Flashcards in Stroke Deck (21)
What is a stroke?
The sudden onset of focal or global neurological symptoms caused by ischaemia or haemorrhage and lasting more than 24 hours
What is a transient ischaemic attack?
The term used if the symptoms resolve within 24 hours
What is a CVA?
What are the causes of ischaemic stroke?
Large artery artherosclerosis (carotid)
Small artery occlusion (lacune)
What are the causes of haemorrhagic strokes?
Primary intracerebral haemorrhage
Secondary haemorrhage (subarachnoid haemorrhage, arteriovenous malformation)
What are the risk factors for stroke?
Impaired cardiac function
Oral contraceptives/HRT with high oestrogen content
What arteries complete the anterior circulation to the brain?
Anterior cerebral arteries
Middle cerebral arteries (both from ICA)
What arteries complete the posterior circulation to the brain?
2 vertebral arteries -> 1 basilar
3 pairs of cerebellar arteries
2 posterior cerebral arteries
What is the name of the structure where the arteries in the brain anastomose?
Circle of Willis
What are the symptoms of an ACA occlusion?
Paralysis of foot and leg
Sensory loss over foot and leg
Impairment of gait and stance
What are the symptoms of an MCA occlusion?
Paralysis of face, arm, leg
Sensory loss of face, arm, leg
Gaze paralysis to opposite side
Aphasia if stroke on dominant side
What symptoms are present if the stroke involves the right hemisphere of the brain?
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)
What are the 4 subtypes of strokes?
Total anterior circulation stroke (TACS)
Partial anterior circulation stroke (PACS)
Lacunar strokes (LACS)
Posterior circulation stroke (POCS)
What is TPA?
Tissue plasminogen activator
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
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
What is the aetiology for TIAs?
Embolic-cardiac source (AF, recent MI)
Artery to artery embolism
Venous sinus thrombosis
What investigations should be used for stroke?
Routine blood tests
Echocardiogram Carotid doppler ultrasound
Hyper-coaguable blood screen
What is used in the secondary prevention of strokes?
Lipid lowering agents
Warfarin for AF