a LACS?

A

Weakness/numbness of:

  • face + arm + leg OR
  • face + arm OR
  • arm + leg

May have dysarthria, ataxic hemiparesis but no affect on higher function (i.e. no dysphagia, inattention, hemianopia)

30
Q

What causes POCS?

A

Posterior circulation syndrome

Bleed/blockage in any posterior artery

31
Q

What symptoms occur in POCS?

A

Combination of symptoms including:

  • Loss of balance/coordination
  • Vertigo
  • Double vision
  • Dysarthria
  • Visual loss (hemianopia)
32
Q

What does basilar artery occlusion lead to?

A

Ischaemia in pons

33
Q

What sort of signs/symptoms do you see in basilar artery occlusion?

A

Predominantly motor/oculomotor signs/symptoms which are bilateral by asymmetrical

May see alteration in conscious level, may present as unresponsive

34
Q

Which type of stroke has the highest mortality?

A

TACS

35
Q

Which type of stroke has the highest recurrence rate?

A

POCS/PACS

36
Q

What are non-modifiable risk factors for stroke?

A

Prev stroke
Age
Male
FH

37
Q

What are modifiable risk factors for stroke?

A 
Smoking
COCP
HTN
Obesity
Sedentary lifestyle and poor diet
Hyperlipidaemia (high LDL)
Cocaine use
DM
AF
Alcohol excess
38
Q

If someone has cranial nerve deficits and a stroke what type of stroke is it they’ve likely had?

A

Brainstem stroke

39
Q

What is the most important RF for stroke?

A

HTN - chronic HTN exacerbates atheroma + increases involvement of smaller distal arteries

40
Q

How do DM, hyperlipidaemia and smoking contribute to risk of stroke?

A

DM, HTN, cigarette smoke contribute to LDL-C deposition in arterial walls

41
Q

By how much does having AF increase your chance of having a stroke?

A

5x

42
Q

Which two drugs can reduce the risk of stroke in those with AF?

A

DOACs and warfarin

43
Q

Name some DOACs

A

Apixiban
Rivaroxiban
Edoxaban
Dabigatran

44
Q

What are some stroke mimics?

A 
7Ss - 
Seizures
Syncope (hypotension)
Sugar (hypo/hyper)
Sepsis (+ prev stroke)
Severe migraine
Space occupying lesions
Si-chological

Others - vestibular disorders, demyelination, transient global amnesia, mononeuropathy

45
Q

What is the most common stroke mimic?

A

Migraine

46
Q

What things may point towards migraine as opposed to stroke?

A 
Younger age
Positive, spreading symptoms (flashing lights, somatosensory (pain, paraesthesia), motor (jerking)) may be followed by negative symptoms 
LOC v. rare
Assoc. headache, NV, photophobia
Usually lasting 20-30m
47
Q

What causes a migraine aura?

A

Cortical spreading depression

48
Q

What can a migraine aura take the form of?

A

Visual disturbance - scintillating scotomata, geometric (zig-zag patterns), kaleidoscope, running water etc.
can include sensory, motor or speech disturbance
Headache onset can be >1h after the end of aura or no headache

49
Q

What is a acephalgic migraine?

A

Migraine with aura without headache

50
Q

How might functional disorders/anxiety mimic a stroke?

A 
Isolated sensory symptoms common
Mostly occur suddenly/on waking
Often get dissociative symptoms
Often non-dominant side
Tends to be INCONSISTENCY in symptoms
51
Q

What test can you use to try and identify a functional disorder?

A

Hoover’s sign or abductor sign

52
Q

What do you tend to see in acute vestibular syndrome?

A

Acute onset, v. disabling
Nystagmus - unidirectional
Vomiting
MRI may be helpful

53
Q

What symptoms may point towards a seizure as opposed to a stroke?

A 
Tongue biting
Incontinence
Muscle pain 
Disorientation
Headache
Post-ictal symptoms may last days
LOC/amnesia common
Progresses v. quickly, lasts up to 5m
54
Q

What symptoms may point towards a syncope as opposed to a stroke?

A 
Presyncope (light headed)
Vision darkens/muffles
Loss of awareness
Transient LOC with loss of postural tone + rapid recovery 
No focal symptoms
V. rapid and rapid recovery
55
Q

What is transient global amnesia?

A

Temporary loss of anterograde episodic memory

Usually lasts several hours and usually able to fill in old memories and create new ones again

56
Q

In what group of people does transient global amnesia tend to occur?

A

Those over 50Y

Those with vascular RFs

Neurology/Neurosurgery (2 decks)

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