Vascular Flashcards
What are the biggest risk factor to having stroke?
- Previous Stroke/ TIA (CVA)
- Hypertension
- Diabetes
- Vascular diseases (e.g. Ischemic heart disease)
What are tools are used to identify stroke?
FAST - Face, Arm, Speech, Time
ROSIER - Recognition Of Stroke In the Emergency Room
What is the difference between a TIA and Stroke?
In a TIA symptoms should have completely resolved within 24 hours of onset while in stroke symptoms persistent for longer
What are the 2 types of stroke?
Ischaemic and haemorrhagic
What are the causes of an ischaemic stroke?
Thrombotic stroke
- thrombosis from large vessels e.g. carotid
Embolic stroke
- usually a blood clot but fat, air or clumps of bacteria may act as an embolus
- atrial fibrillation is an important cause of emboli forming in the heart
What are the causes of haemorrhagic stroke?
Intracerebral haemorrhage
bleeding within the brain
Subarachnoid haemorrhage
bleeding on the surface of the brain
What are general signs + symptoms of stroke?
- Symptoms present typically asymmetrical
- Limb weakness
- Facial weakness
- Dysphasia (speech disturbance)
- Visual field defects
- Sensory loss
- Ataxia and vertigo (posterior circulation infarction)
What are the symptoms of an anterior cerebral artery?
Contralateral hemiparesis and sensory loss, lower extremity > upper
What are the symptoms of a middle cerebral artery?
Contralateral hemiparesis and sensory loss, lower extremity < upper
Contralateral homonymous hemianopia
Aphasia
What are the symptoms of a posterior cerebral artery?
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
What are the symptoms of a Total anterior circulation infarcts (TACI)?
All 3 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
What are the arteries involved in a Total anterior circulation infarcts (TACI)?
involves middle and anterior cerebral arteries
What are the symptoms of a partial anterior circulation infarcts?
2 of:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
What arteries are involved in a partial anterior circulation infarcts?
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
What are the symptoms of a Lacunar infarcts (LACI)?
1 of:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
What arteries are involved in Lacunar infarcts (LACI)?
involves perforating arteries around the internal capsule, thalamus and basal ganglia
What are the symptoms of a Posterior circulation infarcts (POCI)?
1 of:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
What arteries are involved in posterior circulation infarcts (POCI)?
vertebrobasilar arteries
What are the symptoms of a Lateral medullary syndrome?
aka Wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
What arteries are involved in lateral medullary syndrome?
posterior inferior cerebellar artery
What are the symptoms of a Weber’s syndrome?
- ipsilateral III palsy
- contralateral weakness
What arteries are involved in Weber’s syndrome?
branches of the posterior cerebral artery that supply the midbrain
What are the symptoms of retinal/ophthalmic artery?
Amaurosis fugax (a painless temporary loss of vision in one or both eyes)
What are the symptoms of basilar artery?
Locked in syndrome
What is the first like investigation for a suspected stroke?
non- contrast CT
What is the golden investigation for a suspected stroke?
MRI
What is the immediate management of a TIA?
- Aspirin 300mg daily (started immediately)
- Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)
- Diffusion-weighted MRI scan is the imaging investigation of choice.
What is the immediate management of a stroke?
- Exclude hypoglycaemia
- Immediate CT brain to exclude haemorrhage
- Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
- Admission to a specialist stroke centre
When is thrombolysis and thrombectomy given for stroke?
thrombolysis
