Flashcards in Stroke Deck (42):
1
What are the different types of haemorrhagic stroke?
Structural abnormality
Hypertensive
Amyloid angiopathy
2
What are the different types of infarct stroke?
Cardioembolic
Small vessel
Atheroembolic
3
What are the features of a POCI?
CN deficit with contralateral hemiparesis or sensory deficit
OR
Bilateral stroke
OR
Disorders of conjugate eye movement
OR
Isolated cerebellar stroke
OR
Isolated homonymous hemianopia
4
What are the features of a TACI?
NEED ALL 3:
New higher cerebral function dysfunction: dysphasia, dyscalculia, apraxia, neglect, visuospatial problems
Homonymous visual field defect
Ipsilateral motor and/ or sensory deficit of at least two areas of face, arm and leg
5
What are the features of a PACI?
Two of 3 components of TACI
OR
Isolated dysphasia or other cortical dysfunction
OR motor/ sensory loss more limited than for a LACI
6
What are the features of a LACI?
Pure motor OR pure sensory deficit affecting two of face, arm and leg
Sensorimotor stroke (basal ganglia and internal capsule)
Ataxic hemiparesis (cerebellar type ataxia with ipsilateral pyramidal signs; internal capsule or pons)
OR
Dysarthria plus clumsy hand
OR
Acute onset movement disorders (hemichorea, hemiballismus; basal ganglia)
7
Which stroke has the worst outcomes?
TACI; total anterior circulation infarction
8
What are lacunar strokes associated with?
Hypertx
Diabetes
Smoking etc
9
What does the left side of the brain control?
Motor and sensory of right side
Language centers
Reasoning
Written language
Number skills
10
What does the right hemisphere control?
Motor and sensory of left body
Creativity
Music
Artistic awareness
Spatial awareness; neglect syndrome
11
What is the 1st line investigation in carotid disease?
USS for narrowing
12
What should be done if narrowing of the carotid vessels is seen on USS?
CTA or MRA
13
What is the threshold of narrowing for referral for carotid endarterectomy?
50-99%
14
What is type 1 small vessel disease?
Arteriosclerotic;
Fibrinoid necrosis
Liophylaniosis
Microatheroma
Microaneurysm
15
What is type 2 small vessel disease?
Sporadic and hereditary cerebral amyloid angiopathy
16
What is type 3 small vessel disease?
Genetic small vessel disease; CADASIL
17
What is type 4 small vessel disease?
Inflammatory and immunologically mediated:
eGPA, GPA
18
What is type 5 small vessel disease?
Venous collagenosis
19
What is type 6 small vessel disease?
Post radiation angiopathy
20
What are the MRI expressions of small vessel disease?
White matter hyperintensities
Microbleeds
Leukoaraiosis
21
What conditions result in cardioembolic strokes?
AF; 50%
Acute MI
Prosthetic valves
Ventricular thrombus
Rheumatic heart disease
22
Why can PFO result in a stroke?
Due to patent foramen ovale; venous clots can pass from the venous to arterial side and travel up to the brain
23
What is the treatment for PFO?
If it causes a stroke in a younger patient; surgical closure and clopidogrel
24
Why can arterial dissection result in a stroke?
Exposure of underlying collagen
Clot formation
25
What is the treatment for arterial dissection?
Treat like normal stroke
Give antiplatelets OR anticoags
Recan after 6 months to see if abnormality persists; if it does then continue antiplatelets, if it has completely healed with no structural abnormalities then antiplatelets can be stopped
26
What can cause a primary intracerebral haemorrhage?
Hypertx
Amyloid angiopathy
27
What can cause a secondary intracerebral haemorrhage?
AVM
Aneurysm
Tumour
28
What does a peripheral and lobar haemorrhage suggest?
Amyloid angiopathy
29
What does a deep, central haemorrhage suggest?
Hypertensive in nature
30
What is early haematoma expansion?
Continued arterial bleeding
Secondary bleeding into perilesional tissue
Subsequent perilesional oedema
31
What is a good example of a description of a stroke?
Type, size, laterality and cause
E.g.
Right hemispheric, cardioembolic, partial anterior circulation infarction
32
What is the ABCD of medical stroke prevention?
Antithrombotic therapy
Blood pressure control
Cholesterol control
Diabetes assessment
Don't smoke
33
When will antiplatelets and anticoags be used?
Antiplatelets; atherosclerotic or small vessel disease
Anticoag: cardioembolic
34
Which scoring system is used to assess clot risk for patients with AF?
CHA2DS2 VASc score
35
What score on CHA2DS2 VASc indicates that anticoagulation should be give?
2 or more
36
Which scoring system is used to assess bleeding risk on blood thinners?
HAS-BLED
37
What statin should be given to reduce stroke risk?
High dose atorvastatin; 80mg
38
Should a statin be given post-haemorrhagic stroke?
Need to weigh up pros and cons; slight increase risk of haemorrahgic stroke
39
How is dysphagia managed post-stroke?
Initial swallow screen, if abnormal then a formal assessment by a speech and language therapist
May need NG tube placement or textured diet and thickened lfuids
40
How quickly should patients have their swallow assessed post stroke?
4 hours of arrival at hospital and before being given any oral food, fluid or medication
41
How quickly should an NG tube be placed?
Within 24 hours
42