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Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (51):
1

what is the definition of a stroke?

syndrome of rapid onset cerebral deficit lasting >24 hours

2

85% of strokes are haemorrhagic - true or false?

false

85% are ischaemic, 15% are haemorrhagic

3

what condition is associated with 5 fold increase in stroke and what score is used to determine specific patient risk?

AF

CHA2DSVASc score

4

what score is used to determine bleeding risk in anticoagulation?

HAS-BLED

however, patient would need to fall 300 times for risk of bleeding to outweigh benefit of anticoagulation

5

what type of stroke is low cholesterol associated with?

haemorrhagic

6

what are the 2 main causes of ischaemic stroke?

atherosclerosis

cardioembolic

7

what are the two main causes of cardioembolic ischaemic stroke?

atheroma in internal carotid or aortic arch

embolic from heart due to AF

8

what are the two kinds of haemorrhagic stroke?

intracerebral

subarachnoid

9

where are intracerebral bleeds most commonly found?

basal ganglia

10

what causes primary intracerebral bleeds?

hypertension (deep on MRI)

amyloid angiopathy (lobar on MRI)

11

what causes secondary intracerebral bleeds?

arteriovenous malformation

aneurysm

tumour

12

what is most common cause of subarachnoid haemorrhage and where does this occur?

rupture of berry aneurysm

most commonly occurs in internal carotid or vertebro-basilar circulation

13

what increases the risk of berry aneurysms?

smoking
hypertension
kidney disease

14

what are the symptoms of berry aneurysm rupture?

severe headache
vomiting
LOC

15

what does the frontal lobe control?

motor function

higher cognition - thought processing, reasoning, intelligence

16

what does the parietal lobe control?

sensory function

sensory association

vision - fibres for lower quadrant visual field

17

what does the temporal lobe control?

language

hearing

vision - fibres for upper quadrant visual field

memory and emotion

association

18

what does the occipital lobe control?

vision

19

what does the cerebellum control?

balance
movement
co-ordination

20

what is the difference between brocas area and wernickes area?

brocas - speech production

wernickes - understanding speech and using correct words

21

what lobes do the anterior cerebral arteries supply?

frontal and parietal

22

what lobes do middle cerebral arteries supply?

frontal
parietal
temporal

23

what lobe does the posterior cerebral arteries supply?

occipital

24

what does the right side of the brain control?

left side of body
creativity
music
spatial orientation
artistic awareness

25

what does the left side of the brain control?

right side of body
spoken language
reasoning
number skills
written language

26

what is total anterior circulation syndrome?

large stroke affecting a large vessel of the anterior circulation and subsequently many smaller downstream vessels supplying various brain regions

Hence, all functions of anterior circulation (anterior and middle cerebral arteries) disrupted

27

TACS is the most severe type of stroke - true or false?

true - only 5% of patients alive and independent at 1 year

28

what are the features of TACS?

hemiplegia involving at least 2 of face, arm and leg +/- hemisensory loss
*middle CA = face and arm
*anterior CA = leg

hemianopia (usually contralateral)

higher cortical dysfunction

29

how many features are required for diagnosis of TACS?

all

30

what is partial anterior circulation syndrome?

smaller stroke affecting a smaller vessel of the anterior circulation when compared with TACS

hence, less downstream arteries are affected and not all functions of the anterior circulation (anterior and middle cerebral arteries) are disrupted

31

what % of patients are alive and independent at 1 year following PACS?

55%

32

what are the features of PACS?

2 or 3 of TACS features

or isolated cortical dysfunction such as dysphagia

or pure motor / sensory signs less severe than in lacunar syndromes (eg monoparesis)

33

what is a lacunar infarct?

mildest of strokes affecting the smallest vessels

the deep perforating arteries supply specific areas and infarction results in specific, yet minimal symptoms associated with the posterior or anterior circulations

34

what % of LACS patients are alive and independent at 1 year?

60%

35

what are the features of LACS?

pure motor deficit
pure sensory deficit
sensory and motor deficit
ataxic hemiparesis

36

how many features are required for diagnosis of LACS?

1 feature

*any 2 of face, arm and leg

37

what specific features cannot be present in order to diagnose LACS?

higher cortical dysfunction
posterior circulation syndrome symptoms

*these are not supplied by deep perforating arteries

38

what is posterior circulation syndrome?

large stroke affecting the vertebrobasilar vessels and their branches which supply the occipital lobe, brain stem and cerebellum

the vertebrobasilar vessels also contribute greatly to the circle of willis

the symptoms indicate the affected vessel

39

what % of patients are alive and independent 1 year after POCS?

60%

40

what are the features of POCS?

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

41

how is a stroke diagnosed?

CT - quickly

if this is normal = MRI

42

what does an intracranial bleed look like on CT?

acutely (within 3 days) = blood shows up as white

after this, it is broken down and becomes black

43

what does ischaemia look like on CT?

darker

loss of sulci definition

loss of grey / white matter definition

*dense MCA is really common

44

what is the acute treatment of ischaemic stroke?

thrombolysis (alteplase - start in 4.5 hours)

antiplatelet (aspirin 300mg - start within 24 hours and continue daily for 2 weeks)

45

acute treatment for haemorrhagic stroke is less clear cut but what kind of things are often done?

decompressive surgery

surgical intervention - surgical clipping, endovascular techniques

lower BP

46

what is the long term management of atherosclerotic / carotid ischaemic stroke (white and platelet rich)?

antiplatelet (clopidogrel 75mg - after 2 weeks, aspirin is replaced by this for life)

statin (atorvastatin - start within 48 hours and continue lifelong)

47

what is the long term management of cardioembolic ischaemic stroke (red and protein rich)?

anticoagulant (warfarin - review after 2 weeks)

statin (atorvastatin - start within 48 hours of stroke symptoms and continue lifelong)

48

what is long term management of haemorrhagic stroke?

monitor BP closely

49

what is carotid endarterectomy and when could this be used?

surgical procedure to remove a build up of fatty deposits (plaque) which cause narrowing of carotid artery

used to reduce recurrence of stroke

50

how is dysphagia managed after a stroke?

initial swallow screen

if abnormal - assessment by speech and language

may need NG tube placement or textured diet and thickened fluids depending on swallow

51

what must those with acute stroke be screened for risk of on admission and at least weekly thereafter?

malnutrition