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CR2 > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke

A

Syndrome of rapid onset neurological defect caused by a reduction in the blood supply due to cerebral infarction or haemorrhage

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2
Q

Ischaemic stroke

A

Occlusion of an intracranial or neck vessel leading to ischaemia and subsequent infarction of brain tissue

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3
Q

Haemorrhagic stroke

A

Bleeding into or around the brain classically due to a burst aneurism

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4
Q

Which stroke type is more common

A

Ischaemic

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5
Q

4 mechanisms of ischaemic stroke

A

Thrombosis
Embolism
Systemic hypoperfusion - Watershed stroke
Venous sinus thrombosis

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6
Q

Do thrombi or emboli more commonly cause stroke

A

Thrombi

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7
Q

How does atherosclerosis form

A

Endothelial damage -> lipoproteins and monocytes adhere to vessel wall + enter intima -> monocytes differentiate to macrophages -> macrophages engulf lipoproteins becoming foam cells -> cholesterol and foam cells accumulate forming fatty streak -> foam cells release pro inflammatory cytokines -> smooth muscle proliferation + CT deposition -> fibrous cover and necrotic cord form

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8
Q

Foam cell

A

Macrophages that have engulfed cholesterol

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9
Q

What is the first step in atheroma formation

A

Endothelial damage

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10
Q

How do foam cells cause smooth muscle cell proliferation

A

Release pro inflammatory cytokines

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11
Q

Why can atheroma form a necrotic core

A

Lack of capillaries

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12
Q

How can atheroma cause thrombosis

A

Plaque ruptures removing the endothelium and exposing fibrous cap, which causes clotting

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13
Q

2 types of Haemorrhagic stroke

A

Intracerebral
Subarachnoid

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14
Q

Most important stroke risk factor

A

Hypertension

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15
Q

Main symptom of subarachnoid haemorrhage

A

Thunderclap headache

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16
Q

What investigation can identify >95% Haemorrhagic stroke

A

CT Scan

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17
Q

What investigation is ordered if Haemorrhagic stroke suspected but CT clear

A

Lumbar puncture

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18
Q

What causes a watershed stroke

A

Systemic hypoperfusion

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19
Q

Stroke symptoms

A

Face asymmetry
Slurred speech
Difficulty raising both arms
Headache
Confusion
Aphasia
Dizziness
Loss of balance
Visual disturbance

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20
Q

4 categories in bamford stroke classification

A

Total anterior circulation stroke
Partial anterior circulation stroke
Lacunae syndrome
Posterior circulation syndrome

21
Q

What is lacunae syndrome

A

Small strokes in deep area of brain

22
Q

Stroke risk factors

A

Age
Hypertension
Diabetes
Atrial fibrillation
Hyperlipidaemia
Smoking
Obstructive sleep apnea

23
Q

How are strokes prevented

A

Treat risk factors

24
Q

What can cause cerebral necrosis

A

Mechanical compression
Cerebral oedema
Excitotoxicity

25
Q

How does cerebral oedema form

A

Decr ATP -> Na pump function limited -> incr Na conc in neurones -> water enters

26
Q

How can cerebral oedema lead to death

A

Skull limits expansion so cerebral veins compressed and intracerebral pressure increased

27
Q

Coning

A

Cerebella herniation of tonsils through foramen magnum

28
Q

What causes coning

A

Incr intracranial pressure

29
Q

How does brain coning cause death

A

Compression of lower brainstem and upper cervical spinal cord

30
Q

What triggers excitotoxicity

A

Ischaemia

31
Q

What is excitotoxicity

A

Incr glutamate in synapses -> NMDA receptors activated -> Ca2+ influx -> incr intracellular Ca -> cell death

32
Q

How does incr Ca2+ conc in cell cause apoptosis and necrotic cell death

A

Free radical release
Protease activation
Nitric oxide formation

33
Q

Penumbra

A

Potentially salvageable brain tissue

34
Q

What is the target for acute stroke therapy

A

Penumbra - may be able to save cells

35
Q

What is the dead area of brain tissue after a stroke called

A

Ischaemic core

36
Q

Why is non contrast CT used for in suspected strokes

A

Rule out/in haemorrhage

37
Q

What imaging may be used in stroke diagnosis

A

CT
MRI
Carotid ultrasound

38
Q

Why may carotid ultrasound be used in stroke investigation

A

Check for atherosclerosis

39
Q

Acute stroke therapies

A

Thrombolysis
Mechanical thrombectomy

40
Q

Thrombolysis

A

Intravenous fibrinolytic therapy using altepase to break down clot

41
Q

When can Thrombolysis be used

A

Within 4.5 hrs of stroke onset
Haemorrhage clearly excluded by imaging

42
Q

Thrombolysis contraindications

A

intracranial haemorrhage history
Stroke in last 3 months
Major surgery or sig trauma in last 3 months

43
Q

Mechanical thrombectomy

A

Endovascular removal of a thrombus from a large artery

44
Q

When can mechanical thrombectomy be used

A

Confirmed ischaemic stroke in large artery

45
Q

TIA

A

Sudden loss of function with complete recovery

46
Q

Anterior circulation TIA signs and symptoms

A

Unilateral weakness
Aphasia
Amaurosis fugax
Hemisensory loss
Hemianopic visual loss

47
Q

Posterior circulation TIA signs and symptoms

A

Diplopia
Vertigo
Vomiting
Choking
Dysarthria
Ataxia
Hemisensory loss
Bilateral visual loss

48
Q

Acute TIA management

A

Aspirin
TIA clinic with 24hrs

CR2 (33 decks)

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