Strokes Flashcards
Define stroke
Condition characterised by rapidly progressive clinical symptoms and signs of focal loss of cerebral function lasting >24 hours
What % of strokes are ischaemic
70-80%
What % of strokes are haemorrhagic
20-30%
Prevelance of strokes
5/1000
What % of people who have a stroke die within the year
1/3
What is the leading cause of severe disability
Stroke
3 causes of haemorrhagic strokes
Subarachnoid
Intracerebral
Subdural
What are the steps of the mechanism of an intracerebral haemorrhage
Charcot-Bouchard microaneurysms
Microbleeds
Haemorrhagic transformation of infarcts
Vasculitis
Primary cause of intracerebral haemorrhage
Hypertension
What are the complications that could occur from an intracerebral haemorrhage (40
Local damage
Local mass effect
Raised ICP
Hydrocephalus
5 steps of managing a ICH
Establish cause Stop aspirin/ warfarin Treat complications Treat risk factors Rehabilitation
Symptoms of a subarachnoid haemorrhage
Sudden severe headache
Nausea and vomiting
Aneurysms
What usually causes subarachnoid haemorrhage (3)
Trauma
Ruptured intracranial aneurysm
Arteriovenous malformation
Symptoms of subdural hematoma
Numbness, disorientation, slow onset, irritability, headache
Name some causes of ischaemic strokes
Atherosclerosis Carotid stenosis Carotid dissection Cardiac Fat embolism
What does ischaemia immediately cause
Failure of Na+/ K+ pumps
Depolarisation
What does the depolarisation that results from ischaemia lead to
Glutamate release
Opening of calcium channels
What does glutamate release stemming from ischaemia lead to
AMPA receptors
Metabotropic receptors
NMDA receptors
Combined effect of glutamate and calcium channel opening?
Elevated intracellular calcium and cell death
Name some non-modifiable risk factors for strokes
Age Previous stroke Gender Ethnicity Family history
Name some modifiable risk factors for strokes
Hypertension Hyperlipidemia Smoking CV disease Diabetes
What signs are there if a stroke has affected the anterior circulation
Unilateral motor deficit
Homonymous hemianopia
Higher cerebral function
What signs are there if a stroke has affected the posterior circulation
Pure hemianopia
Cerebellar signs
Diplopia
Bilateral/ crossed sensory-motor signs
What kind of strokes does TOAST classification focus on
Acute ischaemic strokes
5 types of strokes in TOAST classification
Large-artery atherosclerosis Cardioembolism Small-vessel occlusion Stroke of other determined aetiology Stroke of undetermined aetiology
How can large artery atherosclerosis further be categorised
Embolus or thrombosis
4 categories of a LACI (lacunar) stroke
Pure motor
Pure sensory
Ataxic hemiparesis
Sensorimotor
What % of people are suitable for thombolysis
20
What brain structures are supplied by the middle cerebral artery
Motor cortex
Sensory cortex
Brocas and Wernickes
Primary auditory cortex
Is the somatosensory cortex in the right or left cerebral hemisphere
Right
Is the motor cortex in the right or left cerebral hemisphere
Right
