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Flashcards in Stroke Deck (44):
1

what are the types of stroke

haemorrhage:
-structural abnormality
-hypertensive
-amyliod angiopathy

subarachnoid haemorrhage

infarct:
-cardioembolic
-small vessel
-atheroembolic
-other

2

what scan to work out type of stroke

CT (sees if bleed or infarct)

3

what are the features of a posterior circulatory infacrt

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

overall 1 year independence 60%

4

what are the features of a lacunar syndrome

pure motor or sensory deficit affecting two or three of face, arm, leg
or sensorimotor stroke (basal ganglia and internal capsule)

affects down one side but no cortical loss

5

what are the features of total anterior circulation infarct

(contains all three of)
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss Homonymous Hemianopia
Cortical signs (dysphasia, neglect etc)

6

what type of infarct stroke has the worst prognosis

total anterior circulatory infarction

7

what are the features of a partial anterior circulatory syndrome

2 out of 3 features present in a TACS or;
Isolated Cortical Dysfunction such as dysphasia or;
Pure motor/sensory signs less severe than in lacunar syndromes (eg monoparesis).

8

which has the best prognosis of all the strokes

lacunar syndrome

9

what is lacunar syndrome

Lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem.
Caused by occlusion of a single deep penetrating artery. Affect 2 any two of face arm and leg

10

what is lacunar syndrome associated with

hptx
smoking
cholesterol

11

what does a stroke on the right side of the brain affect

creativity
spatial orientation
artistic awareness
music
left side of body

12

what does a stroke on the left side of the brain affect

right side of body
spoken language
reasoning
number skills
written language

13

which side of the brain is dominant in most people

left

14

what is the most common cause of ischaemic cerebrovascular disease

1. atheroembolism
2. intracranial small vessel disease
3. cardiac source of embolism
4. rare causes- thrombophillia, haemological disorders, genetic disorders

15

what are the most common types of haemorrhage in the brain

1. ischaemic stroke
2. primary intracerebral haemorrhage
3. subarachnoid haemorrhage

16

what is a white plaque and how do you treat it

activated platelets (atherosclosis)
antiplatelets (aspirin, clopidogrel)

17

what is a red clot and how do you treat it

clotting protein, cardioembolic (e.g. AF)
anticoagulants (heparins, doacs)

18

what investigations to look for vascular disease

USS, CT, MR angiography

19

what are the types of small vessel disease

1. ateriosclerotic (age/ risk factor related, most common)
-fibrinoid necrosis
-lipohyalinosis
-microatheroma
-microaneurysm

2. sporadic and hereditary cerebral amyloid angiopathy

3. genetic (not amyloid)
-CADASIL

4. inflammatory and immunologically mediated
-churg strauss, wegeners

5. venous collagenosis

6. other
-post radiation

20

what can small vessel disease cause in the brain

dementia

21

what is leukoaraiosis

white matter disease (will show patchy white shadows around ventricles on CT)

22

what are the most common causes of cardioembolic strokes

AF
acute MI
ventricular thrombosis
rheumatic heart disease
prosthetic valves

23

is AF a big risk from strokes

yes increases 6xs
i in 6 strokes caused by AF

24

when do venous clots cause stroke

when there is a patent foramen ovale

25

what can prevent further risk of stroke in PFO

clopidogrel
surgery to close hole (only if fit and young)

26

how does arterial dissection cause stroke

tear in arterial wall
exposes collagen
clotting cascade
embolises
stroke

27

what can cause an arterial dissection

hptx
vertebral artery dissection (twisting neck)

28

what is the tx for arterial dissection

antiplatelets / anticoagulation (both effective)
do scan and if vessel healed can stop antithrombotics

29

what are the causes of primary intracranial haemorrhage

hptx
amyloid angiopathy (deposition creates fragile vessels)

30

what are the causes of secondary intracerebral haemorrhage

AVM
aneurysm
tumour
etc

31

what is the main treatment for primary intracerebral haemorrhage

strict BP control

32

where in brain do the different types of primary intracerebral haemorrhage affect

lobar/ peripheral = amyloid angiopathy
deep/ central = BP (internal capsule, basal ganglia)

33

what is the result of early ICH hematoma expansion

Continued arterial bleeding
Secondary bleeding into perilesional tissue
Subsequent perilesional oedema

(mass effects of bleed and oedema damage brain)

34

what do you need to include in the diagnosis of a stroke

type
size
laterality
cause

35

what is the ABCDD of stroke prevention

Antithrombotic Therapy
-Antiplatelet Therapy
-Anticoagulant therapy
Blood Pressure
Cholesterol
Diabetes
Don’t Smoke

36

what does the CHA2DS2VASc score tell you

risk of getting stroke in patients with AF
2 or more needs anticoagulation

37

what is the HAS-BLED score

identifies reversible risks of a bleed to make it safer for patients to anticoagulated

38

should you give aspirin or warfarin

aspirin not as affect and just as high risk of a bleed

39

how many falls outweight the benefit of anticoagulation

300 times per year

40

what do you treat cardioembolic stroke with

NOT ASPIRIN

use oral anticoagulant

41

what drug can be used to protect against recurrent strokes

perindopril

42

what is low cholesterol associated with

haemorrhagic strokes

43

what surgery can be used to prevent further strokes

carotid endarterectomy (need to treat in 2 weeks after stroke)
depends on patient and surgical centre expertise

44

how is dysphagia managed

swallow screen
assessment by s+t therapist if abnormal
may need NG tube/ textured diet and thickened fluids
assess nutrition and hydration
might need medications they dont need to swallow