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Cardio 3 > Strokes > Flashcards

Strokes Flashcards

1
Q

What are some common risk factors for strokes

A
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2
Q

What are the treatment options for an acute srtoke?

A
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3
Q

What is primary vs secondary prevention of strokes

A
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4
Q

How do we investigate strokes?

A
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5
Q 
WHat order risk factors:
Hypertension
Current Smoker
Waist-to-hip ratio
Diet risk score
Not Regular Physical activity
Diabetes
Alcohol intake
Stresst depression
Cardiac causes
Ratio ApoB to ApoA
A 
Hypertension - 52(%)
Not regular Physical Activity 29
Waist to Hip ratio 27
Ratio ApoB to ApoA 25
Current Smoker 19
Diet risk score 19
Cardiac causes 7
Diabetes 5
Stress/depression 5
Alcohol intake 4
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6
Q

Are cholesterol levels responsiable for stroke risk facto?

A

Not really but ApopB to ApopA IS a relatively big risk factor

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7
Q

What% atheroscolotoc disease? Cardiac Embolism? Small vessel disease? Cryptogenic (unknown)? Haemorrhage?

A 
Crytogenic - 30%
Small vessle 25%
Cardiac embolism and atherosclerotic cerebrovascular each 20%
Haemorrhagic 10-15%
Other 5%
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8
Q

What causes a haemorrhagic stroke?

A

A burst blood vessel

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9
Q

What is Amaloid?

A

When the blood vessel walls become glass like and so can fracture very easily

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10
Q

Which has worse outlook haemorrhage r ischemic?

A

Haemmhorage, more likely toresult in death or dependancy

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11
Q

What is a penumbra and when does it occur?

A

Its the area surrounding th earea of complete ischemia and infaction where the brain tissue gets enough oxygen to survive from other sources for a while but not obtaining enough to keep alive for long

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12
Q

How long in an Ischemic stroke does it take to llose 12km axonal fibres, 13.8 billion synapses and 1.9 million neurons?

A

1 minute!

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13
Q

What is an ischaemic stroke?

A

Caused by the occulsion of a vessel

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14
Q

hypoxia - ……….. - …………… - .oedema (swelling) causing further damage)

A

anoxia - infarction (necrosis)

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15
Q

How long does it take oedema to drecrease?

A

can be 10 days to a couple f weeks

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16
Q

What happens in the ischaemic cascade?

A

Hypoxia, anarobic metabolism - lactate released - eventually no more atp - atp pump fails - cell depolarises (NA CA in K out) - Ca triggers glutamate release - more ca into cells - proteases, lipases and free radiclals released due to over excitation

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17
Q

What is the excitotoxicity

A

Over excitement of the cell due to inappropriate Ca entry causonh extreme lipases, proteases and free radical release

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18
Q

What is released and can increase necrosis on death?

A

glutamate

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19
Q

Are Stroke symptoms fast onset?

A

Yes

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20
Q

Common carotid divide into what? How many common carotids do we have?

A

External and internal common carotids. Usually have 2 carotids (one each side)

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21
Q

How many vertebral arteries? Join to form what?

A

2 vertebral arteries, joining to form Basilar artery

22
Q 
What area of the brain :
Produces speach
Listening
Comprehension of language
speech como
vision
movement
sensations
swallowing, breathing, heartbeat, wakefulness, involuntary 
coordiation
A 
Produces speach -  Broca's area
Listening - Temporal lobe
Comprehension of language - Parietal lobe
speech comprehension - Wenicke's area
vision - occipital
movement - motor cortex
sensations - Sensory cortex
swallowing, breathing, heartbeat, wakefulness, involuntary  - brainstem
coordiation - cerebellum
23
Q

Where does ant cerebral artery supply? Post?

A

Anterior is more the front (shock horror) and posterior is more the back (wow!)

24
Q

SIgns and symptoms of stroke?

A 
Motor (clumsy or weak limb)
Sensory (loss of feeling)
Speech: Dysarthria/Dysphasia
Neglect / visuospatial problems
Vision: loss in one eye, or hemianopia
Gaze palsy

Ataxia/ vertigo / incoordination / nystagmus

25
Q

Anterior cerebral artery occlusion leads to what?

A

paralysis of contra-lateral foot and leg

sensory loss over contra-lateral toes, foot and leg

impairment of gait and stance.

