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JG Year 2 > 202 Stroke > Flashcards

202 Stroke Flashcards

0
Q

What is the definition of a TIA?

A

Neurovascular event of cerebral hypoperfusion with symptoms which last <24hrs

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1
Q

What percentage of strokes are ischaemic?

A

85%

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2
Q

Which artery commonly infarcts in stroke?

A

Middle cerebral artery

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3
Q

What would a stroke in the left occipital lobe cause?

A

Right homonymous hemianopia

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4
Q

What would a stroke in the right thalamus cause?

A

Left hemianaesthesia

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5
Q

What kind of symptoms would an intracranial haemorrhage in the left hemisphere produce?

A

Right hemiparesis

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6
Q

What is Cushing’s triad?

A

Sign of raised ICP - suggests cerebral haemorrhage in trauma or a space occupying lesion.

  1. Change in resps - often irregular or deep
  2. Bradycardia
  3. Widening pulse pressure
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7
Q

What are the symptoms of a sub arachnoid haemorrhage?

A

Sudden thunderclap headache, meningism, loss of consiousness

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8
Q

What are the features of a CVST?

A

Cerebral venous sinus thrombosis - I.e. DVT of the brain.
Raised ICP
No respect of arterial territories
Usually happens in the young

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9
Q

What is the usual cause of TIAs?

A

Carotid emboli

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10
Q

What is amaurosis fugax?

A

Curtain-like loss of vision in one eye due to passage of an embolus through the retinal artery

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11
Q

What is the most modifiable risk factor for stroke?

A

Blood pressure

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12
Q

What is the ROSIER system?

A

Recognition of a stroke in the emergency room

Sensitivity >90%, specificity >80%

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13
Q

What is the most common cause of an ischaemic stroke?

A

Atrial fibrillation causing thrombus in dilated left atrium

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14
Q

What causes stroke in a person with patent foramen ovale?

A

Valsalva manoeuvre - shunting causing clots to move from right atrium into left atrium

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15
Q 
Which circulation is affected given the following symptoms:
Amaurosis fugax
Aphasia
Hemiparesis 
Hemisensory loss
Hemianopia visual loss
A

Anterior circulation

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16
Q

Which arteries make up the anterior circulation of the brain?

A

Internal carotids
Anterior cerebral
Middle cerebral

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17
Q

Which arterial system of the brain is affected with any of the following:

Diplopia, vertigo, vomiting
Choking and dysarthria
Ataxia
Hemisensory loss
Bilateral visual loss
Tetraplasia
A

Posterior circulation i.e. Vestibulobasilar system

18
Q

Which arteries make up the posterior circulation of the brain?

A

Vertebral arteries
Basilar arteries
Posterior cerebral arteries
Posterior communicating arteries

19
Q

Disease of connective tissue is a predisposing factor for carotid and vertebral artery dissection?

A

Marfans

20
Q

Which 5 investigations should be performed when suspecting stroke?

A 
Bloods: FBC, ESR, Glu, Lipids
BP
ECG
CXR
Cerebral imaging
21
Q

What are the specific investigations of a stroke?

6 listed

A

USS Carotids
CT/MRI angiography or venography
Catheter angiogram

22
Q

What is the initial treatment for an ischaemic stroke?

A

Thrombolysis <3 hours post onset of symptoms

23
Q

What are the 5 causes of ischaemic stroke?

A 
Thrombus
Large artery stenosis
Small vessel disease
Cardio embolic
Hypoperfusion
24
Q

What are the 2 types of haemorrhagic stroke?

A

Intracranial haemorrhage

Subarachnoid haemorrhage

25
Q

What is ischaemic penumbra?

A

e.g. In stroke where the infarcted region is surrounded by a swollen area which does not function but is structurally intact - regain of function happens when there is neurological recovery

26
Q

What is the cause of neuronal cell death in a stroke?

A

Hypoxia leading to fall in ATP with release of glutamate which opens up calcium channels with release of free radicals.
Leads to inflammatory damage, necrosis and apoptotic cell death

27
Q

Where is stroke typically seen?

A

Infarction in internal capsule following thromboembolism in middle cerebral artery branch

28
Q

What are the clinical features of a thromboembolus in the right middle cerebral artery?

A

Left limb weakness develops over seconds/mins/hours
Contralateral hemiplegia/hemiparesis with facial weakness
Aphasia
Extensor plantar response

29
Q

What are lacunar infarcts?

A 
Small infarcts seen on CT/MRI/autopsy
Causes:
Pure motor stroke
Pure sensory stroke
Sudden unilateral ataxia and sudden dysarthria with clumsy hand
30
Q

Definition of ataxia?

A

Loss of full control of body movements

31
Q

Define aphasia

A

Inability to nudist and or produce speech

32
Q

Define dysarthria

A

Difficult or unclear articulation of speech that is otherwise linguistically normal

33
Q

Define dysphagia

A

Difficulty/discomfort swallowing

34
Q

Define hemiparesis

A

Paralysis of one side of the body

35
Q

What is papilloedema a sign of?

A

Encephalopathy

36
Q

Define: hemianopia

A

Blindness over half the field of vision

37
Q

What is alteplase?

A

Recombinant tissue plasminogen activator - it generates plasmin which is one of the key enzymes of fibrinolytic pathway. Increased activity causes hyperfibrinolysis

38
Q

What is the long term management for a stroke?

A

Identify and address R/F:
Antihypertensive Rx
Antiplatelet Rx - long term aspirin/clopidogrel
Anticoagulants - heparin/warfarin when there is AF
Rehabilitation

39
Q

What are the risks of using anticoagulants such as heparin and warfarin too soon following an infarction?

A

Risk of provoking cerebral haemorrhage

40
Q

Why is physio important in the first few weeks following stroke?

A

Reduce spasticity
Prevent contractures
Teach use of walking aids

41
Q

What is the 2 year mortality of a stroke?

A

25%

42
Q

Is early mortality more common in thromboembolitic or haemorrhagic strokes?

A

Haemorrhagic

43
Q

What are the surgical options for treatment of stroke?

A

Carotid endarterectomy

Stenting of carotids

JG Year 2 (28 decks)

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