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Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (54)
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1
Q

What is the definition of stroke?

A

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

2
Q

What is the most common type of stroke?

A

Ischaemic

3
Q

How long do symptoms of TIAs usually resolve in?

A

1-60 mins

4
Q

What is the time period that TIAs are defined by?

A

Symptoms lasting < 24hrs

5
Q

What are the main causes of ischaemic stroke?

A

Large artery atherosclerosis
Cardioembolic
Small artery occlusion
Arterial dissection

6
Q

What are the main causes of haemorrhagic stroke?

A

Primary intracerebral haemorrhage

Secondary (SAH, AV malformation)

7
Q

What imaging would you use in stroke?

A

CT (acute)

MRI

8
Q

What is the pathophysiology behind an ischaemic stroke?

A

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
Q

What are some of the modifiable risk factors for stroke?

A
Smoking 
Hypertension 
Diet 
Cholesterols
Exercise 
Obesity
Diabetes
10
Q

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

A

> Age
Male
Family history
Previous history of stroke

11
Q

What is the most important modifiable risk factor for stroke?

A

HYPERTENSION

12
Q

What is the name of the small end arteries?

A

Lacunar arteries

13
Q

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

A

Wernickes area

14
Q

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

A

Brocas Area

15
Q

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

A

Legs

16
Q

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

A

Arms, hands, face

17
Q

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

A

ACA
MCA

ICA

18
Q

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

A

PCA
(2 verebral arteries which form basilar)

3 cerebellar arteries

19
Q

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

A

Anterior & posterior communicating arteries

20
Q

Where does the anterior circulation of the brain arise?

A

ICA

21
Q

What are the symptoms of ACA occlusion?

A

Contralateral foot & leg paralysis
Sensory loss
Impairment of gait

22
Q

What are some of the symptoms of MCA occlusion?

A

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

23
Q

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

A

Dysphagia
Homonymous hemianopia
Right sides hemiplegia

24
Q

What artery supplies the internal capsule?

A

MCA

25
Q

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

A
Left hemiplegia 
Homonymous hemianopia
Visual &amp; sensory agnosia
Anasagnosia 
Prosapagnosia
26
Q

What is hemiparesis?

A

Loss of motor function on one side of body

27
Q

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

A

Pure motor
Pure sensory
Dysarthria
Ataxic hemiparesis

28
Q

What are some of the symptoms of a PCA stroke?

A
Vertigo
Coma
Nausea, vomiting 
Hemiparesis &amp; sensory loss
Visual field defects
29
Q

What are the different stroke classifications?

A

TACS
PACS
LACS
POCS

30
Q

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

A

Thrombolytic therapy (TPA)

31
Q

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

A

Thrombectomy (clot retrieval)

32
Q

Who are the different people present on a stoke unit?

A
Stroke nurse
Physio
OT
Speech &amp; language therapist
Dietician 
Psychologist
33
Q

What are the strict criteria for TPA use?

A

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

34
Q

What may prevent the use of TPA?

A

Any signs of haemorrhagic/ bleeding tendency

35
Q

For what stroke types can TPA be used?

A

Ischaemic

36
Q

What investigations may you do in stroke patient?

A

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

Anterior circular - carotid doppler US scan

Echocardiogram
Cerebral angiogram

37
Q

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

A

Antihypertensives
Antiplatelets
Statins
Endarterectomy

38
Q

What are the differentials for a stroke?

A
Hypoglycaemia 
Post-ictal state
Intracranial mass
Vestibular disease
Migraine 
Demented patient with UTI 
Bell's palsy
39
Q

What preventative drugs would be given after?

A

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

40
Q

What does ischaemia mean?

A

Lack of blood flow

41
Q

What does hypoxia mean?

A

Lack of oxygen

42
Q

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

A

Vessel wall
Change in blood flow
Change in blood constituents

43
Q

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

A

Atheroma + thrombosis
Thromboembolism
Aneurysm

44
Q

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

A

MCA

45
Q

Where will a thromboembolism usually originate?

A

Left atrium in those with AF

46
Q

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

A

Left atrium > Common carotid artery > ICA > MCA

47
Q

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

A

Haemorrhage

Distal ischaemia

48
Q

Where are the 2 most common sites of haemorrhagic stroke?

A
Basal ganglia (microaneurysms)
Circle of Willis (berry aneurysms)
49
Q

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

A

Hypotension
Cardiac arrest
Complex case

50
Q

When will Watershed infarcts present?

A

When there is poor perfusion with oxygenated blood

51
Q

What are Watershed infarcts?

A

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

52
Q

What will hypotension at the brain result in?

A

Watershed infarcts

53
Q

What will cardiac arrest result in?

A

Cortical infarcts

54
Q

What will complex cases result in?

A

Complex infarction pattern