Cerebral Infarct / stroke Flashcards Preview

Neurology Clinical > Cerebral Infarct / stroke > Flashcards

Flashcards in Cerebral Infarct / stroke Deck (26)
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1
Q

what are the modifiable risk factors for stroke?

A
hypercholesterolaemia 
smoking 
alcohol 
hypertension
diabetes
OCP
hyper coagulable states i.e. genetic, malignancy
2
Q

what are the non-modifiable risk factors for stroke?

A

age
male
family history
previous stroke

3
Q

why does chronic hypertension put you at risk of stroke?

A

chronic hypertension worsen atheroma and affected small distal arteries which are at high risk of small artery lipohyalinosis

4
Q

what factors increases the deposition of LDL in vessel walls?

A

hypertension
smoking
diabetes

5
Q

what are the symptoms associated with a stroke due to occlusion of the Anterior cerebral artery?

A

contralateral paralysis of foot and leg
sensory loss over foot and leg
impairment of gait and stance

6
Q

what are the symptoms of a stroke caused by occlusion of the middle cerebral artery?

A

contralateral paralysis of the face/arms/leg
sensory loss of face/arms/leg
homonymous hemianopia
gaze paralysis to oppose side
aphasia if in dominant hemisphere
unilateral neglect and gnosis for half of external space if non-dominant stroke

7
Q

if someone is right handed and they had occlusion of the MCA, what symptoms would they have?

A
left arm/face/leg paralysis/hemiplegia
homonymous hemianopia 
unilateral neglect syndromes
- visual agnosia
- sensory agnosia
- anosagnosia 
- prosopagnosia
8
Q

what arteries are occluded in a lacunar stroke?

A

medial and lateral lenticulostraiate arteries

small branches of the MCA

9
Q

what are the signs of a lacunar stroke?

A

no cortical signs

  • pure motor
  • pure sensory
  • dysarthria
  • ataxia hemiparesis
10
Q

what are the cortical signs associated with stroke ?

A

dysphagia
neglect
hemianopia

11
Q

what are the symptoms of stroke caused by occlusion of the posterior circulation?

A
coma
vertigo
nausea/vomiting 
CN palsies
ataxia 
hemiparesis
hemisensory neglect
crossed sensori-motor deficits
visual field deficits
12
Q

what are the treatments for stroke?

A

aspirin
heparin
thrombolysis r-TPA
clot retrieval/ thrombectomy

13
Q

what does the treatment TPA stand for?

A

tissue plasminogen activator

14
Q

what investigations would you carry out if someone had a stroke?

A
CT/MRI head 
FBC (glucose, lipids, ESR)
ECG (AF, LVH)
ECHO
carotid doppler USS
cerebral angio/venogram 
hypercoaguable blood screen
15
Q

what type of imaging is useful for subtle infarcts ?

A

diffusion weighted MRI

16
Q

what treatment is given for secondary prevention?

A
anti-hypertensives
anti-platelets
lipid lowering drugs (STATIN)
warfarin if AF
carotid endarectomy
17
Q

when is TPA given?

A

if symptoms are present for > 60 minutes but has to be given <4.5 hours after stroke

18
Q

when would you not give TPA?

A
blood on CT
recent surgery
recent episodes of bleeding
coagulation problems
BP >185 systolic or >110 diastolic 
glucose<2.8 or >22mol/L
19
Q

in which type of stroke must there be hemianopia?

A

lacunar

20
Q

what type of stroke has the highest chance of death?

A

TACS

21
Q

what are the main causes of early onset stroke?

A

arterial dissection - vertebral/carotid

cariogenic - AF, ASD, PFO

22
Q

what are the differential diagnoses of stroke?

A
post ictal states i.e. Todd's paralysis
hypoglycaemia
intracranial massess
vestibular disease
bells palsy
functional hemiparesis
migraine
demented patients with UTI's
23
Q

what is the main risk of thrombolysis?

A

bleeding

24
Q

what is a transient ischaemic attack?

A

temporary disruption in the blood supply to the brain causing neurological deficits but resolves within 24 hours
(most resolve within 2-60 mins)

25
Q

what are the causes of ischaemic stroke?

A
large artery atherosclerosis
cardioembolic i.e. AF
small artery occlusion i.e. lacunae 
undetermined/cryptogenic
arterial dissection
venous sinus thrombosis
26
Q

what are the causes of haemorrhage stroke?

A

primary intracranial haemorrhage
secondary intracranial haemorrhage
- subarachnoid
- arteriovenous malformation