Understanding Stroke Flashcards
Stroke definition
Sudden loss of blood flow to the brain tissue causing ischaemia and infarction
“sudden onset of focal or global neurological symptoms caused by ischemia or haemorrhage and lasting more than 24h”
TIA definition
Temporary onset of focal or global symptoms that resolve within 24h
What are the msot common types of ischaemic stroke?
1.Large artery atherosclerosis (Carotic)
2. Cardioembolic (af)
3. small artery occlusion (lacunae)
What are the types of hemorrhagic stroke?
Primary or secondary (eg subarachnoid/ateriovenous malformation)
Proportions of haemorrhagic ovs ischaemic stroke
haemorrhagic = 15%
Ischaemic = 85%
What coilour is blood in ct
white like bone
Lacune stroke often due to what condition
hypertension
What are risk factors fro strokes
taking eostrogen pills
smoking
being a couch potato (high bmi)
High lipid diet
cocaine
high blood pressure
diabetes
af
Where are particularly at risk of developing stokes in the brain and why?
around the basal ganglia, brainstem and subcortical areas (just inside the white matteron outside of brain)
Because they are all small vessles straight off from the big vessles witha highpressure in them and so they are more likely to rupture
Hypertenstion , cigarette smoke and diabetes all contribute to what being deposited in the arterial walls?
LDL-C
WHat can we give someone with AF to reduce the affect of ischaemic stroke?
Can give them DOACs ge edoxaban/apixaban(best), warfrin (not as good)
note: aspirin has no effect on reducing the risk of a stroke
How many cerebellar arteries and what do they come off from?
3 - all off from the basilar artery:
-superior
-anterior inferior
-posterior inferior
Frontal lobe functions
personality
executive functions (concentration, reasoning and abstraction)
motor cortex (in.c speech)
Urinary continance
Parietal lobe functions
sensory cortex, 2 point discrimination (sensation)
spatial orientation and visospatial information (nonn dominant hemisphere)
Ability to performed learned motor tasks (dominant)
Temporal lobe functions
Hearing, comprehension of speech, perception of visual, auditory and olfactory
learning, memory and emotional
Middle cerebral artery stroke vs anterior cerebral aretery stroke effects (due to the homonculus)
middle = extermnal lateral sides of brain, so the face, hands, arm
Amterior = internal medial sides of brain, so the legs, toes, genitals
What are the effects of a brianstem stroke?
same side cranial nerve dysfunction and contralateral hemiparesis
Occipital lobe functions
Vision, and visual perception
What can lead to the chiasm being cut off?
tumours presing on, can be from below (pituiotary) or above (can other tumour)
What is homonomous hemianopia?
When you can only see one visual field (issue beyond the optic chiasm)
WHat can causse Hemianopia due to astroke?
A massive MCA stroke or pca stroke. If MCA will have other symptoms for sure too like motor issues
migrain evs stroke
migraines have plus symptoms whereas stroke are minus symptoms, so loss of functions for stroke but add of visual stimuli or simelar is suggestive of migraine
What are the 4 classifications of stroke?
TACS - Total anterior Circulation Stroke
PACS - PArtial anterior circulation stroke
POCS - Posterior circulation stroke
LACS - Lacunar Stroke
What do you need to test ot distinguish between lacs, pacs, pocs and and tacs?
Anterior strokes distinguished by: Hemianopia , dysphasia (LHS) , neglect (RHS).
TACS = 2 (inc. hemianopia)
PACS = 1
Brainstem = brainstem/cerebellar signs
What are the symtpms of neglet(agnosias) (adn the subtypes)
just being unaware,
eg. of one whole side,
can be visual, sensory, anosagnosia (denial of hemiplagia) or prosopagnosia (inability to recognise faces)
Signs of a basilar artery occlusion
ischaemia in pons, motor/oculomotor signs/symptoms
Hyperdense nasilar artery indicating a blockage
Sub type with highest mortality
TACS
7 mimics if strokes
Seizures, syncope, sugar (hypo/hyper), Sepsis, Severe migraine, Space occuping lesions, SI CHological
AND
vestibular disorders, demylenation, transient global amnesia, mononeuropathy
What ios hoovers sign
functional vs actual paralysis
In actual paralysis, you will feel the non paralysed leg trying to push down whilst they are trying to lift the other leg up.
If the leg has functional paralysis, you won’t get the other leg pushing down.
What investigations for stroke?
CT/MRI
blood tests (check fr infection, hypo/hyper glycemia, lipids)
ECG/Holter - AF/LVH
CArotid US (Stenosis)
Best treatment for strokes
Thrombectomy and thrombolysis
Followed purely by thrombolysis on a stroke unit
Aspirin has little effect.
WHen wouldn’t you give thrombolysis?
Brain bleed(!)
Recent surgery
Oesophageal varices/recent bleeding
Coag issues
High blood pressure (>185 systolic/110 diastolic)
Very abnormal glucose (under 2.8/over 22mmol/L)
What has the best outcome for the patient?
Thromboectomy and thrombolysis, medical treatment and stroke ward
What has tbe most benefit to most peoplr?
Stroke wards!
What is the best treatment of a TIA
Antiplatelets, antihypertensive, statins and endartectomy
When do you perform a carotid endarterectomy?
Ideally pretty immediately after a TIA with at least 50% stenosis
WHat other secondary prevention of strokes can you give following a TIA
antihypertensive, antiplatelets, lipid lowering agents, warfarin for AF, carotid endarterectomy
