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Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (35)
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1
Q

how can type of stroke be determined?

A

only by imaging

2
Q

how can size of stroke be determined?

A

oxford stroke classification scale

divides stroke into 4 syndromes

3
Q

total anterior circulation syndrome features?

A

big stroke affecting most of anterior circulation
all 3 of
- hemiplegia in 2 of face, arm and leg +/- hemisensory loss
- homonymous hemianopia
- cortical signs (dysphasia, neglect etc)
most severe stroke
60% dead at 1 year

4
Q

PACS features?

A

2 of 3 of:

  • isolated cortical dysfunction such as dysphasia
  • pure motor/sensory signs less severe than lacunar syndromes (e.g monoparesis)
5
Q

lacunar syndrome features?

A

small stroke
hemiplegia but no cortical loss
small infarcts in deeper parts of the brain (ganglia, thalamus etc)
caused by occlusion of single deep penetrating artery
affects 2 of face, arm and leg
best prognosis
assoc with cardio risk factors

6
Q

POCS features?

A
areas supplied by posterior circulation
cranial nerve palsies
bilateral motor and/or sensory deficits
conjugate eye movement disorders
isolated homonymous hemianopia
cortical blindness
cerebellar deficits without ipsilateral motor/sensory signs (in contrast to ataxic hemiparetic lacunar syndrome)
can cause locked in syndrome
7
Q

function of right side of brain?

A
left side of body
creativity
music
spatial orientation
artistic awareness
8
Q

function of left side of brain?

A
right side of body
spoken language
written language
reasoning
number skills
9
Q

dominant hemisphere (left) cortical events often affect what?

A

language

10
Q

non-dominant hemisphere (right) cortical events often affect what?

A

spatial awareness

can cause neglect syndrome

11
Q

main causes of ischaemic cerebrovascular disease?

A

atheroembolism - usually carotid (50%)
intracranial small vessel disease (25%)
cardiac source of embolism (20%)
other (5%)

12
Q

atheroembolism vs cardiac embolism treatment??

A

antiplatelets (stops platelet cascade which is causing the problem)
anticoagulation

13
Q

type 1 small vessel disease?

A

arteriosclerotic (age/risk factor related)

  • fibrinoid necrosis
  • lipohyalinosis
  • microatheroma
  • microaneurysm
14
Q

type 2 small vessel disease?

A

sporadic and hereditary amyloid angiopathy

15
Q

type 3 small vessel disease?

A

genetic small vessel disease distinct from cerebral amyloid angiopathy
small lacunar infarctions
cognitive impairment at younger age
no real treatment

16
Q

type 4 small vessel disease?

A

inflammatory and immunologically mediated

e.g - vasculitis

17
Q

type 5 small vessel disease?

A

venous collgenosis

18
Q

type 6 small vessel disease?

A

other small vessel disease

e.g - post radiation angiopathy

19
Q

what usually causes cardioembolic related ischaemic stroke?

A

AF (increases risk 5X)

other causes also (prosthetic valves, MI, thrombus etc)

20
Q

PFO?

A

patent foramen ovale
(between atria)
allows venous clots to pass into arterial chambers of heart which are then pumped out causing a stroke

21
Q

arterial dissection?

A

tear in arterial wall
exposes collagen etc in wall initiating the clotting cascade etc
can occur due to hypertension or artery disease
can occur in sudden turning of head (swimming, driving etc)

22
Q

management of arterial dissection?

A

antiplatelets
anticoagulation
rescan after 6 months

23
Q

2 groups of haemorrhagic stroke?

A
primary intracerebral haemorrhage
- hypertension
- amyloid angiopathy
secondary
- AVM
- aneurysm
- tumour
- etc
24
Q

amyloid vs hypertensive bleed?

A
amyloid = peripheral
hypertensive = centrally
25
Q

describe expansion of early haematoma?

A

continued arterial bleeding
secondary bleeding into perilesional tissue
subsequent perilesional oedema

26
Q

ABCD of stroke prevention?

A
antithrombotic therapy
BP control
cholesterol control
diabetes control
don't smoke
27
Q

what score is used for stroke risk in AF?

A
CHA2DS2VASc score
- CHF
- hypertension
- age >75 (worth 2)
- diabetes
- stroke/TIA/thromboembolism (worth 2)
- vascular disease
- 65-74 yrs old
- female
2+ = antiplatelet/anticoagulation
28
Q

what score for bleeding risk?

A
HAS-BLED
- hypertension
- abnormal renal/liver function (1 each)
- stroke
- bleeding
- liable INRs
- elderly
- drugs or alcohol
don't give aspirin or warfarin if significant bleeding risk
29
Q

is aspirin used in stroke?

A

no
increases bleeding risk and doesn’t reduce stroke risk enough to make it worth it
use anticoagulation instead

30
Q

what are the effects of reducing cholesterol?

A

low cholesterol = increased haemorrhagic stroke risk but reduced overall stroke risk

31
Q

what surgery can be done for severe arterial disease?

A

carotid endarterectomy

32
Q

number needed to treat for carotid endarterectomy to prevent 1 stroke 2 years post op?

A

6

33
Q

management of small vessel disease?

A

manage risk factors

34
Q

how is dysphagia managed?

A

initial swallow screen by nurse
if abnormal > assessment by speech and language therapist
may need NG tube placement or textured diet and thickened fluids depending on swallow

35
Q

risks of dysphagia after stroke?

A

aspiration - pneumonia
malnutrition
dehydration
cant take medication