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Phase 3a - Geriatrics and Neurology > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

What is the difference between TIA and ischaemic stroke?

A

TIA - sudden onset neurological deficit with sx resolving within <1hr

Ischaemic Stroke - sudden onset neurological deficit with sx > 24hrs (or infarction evidence on imaging)

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2
Q

RF for TIA? (4)

A

Htn
DM
Inc. Cholesterol
A fib
Carotid stenosis
Smoking
Fhx of CVD/stroke

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3
Q

Sx of TIA

A
  • Speech difficulty (dysphasia)
  • Arm or leg weakness
  • Amurosis fugax (signals stroke is impeding - dec. blood flow to retina)
  • Sensory changes
  • Ataxia or vertigo
  • Visual disturbance - diplopia
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4
Q

Main cause of TIA

A

Atherothromboembolism from carotid artery

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5
Q

Ix for TIA?

A

1st line - MRI/CT
Carotid artery doppler USS

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6
Q

Tx of TIA?

A

Aspirin 300mg daily - if had sus. TIA within last wk + referral to stroke specialist within 24hrs onset of sx

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7
Q

How does ischaemic stroke occur?

A

When blood supply in cerebral artery is reduced but without occurence of necrosis.

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8
Q

RF for ischaemic stroke? (4)

A

Older
Male
Fhx of strole
HTN
Smoking
DM
A fib

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9
Q

Acute Ix + Mx for ischaemic/haemorrhagic stroke?

A
  • Ix - Urgent CT/MRI to determine if ischaemic or haemorrhagic
  • Mx - DR ABCDE, if ischaemic + within 4.5 hrs give IV Alteplase
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10
Q

Post acute Ix for Ischaemic stroke and Haemorrhagic stroke

A

Ischaemic:
* Carotid USS
* CT/MRI
* ECHO

Haemorrhagic :
* Serum toxicology screen - i.e. cocaine is strong RF for it

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11
Q

Mx of post-acute ischaemic stroke

A

Prophylaxis:
* Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
* Lifelong clopidogrel 75mg
* Atorvastatin - usually after 48 hrs
* Mechanical thrombectomy
* BP and diabetes control
* Smoking cessation

Note - in ischaemic stroke lowering BP can worsen ischaemia therefore high BP tx is only indicated in hypertensive emergency. BUT BP is aggressively treated in pts w/ haemorrhagic stroke

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12
Q

What are the top RF for TIA and stroke?

A

A fib and carotid artery stenosis - Imaging and ECGs are done to identify these

ECG after a stroke is important in order to look for cardiac causes of thrombotic emboli and if there was any MI in the past.

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13
Q

What is extradural haemorrhage? Plus which artery does it commonly originate from?

A

When blood collects between dura mater and the inner surface of skull.
Middle meningeal artery often implicated.

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14
Q

Common cause of extradural haemorrhage?

A

Almost always trauma-related - severe head trauma causing a tear in middle meningeal artery

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15
Q

Sx of extradural haemorrhage?

A
  • Initial brief memory loss following trauma
  • Period of regained consciousness and apparent recovery (lucid interval)
  • Followed by subsequent deterioration of consciousness and headache onset
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16
Q

Ix for extradural haemorrhage?

A

Non-contrast CT head - biconvex/lens shape seen on scan

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17
Q

Mx of extradural haemorrhage?

A

Conservative if mild and urgent surgery if severe

18
Q

What is subarachnoid haemorrhage?

A

A bleed that occurs in subarachnoid space (beneath arachnoid mater)

19
Q

What is the main cause of subarachnoid haemorrhage in pts not related to trauma?

A

Berry aneurysm

20
Q

What are the RF for subarachnoid haemorrhage?

A
  • HTN
  • Adult PKD
  • Excessive alcohol consumption
  • Smoking
21
Q

Sx of subarachnoid haemorrhage?

A
  • Sudden onset SEVERE headache (worst headache of pt’s life) - thunderclap headache
  • Hx of physical exertion or coitus prior to onset
  • LOC or Vomiting
  • Previous ‘sentinel headache’
  • Meningism Sx
  • Retinal haemorrhages
22
Q

Ix for subarachnoid haemorrhage?

A
  1. Non-contrast CT head - within first 24 hrs
  2. Lumbar puncture - if CT head not definitive - presence of xanthochromia (not reliable within first 12 hrs)
23
Q

Mx of subarachnoid haemorrhage?