26
Q

Middle cerebral artery occlusion leads to what?

A

Contra-lateral paralysis of face/arm/leg

Contra-lateral sensory impairment

Contralateral homonymous hemianopia (sees only one side of each eye)

Gaze paralysis to the opposite side

Aphasia if stroke on the dominant (left) side

Unilateral neglect for half of external space if non-dominant stroke (usually right side).

27
Q

What is aphasia?

A

Unable to communucate

28
Q

What is a small vessel stroke?

A

Lacunar stroke

Devoid of ‘cortical’ signs
E.g. no dysphasia, neglect, hemianopia

Pure motor stroke

Pure sensory stroke

Dysarthria - clumsy hand syndrome

Ataxic hemiparesis

29
Q

Why do lacunae (small vessel) strokes have such big implications even ifit can be a small stroke?

A

Because they are in a central area and so affect a large amount of cells/ cell bodies.

30
Q

Coma, nausea, vomiting, ataxia, drop attacks, vertigo are symptoms of what type of stroke?

A

Brain stem

31
Q

TACS PACS, LACS, POCS mean what? What are they all? Highest mortality and recurrence?

A 
TACS = WHole of Middle Cerebral Artery (most of brain), Total anterior circulation stroke
PACS = Partial anterior circulation stroke (part of MCA)
LACS = Lacunar (small vessel stroke)
POCS = Posterior Circulation Stroke

All types of stroke

highest mrotalitity is TAC (60%), then POCS (19), PACS (16) and LACS (11)

Recurrence at 1 year POCS 20%, PACS 17%, LACS 9% and TACS 6%

32
Q

Is stoke a disease of the elderly?

A

Yes

33
Q

risk of stoke is higher in more affluent areas?

A

No, nearly twice as common in poorer more deprived areas

34
Q

What is the most important modifiable risk for strokes?

A

Hypertension!

35
Q

What modifiable risk factors are there?

A

Hypertension, smoking, weight, lipids (LDL in conjunction with other risk factors), excessive alcohol intake

36
Q

When will high cholesterol have an impact?

A

Yes, high LDL will but only significant when in conjunction with other risk factors

37
Q

Do smoking and alcohol increase risk factors?

A

Smoking does, alcohol does but only in excess, a small amount is said to decrease the risk.

38
Q

Why is high eostrogen related to strokes?

A

Because it is pro thrombotic

39
Q

Why would malignancy and genetic factors increase risk of stroke?

A

Because they can cause a hypercoaguable state

40
Q

Do stroke units save live? What happens in a stroke unit?

A

Yes, specialist nurses and staff, they are keen to do scans and prepared to do treatment.

41
Q

What works well in ischemic stroke?

A

Asprin

42
Q

What is Alteplase? WHen best given?

A

A Thrombolytic agent, best given in the first 4.5 hours

43
Q

Is IV Thrombolysis time dependant? When is the cut off?

A

Yes, a dose is goven initially and then a proportion is then given IV over a set time. The cut off is 4.5 hours.

44
Q

FAST stands for what?

A

Face
Arms
Speach difficulties
Time

45
Q

How long to be thrombolysed ?

A

Within 4.5 hours, after that the risk of harm from bleeding becomes greater than the benefit

46
Q

Firstr scan of choice?

A

CT

47
Q

Specific aditional scans?

A

Perfusion CT/ Angiogram. If time (which there isn’t) can do MRI/diffusion/perfusion MRIs

48
Q

What is good about Fast field cycling MRI?

A

Should be much faster and cheaper esp in the long run. Uses a much lower magnetic field and so potentially safer and shows up areas of infarct very clearly.

49
Q

What are the pros and cons of MRIs

A

Quality of photo, but takes time and there are safety issues

50
Q

WHat s dyarthia?

A

Slurred speach

51
Q

Can clot retrieval be used to solve strokes? How does it work?

A

Yes, studys show that it is more effective than thrombolytic treatment. Basically insert a uninflated balloon past the clot and inflate then drag out the clot.

52
Q

WHat other treatments are given?

A

Antiplatelets
Statins
Blood pressure management

Anticoagulation (apixaban, rivaroxaban) - esp if found to have af or other conditions with predispose to thrombosis

Cardio 3 (5 decks)

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