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NEUROLOGY > Stroke > Flashcards

Stroke Flashcards

1
Q

What 4 things are required in the description of a stroke?

A
  • Type of stroke
  • Size of stroke
  • Laterality of stroke
  • Cause of stroke
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2
Q

How are strokes classified?

A

Posterior circulation infarction (POCI)
Lacunar circulation infarct (LACI)
Total anterior circulation infarct (TACI)
Partial anterior circulation infarct (PACI)

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3
Q

Where are lacunar infarcts most likely to occur?

A

Basal Ganglia

or thalamus / white matter

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4
Q

What type of stroke causes the least number of deaths after 1 year?

A

Lacunar infarcts

LACI

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5
Q

What stroke has the worst outcome after 1 year?

A

Total anterior circulation infarcts (TACI)

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6
Q

What symptoms are seen in a TACI?

A
  • Hemiplegia (At least 2 of face, arm and leg)
    +/- hemisensory loss
  • Homonymous Hemianopia
  • Cortical signs (dysphasia, neglect etc)
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7
Q

What symptoms indicate a partial anterior circulation stroke (PACI)?

A

2/3 features of TACI:

  • Hemiplegia
  • Homonomous hemianopia
  • Focal Cortical sign (dysphagia etc)

motor/sensory symptoms not as severe as TACI

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8
Q

How do lacunar infarcts show symptoms?

A 
Only occlude one deep penetrating vessel 
=> symptoms usually affect 2 of:
- face
- arm 
- leg
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9
Q

What variety of symptoms can be caused by posterior circulation infarcts (POCI)?

A
  • Cranial nerve palsies
  • Bilateral motor and/or sensory deficits
  • Eye movement disorders
  • homonymous hemianopia
  • Cortical blindness
  • Cerebellar deficits => balance, ataxia
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10
Q

Why is laterality of stroke important?

A

If it occurs in the dominant hemisphere, speech and language can become affected

If occurs in non-dominant, then spatial awareness is affected

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11
Q

Where can clots originate to cause infarctions?

A
  • atherothromboembolic (carotids/ larger vessels)
  • cardioembolic (AF)
  • Small vessel disease (clot forms in small vessel itself)
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12
Q

Describe the difference in appearance and treatment of clots which have formed in the carotids compared to cardioembolic clots.

A 
Carotid/atherothromboembolic = white and platelet rich 
=> Tx = antiplatelets

Cardioembolic = red and protein rich
=> Tx = anticoagulants

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13
Q

What investigations can be used to visualise atherothromboembolic disease in the carotid?

A

Ultrasound (doppler)

CT/MRI angiogram (often more visible)

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14
Q

What are the possible contributors to small vessel disease?

A
  • Ateriosclerotic (Age/risk factor related)
  • Genetic - related to cerebral amyloid angiopathy
  • Inflammatory/ immunologically mediated (e.g. eosinophilic granulomatosis/ granulomatosis with polyangitis)
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15
Q

What signs on MRI indicate small vessel disease?

A

White matter hyperintensities
Previous lacunes
Microbleeds

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16
Q

How large is a risk of stroke in those with AF compared to the normal population?

A

AF patients 5x more likely to have stroke

especially if they have atrial appendage as this is where clot is formed

17
Q

What heart defect can also predispose to stroke?

A

Patent foramen ovale

venous clots can cross to arterial side of heart

18
Q

How is a patent foramen ovale treated?

A

Clopidogrel

OR if younger - surgery to close

19
Q

What causes a Primary intracerebral haemorrhage vs a Secondary intracerebral haemorrhage?

A

Primary = Hypertension, amyloid angiopathy

Secondary = Arteriovenous malformation, Aneurysm, Tumour

20
Q

What cause of primary intracerebral haemorrhage is more likely to be lobar than deep?

A

Amyloid angiopathy more likely lobar

Hypertension = deep

21
Q

What is meant by Early haematoma expansion?

A

Continued arterial bleeding into perilesional tissue

causes oedema around the original area

22
Q

What is the ABCD of stroke prevention?

A
  • Antithrombotic/Antiplatelet/Anticoagulant Therapy
  • Blood Pressure
  • Cholesterol
  • Diabetes
  • Don’t Smoke
23
Q

What score is used to predict AF patients risk of a further stroke?

A

CHADVASC score

Score of >2 = indication for anticoagulation

24
Q

What gender is more prone to stroke if they have AF?

A

Females

25
Q

What scoring system is used to estimate patients risk of bleeding, and what else is it used for?

A

HASBLED score

  • allows you to fix reversible causes of bleeding
    e. g. hypertension or INR
26
Q

What statin is usually started after a stroke?

A

High dose atorvastatin
(eventually reduced)

**beware of giving in haemorrhagic stroke as low cholesterol could be a cause of this type)

27
Q

What is an endarterectomy?

A

Removal of material to correct stenosis in the common carotid artery or internal carotid artery

28
Q

How long after a stroke is endarterectomy no longer of benefit?

A

2 weeks

29
Q

Why is there a risk of stroke during endarterectomy?

A

Easy for bits of material to break off and travel up carotids during surgery

30
Q

How should dysphagia after a stroke be managed?

A
  • Initial swallow screen
  • If abnormal - assessment by speech and language
  • NG tube placement OR textured diet/thickened fluids

NEUROLOGY (29 decks)

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