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Flashcards in Stroke Deck (21)
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1

What is a stroke?

The sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting more than 24 hours

2

What is a transient ischaemic attack?

The term used if the symptoms resolve within 24 hours

3

What is a CVA?

Cerebrovascular accident

4

What are the causes of ischaemic stroke?

Large artery artherosclerosis (carotid)
Small artery occlusion (lacune)
Cardioembolic (AF)
Undetermined/ cryptogenic

5

What are the causes of haemorrhagic strokes?

Primary intracerebral haemorrhage
Secondary haemorrhage (subarachnoid haemorrhage, arteriovenous malformation)

6

What are the risk factors for stroke?

Previous stroke
Age
Male
Family history
Hypertension
Diabetes
Smoking
Alcohol
Obesity
Inactivity
Impaired cardiac function
Oral contraceptives/HRT with high oestrogen content
Hyper-coagulable states

7

What arteries complete the anterior circulation to the brain?

Anterior cerebral arteries
Middle cerebral arteries (both from ICA)

8

What arteries complete the posterior circulation to the brain?

2 vertebral arteries -> 1 basilar
3 pairs of cerebellar arteries
2 posterior cerebral arteries

9

What is the name of the structure where the arteries in the brain anastomose?

Circle of Willis

10

What are the symptoms of an ACA occlusion?

(Contra-lateral)
Paralysis of foot and leg
Sensory loss over foot and leg
Impairment of gait and stance

11

What are the symptoms of an MCA occlusion?

(Contra-lateral)
Paralysis of face, arm, leg
Sensory loss of face, arm, leg
Homonymous hemianopia
Gaze paralysis to opposite side
Aphasia if stroke on dominant side

12

What symptoms are present if the stroke involves the right hemisphere of the brain?

Left hemiplegia
Homonymous hemianopia
Visual agnosia
Sensory agnosia
Anosagnosia
Prosopagnosia

13

What are the symptoms of a PCA occlusion?

Visual fields deficits
Crossed sensori-motor deficits
Hemiparesis, hemisensory loss
Coma, vertigo, nausea, vomiting, cranial nerve palsies, ataxia (brainstem)

14

What are the 4 subtypes of strokes?

Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar strokes (LACS)
Posterior circulation stroke (POCS)

15

What is TPA?

Tissue plasminogen activator

16

What is the criteria for TPA use?

Less than 4.5 hours from symptom onset
Diasbling neurological deficit
Symptoms present for more than 60 minutes
Consent obtained

17

What is the exclusion criteria for IV TPA use?

Anything that increases the possibility of haemorrhage (blood on CT, recent surgery, recent bleeding episodes, coag problems)
BP > 185 systolic or >110 diastolic
Glucose <2.8 or >22mmol/L

18

What is the aetiology for TIAs?

Atherosclerotic narrowing
Embolic-cardiac source (AF, recent MI)
Artery to artery embolism
Hypercoaguable state
Arterial dissection
Venous sinus thrombosis

19

What investigations should be used for stroke?

Routine blood tests
CT/MRI
ECG
Echocardiogram Carotid doppler ultrasound
Cerebral angiogram
Hyper-coaguable blood screen

20

What is used in the secondary prevention of strokes?

Anti-hypertensives
Anti-platelets
Lipid lowering agents
Warfarin for AF
Carotid endarterectomy

21

What are other possible differential diagnosis' for stroke symptoms?

Hypogylcaemia
Bell's palsy
Vestibular disease
Migraine
Functional hemiparesis
Intracranial masses