Stroke Flashcards

1
Q

What is stroke?

A

Rapidly developing clinical symptoms and/or focal signs, and at times global loss of brain function, with symptoms lasting more than 24h leading to death with no apparent cause other than vascular origin

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2
Q

STROKE is a diagnosis TRUE/FALSE

A

FALSE

It is not a diagnosis, it is the experience of persisting neurological complications of cardiovascular disease

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3
Q

Which score helps to diagnose strokes?

A

Rosier Score

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4
Q

What fraction of all stroke presentations are stroke mimics e.g. seizures?

A

1/3

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5
Q

A TIA as compared to a stroke is benign TRUE/FALSE

A

FALSE

It is not benign

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6
Q

What time frame do symtoms have to last for for it to be classed as a TIA rather than a stroke?

A

Less than 24h

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7
Q

Define TIA

A

A brief episode of neurological dysfunction caused by ischaemia with clinical symptoms typically lasting less then 1h and without evidence of acute infarction

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8
Q

Which age group is stroke most common in?

A

More common in elderly, peak incidence >70 but can occur in other age groups

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9
Q

Strokes are more common in females T/F

A

False

Stroke more common in males

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10
Q

What 4 things is the extent of damage determined by?

A

Arterial territory of the affected artery
Timescale of the occlusion
Extent of the circulatory relief
System perfusion pressure

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11
Q

Before how many hours is there very little to observe on microscopy/microscopy after a stroke?

A

Less than 12h

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12
Q

How many days post stroke does the brain become gelatinous and febrile?

A

2-14 days

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13
Q

How long post stroke does it take for microglia to become the predominant cell type?

A

2-14 days

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14
Q

How early does reactive gliosis begin?

A

As early as wk 1

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15
Q

A CT is excellent and always picks up bleeds in the brain TRUE/FALSE

A

It is rather excellent however if hyperacute it may be essentially normal and it is not sensitive to bleeds over 1 week old

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16
Q

MRI is good with stroke at identifying…

A

Old lesions

Those of non-vascular origin

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17
Q

What is the time limit on using IV tissue plasminogen activator?

A

<4.5h

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18
Q

Do not treat cardioembolic stroke with aspirin TRUE/FALSE

A

TRUE

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19
Q

Aspirin can be used after thrombolysis TRUE/FALSE

A

TRUE but wait 24h

20
Q

ABCDE of prevention of stroke

A
A-Antithrombotic therapy
B-BP
C-Cholesterole
D-Diabetes
E-Especially don't smoke
21
Q

What fraction of strokes are due to AF?

A

1/6

22
Q

For the majority of strokes antithrombotic therapy is started?

A

Aspirin 300mg for 2wks

23
Q

What are the three types of ischaemic stroke?

A

Cardioembolic
Atheroembolic
Small vessel disease

24
Q

Describe Cardioembolic stroke

A

Fibrin dependent “red thrombus” e.g. endocarditis

25
Q

Describe atheroembolic stroke

A

Platelet dependent “white thrombus” e.g. from carotids

26
Q

Where is the most likely place to get a thrombus?

A

Middle cerebral artery ( as it is aligned with the internal carotid artery)

27
Q

CNS bleeds are the cause of what percentage of strokes?

A

10%

28
Q

What are the two main reasons for haemorrhage stroke?

A

BBB disrupted

Damaged vessels

29
Q

What are the four types of stroke?

A

TACS
PACS
LACS
POCS

30
Q

What is the most severe type of stroke?

A

Total Anterior Circulation Syndrome (TACS)- only 5% of patients alive at 1 year

31
Q

What are the 3 characteristics of total anterior circulation syndrome?

A

Hemiplegia involving 2/3 of face, arm,leg
Homonymous hemianopia
Cortical signs

32
Q

With PACS how many of the patients are alive and independent at 1 year?

A

50%

33
Q

With PACS they must have 2 of…

A

Hemiplegia involving 2/3 of face, arm,leg
Homonymous hemianopia
Cortical signs

34
Q

What are lacunar infarcts?

A

Small infarcts in the deeper parts of the brain

35
Q

What has the best prognosis of stroke?

A

LACS

36
Q

What is LACS caused by?

A

Occlusion of a single deep penetrating artery

37
Q

POCS can lead to multiple presentations, which are some of the most common

A
CN palsies
Bilateral motor and/or sensory defecits
Conjugate eye movement disorders
Isolated homonymous hemianopia
Cortical blindness
Cerebellar deficits w/o
38
Q

What is the right side of the brain responsible for?

A

Creativity, music, spatial orientation and artistic awareness

39
Q

What is the left side of the brain responsible for?

A

Spoken language, reasoning, number skills and written language

40
Q

With the small disease classification what type is churg-strauss?

A

Type 4

41
Q

What is type 1 small vessel disease classification?

A

Arteriosclerosis

42
Q

Causes of intracerebral haemorrhage

A
Hypertension
Amyloid angiopathy
AVM
aneurysm 
Tumour
43
Q

What are the two scoring tools to determine the risk of bleeding?

A

CHA2DS2VASc and HAS-BLED

44
Q

Where would the weakness present if the lesion was in the middle v anterior cerebral artery

A

If middle- contralateral face and arm

If anterior- contralateral leg

45
Q

TRUE/FALSE

Bleeding risk with aspirin is just as big as with warfarin

A

true

46
Q

What does a cardio protective diet look like?

A

5+ portions of fruit/veg per day from a variety of sources
Two portions of oily fish per wk
Replace saturated fasts with polyunsaturated/monounsaturated fats
Reduce salt intake
Limit alcohol to 14u/week
If overweight/obese then lose weight