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Year 2 C&M symposia > Stroke & Vascular Disorders > Flashcards

Stroke & Vascular Disorders Flashcards

1
Q

What are the clinical signs of a stroke?

A
  • Sudden onset
  • Focal neurological deficit
  • Vascular origin
  • Symptoms >24 hrs or leading to death
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2
Q

What are symptoms lasting

A

Transient Ischemic Attack (TIA).

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3
Q

What is another term for a stroke?

A

Cerebral apoplexy.

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4
Q

What is a stroke?

A

Sudden disease due to vascular lesion in the brain.

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5
Q

What are the 2 types of stroke?

A
  • Infarction (85%)

- Haemorrhage (15%)

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6
Q

What is the pathophysiology for an acute ischemic stroke?

A

Initial reduction in cerebral blood flow&raquo_space; ischaemia & cellular necrosis.

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7
Q

What is the average cerebral blood flow (CBF)?

A

800ml/min.

15% cardiac output

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8
Q

Why does blocking blood flow to the brain lead to relatively rapid cellular failure?

A

The brain cannot store energy.

-neurones require a constant supply of ATP

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9
Q

What happens to the amount of O2 extracted from the blood if flow is reduced?

A

Amount of O2 extracted increases.

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10
Q

What happens to blood vessels when paCO2 increases?

A

Vessels dilate with increased paCO2.

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11
Q

What is the sole substrate for cerebral metabolism?

A

Glucose.

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12
Q

How is glucose metabolised?

A
  • Glycolytic sequence

- TCA/Krebs cycle

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13
Q

What is the glucose threshold for normal cerebral function?

A

> 20 ml/100g/min

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14
Q

What are the glucose thresholds for cerebral ischaemia (ml/100g/min)?

A

12-20&raquo_space; electrical function impaired.
8-12&raquo_space; release K+ and water movement.
> cell death.

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15
Q

What are the layers of ischaemia in a brain?

A

Core
» penumbra
» oligemia
» normal tissue

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16
Q

What are the 3 stages following an occlusion?

A
  • Auto-regulation
  • Impaired perfusion reserve
  • Ischaemia
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17
Q

What happens during auto-regulation?

A
  • Decreased cerebral perfusion pressure

- Increased vessel volume

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18
Q

What happens during impaired perfusion reserve?

A
  • Decreased cerebral blood flow & perfusion pressure

- Increased O2 extraction

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19
Q

What happens during ischaemia?

A

Maximum O2 threshold crossed:

-decreased cerebral metabolic rate

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20
Q

At what stages following an occlusion do symptoms start?

A

Ischaemia.

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21
Q

What are the causes of an ischaemic stroke? (2)

A
  • Thrombosis

- Embolism

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22
Q

Where are thromboses that cause ischaemic stroke?

A
  • Large arteries (extra-cranial)

- Small arteries (intra-cranial)

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23
Q

Where do emboli that cause ischaemic stroke originate?

A
  • HEART (cardiogenic embolism)

- PROXIMAL ARTERIES (artery to artery embolism)

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24
Q

What is the main mechanism for ischaemic stroke?

A

Large vessel atherosclerosis (40%).

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25
Q

What is the most common cause of cardiac embolism?

A

Atrial fibrillation.

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26
Q

What is warfarin used for?

A

2* prevention after TIA or minor stroke.

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27
Q

What does F.A.S.T. stand for (public posters)?

A

Face
Arms
Speech
Time

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28
Q

What is a ‘recombinant tissue plasminogen activator’ (rt-PA)?

A

IV thrombolysis agent used for acute stroke.

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29
Q

When is IV thrombolysis not always effective?

A

For clots in deep cerebral artery.

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30
Q

What type of occlusion accounts for 18-25% of all ischaemic stroke, but 60-70% of deaths/disability?

A

Proximal anterior circulation large vessel occlusion.

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31
Q

What are ‘stentrievers’?

A

Stents placed across occlusion in acute stroke. Most of clot attaches&raquo_space; improve efficacy of IV.

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32
Q

What is the modified rankin scale?

A

Measure of disability after stroke.

- 0 (no symptoms)&raquo_space; 6 (death)

33
Q

What is a Transient Ischaemic Attack (TIA)?

A

Neurological deficit lasting

34
Q

How long do most TIAs last?

A

> brain damage

35
Q

What are the vascular risk factors? (3)

A
  • Carotid/large artery disease
  • Cerebral small vessel disease
  • Cardiac embolism

-NB same as stroke

36
Q

What proportion of strokes are preceded by TIAs?

A

20%

37
Q

What are the main TIA mimics? (4)

A
  • Seizures
  • Syncope
  • Hypoglycaemia
  • Migraine
38
Q

What are symptoms of TIA in anterior circulation? (4)

A
  • Amarausis fugax
  • Dysphasia
  • Apraxia
  • Inattention
39
Q

What is amarausis fugax?

A

Temporary loss of vision in one eye.

40
Q

What are symptoms of TIA in posterior circulation? (4)

A
  • Ataxia
  • Diplopia
  • Vertigo
  • Bilateral symptoms
41
Q

What is ataxia?

A

Loss of control of movements.

42
Q

What are symptoms of TIA in either posterior or anterior circulation?