A
  • Medical - Nimodipine (prevent vasospasm)
  • Surgical - clipping and endovascular techniques such as coiling or stenting
24
Q

What is subdural haemorrhage?

A

Accumulation of venous blood in space between dura mater and arachnoid mater.

25
RF of subdural haemorrhage?
* >65 yrs * Bleeding disorders or anticoag therapy * Chronic alcohol use * Recent trauma
26
Sx of subdural haemorrhage
* Headache * N+V * Confusion * Diminished eye, verbal or motor response Presents typically sub-acute (3 days - 3wks) or chronic (>3wks)
27
Ix of subdural haemorrhage?
Non-contrast CT head - crescent shaped
28
Mx of subdural haemorrhage?
* **If acute** - craniotomy * **If chronic** - Burr holes ## Footnote * A craniotomy is a surgical procedure that involves removing a piece of the skull to access the brain. * Burr hole surgery is a procedure that involves drilling small holes in the skull to relieve pressure on the brain and drain blood or fluid.
29
What is giant cell arteritis?
Aka temporal arteritis, cdtn where arteries (esp. those at temples) become inflamed.
30
Sx of giant cell arteritis?
* Temporal headache - can cause blindness/stroke thus consider in an elderly with headache * Jaw claudication (pain on chewing food) * Amaurosis fugax (temp loss of vision in one eye) * Scalp tenderness * Systemic fx - fatigue, fevers, wgt loss, malaise Often occurs alongside polymyalgia rheumatica
31
Complications of GCA?
* Permanent monocular blindness * Stroke * Aortic aneurysms
32
Ix for GCA?
1st line - bloods (infl markers i.e. CRP,ESR + FBC + LFTs) * Findings: often normochromic normocytic anaemia + abnormal LFTs GS - Temporal artery biopsy * Findings - giant cells on histology Doppler ultrasonography * Findings - 'halo sign'
33
Tx of GCA?
Immediate: High dose steroids (prednisolone) - dec risk of stroke/blindness Once sx resolve - gradually taper pred over a long period of 1-2 yrs. If weaning off problematic, may use steroid sparing agents to lower dose i.e. methotrexate Bisphosphonates/PPI given due to prolonged corticosteroid use Low dose aspirin - further reduce risk of stroke/blindness
34
What is hypothermia?
A core body temperature below 35°C
35
Sx of hypothermia?
Shivering Hunger Dizziness Chills Slurred speech Paradoxical undressing Tachycardia initially if severe bradychardia Cool peripheries secondary to vasoconstriction Hypotension Ataxia Reduced level of consciousness
36
Ix + findings for hypothermia?
* Urine toxicology screen * ABG - initially resp alkalosis followed by reso acidosis * ECG - Prolonged PR, QRS and QT intervals, J waves present, bradyarrhythmias * Bloods + imaging to rule out cause
37
What are the sx of left HF vs right HF?
Left HF: * Shortness of breath on exertion * Orthopnoea * Paroxysmal nocturnal dyspnoea * Nocturnal cough (± pink frothy sputum) * Fatigue * Bibasal fine crackles on auscultation of the lungs * Cyanosis * Prolonged capillary refill time * S3 gallop rhythm Right HF: * Ankle swelling * Weight gain * Abdominal swelling and discomfort * Anorexia and nausea * Raised JVP * Pitting peripheral oedema (ankle to thighs to sacrum) * Tender smooth hepatomegaly * Ascites * Transudative pleural effusions (typically bilaterally)
38
Ix for heart failure?
1st line = NT-pro-BNP level ECG Transthoracic echocardiogram (TTE) Chest X-ray
39
What are the CXR in HF?
A: Alveolar oedema (with 'batwing' perihilar shadowing) B: Kerley B lines (caused by interstitial oedema) C: Cardiomegaly (cardiothoracic ratio >0.5) D: upper lobe blood diversion E: Pleural effusions (typically bilateral transudates) F: Fluid in the horizontal fissure
40
Tx of heart failure?
ABAL mnemonic: 1. Ace-i + b-blocker (i.e. bisoprolol) 2. Aldosterone antagonists (spironolactone) + Loop diuretic (furosemide) ## Footnote Consider ARB if intolerant to ACE-I. Consider hydralazine if intolerant to ACE-I/ARB. Hydralazine and a nitrate for Afro-Caribbean patients.

Phase 3a - Geriatrics and Neurology (11 decks)

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