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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
Q

RF of subdural haemorrhage?

A
  • > 65 yrs
  • Bleeding disorders or anticoag therapy
  • Chronic alcohol use
  • Recent trauma
26
Q

Sx of subdural haemorrhage

A
  • Headache
  • N+V
  • Confusion
  • Diminished eye, verbal or motor response

Presents typically sub-acute (3 days - 3wks) or chronic (>3wks)

27
Q

Ix of subdural haemorrhage?

A

Non-contrast CT head - crescent shaped

28
Q

Mx of subdural haemorrhage?

A
  • If acute - craniotomy
  • If chronic - Burr holes

  • 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
Q

What is giant cell arteritis?

A

Aka temporal arteritis, cdtn where arteries (esp. those at temples) become inflamed.

30
Q

Sx of giant cell arteritis?

A
  • 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
Q

Complications of GCA?

A
  • Permanent monocular blindness
  • Stroke
  • Aortic aneurysms
32
Q

Ix for GCA?

A

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
Q

Tx of GCA?

A

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
Q

What is hypothermia?

A

A core body temperature below 35°C

35
Q

Sx of hypothermia?

A

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
Q

Ix + findings for hypothermia?

A
  • 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
Q

What are the sx of left HF vs right HF?

A

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
Q

Ix for heart failure?

A

1st line = NT-pro-BNP level
ECG
Transthoracic echocardiogram (TTE)
Chest X-ray

39
Q

What are the CXR in HF?

A

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
Q

Tx of heart failure?

A

ABAL mnemonic:
1. Ace-i + b-blocker (i.e. bisoprolol)
2. Aldosterone antagonists (spironolactone) + Loop diuretic (furosemide)

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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