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Internal Med > Strokes > Flashcards

Strokes Flashcards

1
Q

What are the 2 types of strokes?

A
  1. ischaemic and haemorrhagic stroke
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2
Q

What is a TIA?

A

It is an ischaemic stroke that has symptoms that resolve within 24 hours
But generally presents for just an hour

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3
Q

What are the 4 lobes of each cortex?

A
  1. frontal
  2. temporal
  3. parietal
  4. occipital
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4
Q

What does the frontal lobe control?

A
  1. executive function

2. movement

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5
Q

What does the temporal lobe control?

A
  1. Hearing
  2. memory
  3. facial recognition
  4. smell languages
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6
Q

What does the parietal lobe control?

A

sensory information

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7
Q

What does he occipital lobe control?

A

vision

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8
Q

What does the cerebellum controls?

A
  1. balance

2. muscle co-ordination

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9
Q

What does the brainstem control?

A
  1. heart rate
  2. blood pressure
  3. Breathing
  4. GIT tract
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10
Q

What is the circle of willis?

A

It is the circulation in the brain that ensures that the brain always has a secondary supply

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11
Q

How is stroke classification?

A

According to the oxfordshire community project

  1. TACS- TOTAL ANTERIOR CIRCULATION SYNDROME
  2. PACS-PARTIAL ANTERIOR CIRCULATION SYNDROME
  3. LACS-LACUNAR STROKE
  4. POCS-POSTERIOR CIRCULATION SYNDROME
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12
Q

What is TACS?

A

This means that the deep structures have experienced haemorhage or iscahemia as well as cortical infarction

  • If it is ischaemic in origin it is frequently caused by the middle cerebral artery
  • 90% of patients are dead or dependent 1 year after the stroke
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13
Q

What is PACS?

A

Also affects the proximal middle cerebral artery but the overlying cortex is spared because of good collateral from the leptomeningeal collaterals

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14
Q

What is LACS?

A

Usually occur in the basal ganglia and pons and ususally caused by hyalinosis

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15
Q

What is the definition of a stroke?

A

It is an acute neuronal event that occurs as a result of ischaemic or haemoorhagic event

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16
Q

What is the definition of a stroke?

A

It is an acute neurological event that occurs as a result of ischaemic or haemoorhagic event

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17
Q

What is the penumbra?

A

It is when the tissue has neurological fallout but there is still viable tissue

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18
Q

What forms the posterior cerebral artery?

A

The subclavian artery then the vertrbral and then the basilar artery

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19
Q

What are the causes of haemorrhagic strokes?

A
  1. hypertensive bleed
  2. aneurysms
  3. tumours
  4. inherited bleeding disorders
  5. cerebral amyloid angiopathy in the elderly
20
Q

What are the causes of Ischaemic strokes?

A
  1. artherosclerosis
  2. cardiac emboli
  3. small vessel disease-diabetes, smoking, alcohol, hypertension
21
Q

What is Virchows triad about?

A
  1. endothelial injury
  2. hypercoagubality
  3. stasis
22
Q

What are the causes of rare strokes especially in younger patients?

A
  1. arteritis: SLE, Takayasus HIV
  2. carotid and vertebral dissection
  3. fibromuscular dysplasia
  4. cancer, pregnancy(hypercoaguable states)
  5. antiphospholipid syndrome
23
Q

What are the causes of stroke in young patients?

A
  1. Illicit drus like TIK, cocaine, amphetamine,

2.

24
Q

Where do emboli come from most o the time?

A
  1. left atrium and left ventricle
  2. aorta
  3. carotid artery
25
Q

Which arrythmia causes strokes?

A

Atrial fibrillation

26
Q

What are the modifiable risk factors of strokes?

A
  1. smoking
  2. diabetes mellitus
  3. hypertension
  4. the pill
  5. alcohol
27
Q

Which blood vessels are prone to developing lacunar infarcts?

A
  1. small vessels from the middle cerebral artery (lenticulo striate vessels)
28
Q

What is aphasia and how do we test it?

