Week 3-stroke Flashcards Preview

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Flashcards in Week 3-stroke Deck (40)
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1
Q

What is a transient ischaemic attack?

A

A transient ischaemic attack is a stroke lasting less than 24 hours.
“Brief episode of neurological dysfunction caused by focal brain or retinal ischaemia with symptoms lasting typically less than 1 hour without evidence of acute infarction”

2
Q

Does a TIA need treatment?

A

Yes needs immediate treatment to prevent a full blown stroke.

3
Q

What investigations would be done by the rapid access neuromuscular clinicians after a suspected TIA?

A

History
Cardiac imaging
ECG
Blood tests.

4
Q

Which forms of drug reduce the risk of stroke?

A

Statins and antiplatelet drugs

5
Q

What is a TIA referred to before the 24 hours is up?

A

TIA is a retrospective diagnosis so until the 24 hour mark has passed it is known as an acute cerebrovascular syndrome.

6
Q

What causes cell death in hemorrhagic stroke?

A

Not only does hypoxia lead to cell death but the bleeding itself activates an inflammatory cascade leading to cellular damage and death.

7
Q

What common medical conditions can mimic stroke?

A

Seizures (can give unilateral weakness)
Presyncope (dizziness and lightheadedness don’t normally coincide with stroke. Vertigo can however be seen in posterior strokes)
Sepsis
Acute confusion (delirium)
Transient global amnesia (period where people can’t remember what happened).

8
Q

What does ROSIER score stand for?

A

Recognition of stroke in the emergency room.

9
Q

Positive points on the ROSIER score?

A

Asymmetrical face weakness, asymmetrical arm weakness, asymmetrical leg weakness, speech disturbance, visual field defect.

10
Q

Negative points on the ROSIER score

A

Loss of consciousness or syncope, seizures.

11
Q

When is the ROSIER score indicative of a stroke?

A

When the score is more than 0. If less than zero, unlikely.

12
Q

What sort of imaging will you initially do on presentation of a patient with suspected stroke?

A

CT scan initially. Very sensitive for blood acutely and readily accessible.

13
Q

What colour does blood show up on a CT scan?

A

White.

14
Q

When would you use an MRI over a CT scan in stroke patients?

A

CT scan loses sensitivity for blood after about 1 week. Then you should use MRI.

15
Q

What would an infarcted area look like on a CT scan?

A

Darker area.

16
Q

What symptoms would you expect with a total anterior circulation stroke?

A

Hemiplegia (paralysis of one side of the body) contralateral to the lesion usually with ipsilateral sensory loss.
Hemianopia contralateral to the lesion
New disturbance of higher cerebral dysfunction (e.g. dysphagia)

17
Q

What symptoms would you expect with a partial anterior circulation stroke?

A

any of:
Motor/sensory deficit with hemianopia
Motor/sensory deficit with new higher cerebral dysfunction
New higher cerebral dysfunction with hemianopia
New higher cerebral dysfunction alone
A pure motor/sensory deficit less extensive than would be seen in lacunar stroke.

18
Q

What symptoms would you expect with a posterior circulation stroke?

A

Any of- ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Disorder of conjugate eye movement
Cerebellar dysfunction without ipsilateral long tract sign
Isolated hemianopia or cortical blindness

19
Q

What is a lacunar infarct?

A

Infarcts in the small perforating vessels supplying the deep structures of the brain.

20
Q

Which imaging method is best for a posterior circulation stroke?

A

Generally MRI because CT doesn’t deal well with all the bony structures.

21
Q

What sorts of functions does the left side of the brain control?

A

In most people this is the dominant side. From here you get speech, number skills, written language and reasoning.

22
Q

What sorts of functions does the right side of the brain control?

A

Creativity, music, spatial orientation and artistic awareness.

23
Q

What is the most common cause of stroke?

A

Atheroemboli (50%)

cardioembolic are just 20%

24
Q

What is the most common cause of cardioembolic stroke?

What else can cause it?

A

Atrial fibrillation.

Ventricular thrombus, prosthetic valves, rheumatic fever

25
Q

Why can patent foramen ovale cause cardioembolic stroke?

A

There is a connection between the two atria meaning clots that form in the venous system can get into the arterial system. These can then travel up and cause a stroke.

26
Q

What are the primary causes of hemorrhagic stroke?

A

Hypertension

Amyloid angiopathy

27
Q

Where do hypertensive hemorrhagic strokes occur in contrast to amyloid antipathy hemorrhagic stroke?

A

Hypertensive tend to be deeper in the brain whereas amyloid ones are more on the peripheries.

28
Q

What is the aim of thrombolysis treatment?

A

To break up the clot.

29
Q

When should thrombolysis be done by?

A

4.5 hours after symptom onset.

30
Q

Benefit increases the quicker you thrombolyse a patient. True or false?

A

True- time=brain tissue. The quicker you are, the less brain tissue is deprived of oxygen and therefore the more brain tissue saved.

31
Q

What would you do to differentiate between hemorrhagic and infarct stroke?

A

CT head- to make sure you don’t thrombolyse a patient with a hemorrhagic stroke.

32
Q

In the acute setting, the CT scan of a infarct stroke will show?

A

Often it will be normal. This is good because the tissue hasn’t been too damaged and inflammation and oedema haven’t set in.

33
Q

After the initial management of a stroke patient, what other investigations would you like to have done?

A

Blood pressure
Cholesterol
Carotid scan (to look for a clot)
ECG- look for AF. Possibly 24 hour monitoring.

34
Q

What does the ABCD2 stand for?

A

A-ge- greater than 60 (1 pt)
B- Blood pressure > 140/90 (+1)
C- Clinical features- unilateral weakness (+2), speech disturbance w/out weakness (1)
D-duration of symptoms- ( <10 mins-0, 10-59 mins- 1, >60-2)
D-diabetes (1 pt)

35
Q

What medications would you prescribe once the patient has been confirmed to have a stroke?

A

Antiplatelet therapy. In the acute setting use aspirin.
Then afterwards 1st line is clopidogrel, 2nd line is aspirin.
Statins- lower cholesterol

36
Q

What two scores assess bleeding risk? What is the purpose of each of them?

A

CHA2DVASc score- assesses the risk of infarct within 1 year. If the person scores 0- don’t give anticoagulation. If greater than 0- give anticoagulation.
HASBLED score- works out the risk of bleeding when on anticoagulation.

37
Q

A total anterior circulation infarct usually affects which arteries in the brain?

A

Usually affects the MCA and ACA. This means you will have symptoms affecting both these areas- higher cortical dysfunction (dysphagia, dysphasia), hemianopia, contralateral motor and/or sensory deficit (hemiplegia)

38
Q

A partial anterior circulation infarct usually affects which arteries in the brain?

A

Usually a branch of the MCA or ACA.

Results in two out of the three TACI symptoms. Higher cortical dysfunction, hemianopia, hemiplegia.

39
Q

A lacunar infarct usually affects which arteries in the brain?

A

Usually affects the deep penetrating vessels that supply the deep cerebral white matter, basal ganglia or pons. Results in symptoms- any one of the following

  • pure motor or pure sensory
  • sensorimotor ataxic
  • hemiparesis, clumsy
  • hand dysarthria
  • higher cortical dysfunction
40
Q

A posterior circulation infarct affects which arteries in the brain?

A

The ones supplying the brainstem, occipital lobes and cerebellum. (PCA supplies occipital lobe)
Results in symptoms of brainstem signs, ataxia, isolated homonymous hemianopia.