A
  • Visual field disturbance
  • Hemiparesis
  • Hemisensory loss
  • Dysarthria
43
Q

What is the ABCD2 score used to calculate?

A

Risk of TIA leading to a stroke.

44
Q

What are the 5 factors of an ABCD2 score?

A
  • Age
  • BP
  • Clinical features
  • Duration symptoms
  • Diabetes
45
Q

What are the risks of stroke for different ABCD2 scores?

A

5 = high risk

46
Q

What is the risk of stroke with ‘recurrent “crescendo” TIAs’?

A

High risk regardless of ABCD2 score.

47
Q

What are the most effective 2* preventions for TIAs? (5)

A
  • Warfarin
  • Diet
  • Exercise
  • Stop smoking
  • Aspirin
48
Q

Polypill combines many medications to possibly reduce stroke risk. What drugs does it contain? (4)

A
  • Statin
  • Aspirin
  • Antihypertensives
  • Folic acid
49
Q

What is a 2* vascular prevention of stroke?

A

Carotid endarterectomy.

-for carotid territory TIA

50
Q

What are the risks of a carotid endarterectomy?

A

Stroke/death

Nerve palsy

51
Q

What is the intervention for an occluded carotid artery?

A

No intervention - technically impossible.

52
Q

What is the 3rd most common cause of death in the UK?

A

Stroke.

53
Q

What weaknesses do strokes cause?

A
  • Contralateral weakness of LIMBS

- Weakness of OROPHARYNGEAL muscles (» dysarthria & incoordination of swallowing)

54
Q

Where is Broca’s area located?

A

Infero-lateral frontal lobe.

55
Q

What does damage to Broca’s area cause?

A

Stilted speech/expressive dysphasia.

  • difficulty finding words
  • reading & writing relatively intact
56
Q

Where is Wernicke’s area located?

A

Left posterior superior temporal lobe.

57
Q

What does damage to Wernicke’s area cause?

A

Fluent flow of speech, but neologisms (made up words) & mistake words (e.g. yes/no).
-Reading & writing impaired

58
Q

What happens to BP after a stroke?

A

Rises acutely, then may settle within days.

59
Q

When is anti-hypertensive treatment recommended after acute stroke? (4)

A
  • Intracerebral haemorrhage wuth systolic BP > 200
  • Hypertensive encephalopathy
  • Aortic dissection
  • Eclampsia
60
Q

How is swallowing assessed?

A
  • Give teaspoon of water
  • Give 2 more
  • Give 50 ml water
  • No drooling&raquo_space; SAFE.
  • Drooling/coughing at any point&raquo_space; UNSAFE&raquo_space; NG tube
61
Q

What are possible complications associated with strokes?

A
  • ASPIRATION PNEUMONIA (NG tube not completely protective)
  • DVT
  • PRESSURE ULCERS
  • SHOULDER SUBLAXATION (muscle weakness/neglect)
  • PAIN
  • INCONTINENCE
62
Q

Why do strokes cause pain?

A

Damage to sensory cortex&raquo_space; contralateral disturbance.

63
Q

What are the 2 types of pain phenomena caused by strokes?

A
  • Positive phenomena (paraesthesia, burning pain)

- Negative phenomena (decreased sensation)

64
Q

How is pain due to stroke treated?

A

Pregabalin & Gabapentin.

-paracetamol/NSAIDs don’t work

65
Q

How should DVT be treated?

A
  • Consider low molecular weight heparin.

- Warfarin for 6 months.

66
Q

How may patients compensate for weakness on affected side?

A

Increased use of unaffected side.

-neglect affected side

67
Q

What happens physiologically in the first few days after stroke?

A

Natural recovery.

  • Resolution of oedema
  • Reperfusion of ischaemic penumbra
68
Q

What happens physiologically in the weeks/months following a stroke?

A

Neuronal plasticity & cortical remodelling.

  • dendrite sprouting
  • synaptic remodelling.
69
Q

Where is input from the right half of the visual field processed?

A

In the left hemisphere.

70
Q

When does neglect occur and what senses does it affect?

A

Right parietal lobe stroke.

-visual & somatosensory

71
Q

What is neglect due to?

A

Failure to attend to left side.

72
Q

What is agnosias?

A

Inability to interpret senses & recognise things.

73
Q

What is prosopoagnosia?

A

Type of agnosia.

|&raquo_space; inability to recognise faces

74
Q

What is dyspraxia?

A

Loss of ability to conceptualise/plan a sequence of motor actions.

  • loss of cortical pathways
  • e.g. difficulty walking
75
Q

What are possible anatomical lesions leading to dyspraxia? (2)

A
  • Left inferior parietal lobe

- Supplementary motor area

76
Q

What are the symptoms of spastic hemiparetic gait?

A
  • Stiff legged
  • Short, slow steps
  • Risk of falls
77
Q

What may cause a painful hand after a stroke?

A

Spasticity - hypereexcitability of stretch reflex.

78
Q

What are symptoms of hand spasticity?

A
  • Loss of function
  • Unable to maintain hygiene
  • Pain
79
Q

How is hand spasticity managed?

A
  • Physiotherapy

- Drugs (botulinum toxin, baclofen)

Year 2 C&M symposia (11 decks)

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