A
  1. fluency
  2. naming-ask to name body parts
  3. comprehension
  4. repetition
  5. reading
29
Q

What is neglect?

A
  1. visual-ask them to draw a clock and draw the numbers
  2. auditory
  3. tactile
30
Q

What is anosognosia?

A

The denial of being ill

31
Q

What blood vessels are involved in developing a homonomous hemianopia?

A

anterior circulatioion or poserior circulation

32
Q

How do patients with TACS present?

A
  1. hemiplegia or severe hemipareiss contralateral to the lesion
  2. hemanopia contralateral to the cerebral lesion
  3. higher cerebral function disturbance: aphasia
33
Q

How do patients with PACS present?

A

With 2/3 of:

  • motor/sensory deficit
  • hemianopia
  • higher cerebral dysfunction
34
Q

How does POCS presnet?

A
  1. with isolated homonymous hemianopia
  2. cranial nerve palsy and contralateral motor deficit
  3. horizontal gaze palsy
  4. cerebellar dysfunction like nystagmus, vertigo
35
Q

What are stroke mimics?

A
  1. hypoglycaemia
  2. seizures
  3. migraine
  4. conversion syndrome
36
Q

What special investigtions would you do in stroke patients?

A
  1. blood glucose
  2. blood pressure
  3. bloods: HIV, RPR, cholesterol, FBC
  4. Imaging:
    ECG, CXR, uncontrasted CT
  5. extra things:
    -carotid ultrasound, Transthoracic/transoesophageal echocardiogram
37
Q

What is the causes of strokes?

A
  1. large vessels atheroemboli-atheromatous plaques in the carotid or vetebral arteries which caues narrowing and turbulent flow
  2. cardioemboli
  3. small vessel occlusion
38
Q

What leads to an increased risk of cardiac emboli?

A 
1. dilated cardiomyopathy
. infective endocarditis
3. mechanical valve lesions
4. atrial and ventricular thrombi
5.myocardial infarction in the last month
39
Q

How do you manage acute stroke?

A
  1. Confirm patent airway and vital signs
  2. Give oxyfen 2-4l/minutes via face mask or nasal prongs if SATS <95%
  3. Monitor ECG for atrial fibrillation for the first 24 hours
  4. Make sure you don’t give blood pressure lowering agents unless it’s a patient with myocardial infarction, aortic dissection
  5. Keep patient NPO to prevent aspiration and give 0,9% normal saline if dehydrated
  6. Check Hb and if <10 give oxygen and investigate cause
  7. manage hgt
40
Q

What are the complications of strokes?

A
  1. Aspiration and pneumonia cause 15-25% death
  2. depression
  3. cardiac dysfunction(myocardial infarction
  4. brain herniation and increased intracranial pressure
  5. seizures
  6. DVT, pulmonary embolism
  7. pressure sores
  8. UTI’s
41
Q

What does the CT scan of ischameic stroke look like?

A

The white and grey matter become dark and get progressively darker
The hypodensity means that there is irreversible damage

42
Q

How can we prevent a secondary stroke?

A
  1. control the risk factors
  2. Statin to lower the cholesterol
  3. warfarin especially in AF
  4. Antiplatelet agent aspirin 75-150mg/d)
  5. blood pressure always lowered
  6. carotid endarcetomy or stent if >70% stenosis of ipsilateral carotid
43
Q

What are the side effects of using aspirin?

A

-it causes gastrointestinal haemorrhage and irritation

44
Q

What are the new drugs we can use to help prevent scondary strokes that do not need monitoring of the INR?

A

NOACS-Novel oral anticogulants

-can cause left intracranial haemmorhage

45
Q

What are the causes of TIA?

A
  1. cardiac emboliism
  2. artherothromboembolism from carotid arteries
  3. hyperviscosity like in polycythemia
46
Q

What is the differential diagnosis of TIA?

A
  1. Hypoglycaemia
  2. migraine aura
  3. focal epilepsy

Internal Med (15 decks)

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