Stroke W4 Flashcards by Freya Balcombe

stroke definition?

sudden-onset focal neurological dysfunction due to vascular disease
neurological emergency!!!!!!!

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2 types of stroke?

ischaemic (80%)
haemorrhagic (20%)

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what is ischaemic stroke

blockage in arterial supply leads to tissue infarction

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what is intracerebral haemorrhagic stroke?

direct bleeding into brain parenchyma

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2 other types of stoke separate to ischaemic/haemorrhagic?

subarachnoid haemorrhage (due to aneurysmal rupture)
cerebral venous thrombosis

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blood supply to brain - anterior, middle, posterior cerebral arteries supply which areas?

anterior - medial (frontal, parietal)
middle - lateral (frontal, parietal, temporal)
posterior - (occipital, temporal)

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major risk factors of stoke?

ageing
vascular risk factors
cardiac pathology - emboli travel from heart

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vascular risk factors for stroke?

hypertension
smoking
diabetes
hypercholesterolaemia

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cardiac pathology risk factors for stoke?

atrial fibrillation
valvular disease
defects

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clinical features of stroke

sudden-onset
focal - features reflect area affected
75% anterior circulation
25% posterior circulation

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clinical features of anterior stroke?

cortical deficits (dysphasia, neglect, visual field deficits)
motor weakness, sensory disturbance

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types of dysphasia?

expressive - patients struggle to express themselves in words and writing
receptive - patients struggle to understand things said to them, follow commands

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clinical features of posterior stroke?

ataxia
diplopia
weakness and sensory disturbance

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diplopia?

double vision

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schema which is used clinically to classify stokes?

Bamford classification

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4 types of stroke in Bamford classification?

total anterior circulation stroke (TACS)
partial anterior circulation stroke (PACS)
lacunar stroke (LACS)
posterior circulation stroke (POCS)

total anterior circulation stroke (TACS) location, vessel, and frequency?

large cortical stroke
anterior/middle cerebral arteries
15%

total anterior circulation stroke (TACS) criteria?

unilateral weakness and/or sensory deficit of the face and/or arms and/or legs
homonymous hemianopia
higher cerebral dysfunction

partial anterior circulation stroke (PACS) location, vessel, frequency?

cortical stroke
anterior or middle cerebral arteries
35%

partial anterior circulation stroke criteria?

2/3 TACS criteria

lacunar stroke (LACS) location, vessel, frequency?

subcortical stroke
small deep perforating arteries
25%

lacunar stroke (LACS) criteria?

pure motor, sensory or sensorimotor (min 2: face, arm, leg)
ataxic hemiparesis

posterior circulation stroke (POCS) location, vessel, frequency?

cortical, cerebellum, brainstem stroke
posterior cerebral, vertebral, basilar arteries and branches
25%

posterior circulation stroke (POCS) criteria?

cerebellar or brainstem syndrome
loss of consciousness
isolated homonymous hemianopia

homonymous hemianopia?

field loss deficit in same halves of the visual field of each eye

transient ischaemic attack (TIA) definition?

symptoms and signs of ischaemic stroke but resolving (hence transient) most resolves within minutes, by definition all resolve within 24 hours

TIA imaging features?

if there is evidence of cerebral infarction then its not a TIA - its a stroke!! (even if clinical features have resolved)

what does a TIA indicate?

warning sign - patient at elevated risk of ischaemic stroke in next few weeks - opportunity to intervene and reduce risk

management of stroke - 3 categories?

hyperacute secondary prevention supportive care and rehab

hyperacute management of ischaemic stroke?

reperfusion therapy: thrombolysis ('clot-busting' medication) thrombectomy ('clot retrieval' intervention) both reduce long term disability after ischaemic stroke. time dependant!!!!

hyperacute management of haemorrhagic stroke?

control BP and coagulation issues (eg due to medication like warfarin)

secondary prevention management for ischaemic stroke?

antiplatelet therapy (300mg aspirin for 2 weeks, then low lose clopidogrel for life) screen for and treat atrial fibrillation (all patients should have ECG) surgery for carotid artery disease if present

secondary prevention management for ischaemic and haemorrhagic stroke

BP control lipid lowering lifestyle (diet, exercise, weight loss, smoking cessation)

supportive management for stroke?

dysphagia (unsafe swallow) - NG/PEG feeding, modified diets, speech & language therapy dysphasia - communication aids, SLT mobility - rehabilitation cognition - supportive strategies spasticity and contractures pain psychological support