Cerebrovascular Disease Flashcards Preview

OSCE Conditions > Cerebrovascular Disease > Flashcards

Flashcards in Cerebrovascular Disease Deck (25):
1

Define a TIA

A sudden onset focal neurological deficit, resolving in under 24 hours

2

Modifiable risk factors for a stroke

Diabetes, raised cholesterol, hypertension, smoking, alcohol, obesity, drug abuse, infections

3

Pathophysiology of an ischaemic stroke

Blood clot stopping blood flow to an area of the brain
Can de due to:
- a thrombus in situ (small vessel disease)
- an embolism from the heart/aortic arch/carotid artery
- vasculitis
- cryptogenic (no cause identified)

4

Pathophysiology of a haemorrhagic stroke

Bleed in to the brain after rupture of diseased/weakened blood vessels
Primary bleed - usually due to hypertension
Secondary bleed - underlying cause eg. vascular abnormality/tumour/iatrogenic eg. Anticoagulants

5

Unmodifiable risk factors for stroke

Male, age, family history, previous stroke/TIA

6

Describe blood supply of the anterior cerebral artery

Supplies the anteromedial cerebrum
Part of the frontal and parietal lobes

7

Describe blood supply of the middle cerebral artery

Lateral cerebrum
Parts of the frontal, parietal, and temporal lobes

8

Describe blood supply of the posterior cerebral artery

Supplies the medial and lateral parts of the posterior cerebrum
Supplies the temporal and occipital lobes and the midbrain and thalamus

9

Which blood vessel is most commonly involved in a stroke?

Middle cerebral artery

10

Describe a Total Anterior Circulation Stroke (TACS)

Occlusion occurs in the ICA or the proximal MCA
Causes hemiparesis, hemisensory loss, hemianopia, higher cortical dysfunction (eg. Dysphasia, visuospatial disorders)

Usually due to a cardiac emboli
Poor prognosis - 50% mortality

11

Describe a Partial Anterior Circulation Stroke

Occlusion of MCA, usually due to large vessel disease eg. Carotids/arch of aorta

Causes 2 of hemiparesis/hemisensory loss/hemianopia or higher cortical dysfunction

12

Describe a Lacunar Stroke

Occlusion of a single perforating artery, due to small vessel disease ie. Atheroma in situ
Gives a pure motor or pure sensory deficit

13

Describe a Posterior Circulation Stroke

Leads to cranial nerve palsies, motor and sensory loss, cerebellar dysfunction, visual field defects

Can have any cause

14

Define stroke

A sudden onset focal neurological deficit, lasting over 24 hours

15

Symptoms of a stroke in the frontal lobe region

Muscle weakness (hemiparesis)
Expressive dysphasia (brocas)
Personality/behaviour changes

16

Symptoms of a stroke in parietal lobe

Hemisensory loss (primary sensory cortex)
Visuospatial deficit
Inferior quadrantanopia (superior optic radiation)

17

Symptoms of stroke in temporal lobe

Loss of auditory/vestibular function
Taste and smell dysfunction
Receptive dysphasia (wernickes)
Memory loss
Superior quadrantanopia (inferior optic radiation)

18

Symptoms of stroke in occipital lobe

Loss of vision

19

Symptoms of stroke affecting the cerebellum

Dysdiadokokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech
Hypotonia

20

Stroke differential diagnosis

Hypoglycaemia
Epilepsy
SOL
MS

21

Investigations of stroke

CT head - to look for bleeding/infarct
Carotid ultrasound/cardiac investigations
Coagulation profile

22

Management of ischaemic stroke

Thrombolysis - give rTPA, give <3hrs of symptom onset (<4.5hrs if patient <80yrs), only if INR<1.7

Thrombectomy/craniotomy

Carotid endarterectomy (if carotid embolus suspected)

Secondary prevention: Aspirin, risk factor reduction

23

Management of haemorrhagic stroke

Reverse any anticoagulation
Craniotomy
Secondary prevention: control of BP

24

Mechanism of action of rTPAs
Give some examples

rTPAs = recombinant Tissue plasminogen activator
Convert plasminogen to plasmin, which acts to cleave fibrin and break down blood clot.

Eg. Alteplase, Reteplase

25

Give some contraindications for thrombolysis

History of haemorrhagic stroke
Active peptic ulcer
Recent trauma or surgery
CNS neoplasm
Uncontrolled hypertension
Coagulopathies