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Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (54)
1

What is the definition of stroke?

A sudden onset of focal or global neurological symptoms caused by ischameia or haemorrhage which lasts >24hrs.

2

What is the most common type of stroke?

Ischaemic

3

How long do symptoms of TIAs usually resolve in?

1-60 mins

4

What is the time period that TIAs are defined by?

Symptoms lasting < 24hrs

5

What are the main causes of ischaemic stroke?

Large artery atherosclerosis
Cardioembolic
Small artery occlusion
Arterial dissection

6

What are the main causes of haemorrhagic stroke?

Primary intracerebral haemorrhage
Secondary (SAH, AV malformation)

7

What imaging would you use in stroke?

CT (acute)
MRI

8

What is the pathophysiology behind an ischaemic stroke?

Failure of cerebral blood flow due to interruption. This causes hypoxia and
Ischaemic penumbra.
When there is no oxygen (anoxia), infarction occurs & cell death.

9

What are some of the modifiable risk factors for stroke?

Smoking
Hypertension
Diet
Cholesterols
Exercise
Obesity
Diabetes

10

What are some of the non-modifiable risk factors for stroke?

> Age
Male
Family history
Previous history of stroke

11

What is the most important modifiable risk factor for stroke?

HYPERTENSION

12

What is the name of the small end arteries?

Lacunar arteries

13

What area of the brain will be affected in a receptive dysphagia?

Wernickes area

14

What area of the brain will be affected in a expressive dysphagia?

Brocas Area

15

If the ACA is blocked, where will symptoms be observed?

Legs

16

IF the MCA is blocked, where will symptoms be observed?

Arms, hands, face

17

What arteries comprise the anterior circulation of the brain? What is their origin

ACA
MCA

ICA

18

What arteries comprise the posterior circulation of the brain? What is their origin

PCA
(2 verebral arteries which form basilar)

3 cerebellar arteries

19

What arteries are responsible for the anatostomoses that comprise the Circle of Willis?

Anterior & posterior communicating arteries

20

Where does the anterior circulation of the brain arise?

ICA

21

What are the symptoms of ACA occlusion?

Contralateral foot & leg paralysis
Sensory loss
Impairment of gait

22

What are some of the symptoms of MCA occlusion?

Contralateral:
Leg/Arm/Face paralysis & loss of sensation
Homonymous hemianopia
Gaze paralysis
Aphasia (if affected dominant hemisphere)
Unilateral neglect & agnosia

23

If a stroke affects the Left side of the brain, what will be observed?

Dysphagia
Homonymous hemianopia
Right sides hemiplegia

24

What artery supplies the internal capsule?

MCA

25

What symptoms will be observed in a stroke on the right side of brain?

Left hemiplegia
Homonymous hemianopia
Visual & sensory agnosia
Anasagnosia
Prosapagnosia

26

What is hemiparesis?

Loss of motor function on one side of body

27

What are some of the symptoms of a lacunar artery stroke?

Pure motor
Pure sensory
Dysarthria
Ataxic hemiparesis

28

What are some of the symptoms of a PCA stroke?

Vertigo
Coma
Nausea, vomiting
Hemiparesis & sensory loss
Visual field defects

29

What are the different stroke classifications?

TACS
PACS
LACS
POCS

30

What is the most effective stroke treatment in first 3 hrs?

Thrombolytic therapy (TPA)

31

What type of treatment can be used in large vessel occlusions?

Thrombectomy (clot retrieval)

32

Who are the different people present on a stoke unit?

Stroke nurse
Physio
OT
Speech & language therapist
Dietician
Psychologist

33

What are the strict criteria for TPA use?

< 4.5 hrs onset of symptoms
Have to show disabling neulogical deficits
Symptoms > 1hr

34

What may prevent the use of TPA?

Any signs of haemorrhagic/ bleeding tendency

35

For what stroke types can TPA be used?

Ischaemic

36

What investigations may you do in stroke patient?

Bloods (FBC, Glucose, lipids)
CT or MRI head scan
ECG

Anterior circular - carotid doppler US scan

Echocardiogram
Cerebral angiogram

37

What treatment may be given to someone following TIA to prevent stroke?

Antihypertensives
Antiplatelets
Statins
Endarterectomy

38

What are the differentials for a stroke?

Hypoglycaemia
Post-ictal state
Intracranial mass
Vestibular disease
Migraine
Demented patient with UTI
Bell's palsy

39

What preventative drugs would be given after?

Anti-hypertensives
Anti-platelets
Statins
(Anti-coagulate in AF)

40

What does ischaemia mean?

Lack of blood flow

41

What does hypoxia mean?

Lack of oxygen

42

The interruption of blood flow to the brain can be defined by Virchows triad whats this?

Vessel wall
Change in blood flow
Change in blood constituents

43

What are the 3 main causes of localised interrupted blood flow?

Atheroma + thrombosis
Thromboembolism
Aneurysm

44

If thrombus is present in ICA, which cerebral artery will be affected?

MCA

45

Where will a thromboembolism usually originate?

Left atrium in those with AF

46

What arteries will it move through until it reaches the brain?

Left atrium > Common carotid artery > ICA > MCA

47

If rupture of cerebral artery occurs, what will be observed?

Haemorrhage
Distal ischaemia

48

Where are the 2 most common sites of haemorrhagic stroke?

Basal ganglia (microaneurysms)
Circle of Willis (berry aneurysms)

49

What are 3 examples of brain injury caused by generalised interrupted blood flow?

Hypotension
Cardiac arrest
Complex case

50

When will Watershed infarcts present?

When there is poor perfusion with oxygenated blood

51

What are Watershed infarcts?

Areas of ischaemias that are present at the zonal territory of arterial supply

52

What will hypotension at the brain result in?

Watershed infarcts

53

What will cardiac arrest result in?

Cortical infarcts

54

What will complex cases result in?

Complex infarction pattern