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1st year systems > stroke- presentation > Flashcards

stroke- presentation Flashcards

1
Q

whats the commonest cause of long term disability in the uk?

A

stroke

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2
Q

how many NHS beds to people who have had strokes occupy?

A

20%

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3
Q

what is a stroke?

A

neurological deficet of sudden onset lasting more than 24 hours

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4
Q

what are stroke symptoms?

A

Loss of power

Loss of sensation

Loss of speech

Loss of vision

Loss of coordination

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5
Q

what part of the body does stroke effect?

A

brain- due to a blockage of a blood vessel by thrombus or embolus

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6
Q

what part of the brain is supplied by the carotid system?

A

most of the hemispheres and cortical deep white matter

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7
Q

what part of the brain does the vertebro basilar system supply?

A

brain stem, cerebellum and occipatl lobes

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8
Q

whats the function of the sensory cortex?

A

pain, heat and other sensations

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9
Q

whats the function of tge temporal lobe?

A

hearing, intellectual and emotional functions

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10
Q

whats the function of the parietal lobe?

A

comprehension of language

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11
Q

whats the function of the occipital lobe?

A

primary visual area

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12
Q

whats the function of wernicke’s area

A

speech comprehension

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13
Q

whats the function of the cerebellum

A

coordination

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14
Q

whats the function of the brainstem?

A

swallowing, breathing, heartbeat, wakefulness centre and other involuntary functions

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15
Q

whats the function of the frontal lobe?

A

smell, judgement, foresight and voluntary movement

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16
Q

whats the function of broca’s area?

A

speech

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17
Q

what causes a stroke?

A

blockage of a vessel with thrombus or clot

disease of vessel wall

distrubance of normal properties of blood

rupture of vessel wall

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18
Q

whats the commonest cause of cardioembolic stroke?

A

atrial fibrillation

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19
Q

what part of the brain can be affected by a stroke?

A

left or right
carotid territory or vertebrobasilar
cerebral hemispheres or brainstem
cortex or deep white matter

20
Q

what would a brainstem stroke be?

A

wether the lesion is in the brainstem

21
Q

what would a cortical stroke be?

A

wether there is a lesion in the cortex

22
Q

what would a lacunar stroke be?

A

if the lesion is in the deep white matter

23
Q

what example of lesion would be unilateral field loss?

A

left optic nerve compression

24
Q

what example of lesion would be bitemporal hemianopia?

A

chiasmal compression from pituitary tumour

25
Q

what example of lesion would be homonymous hemianopia?

A

left cerebrovascular event

26
Q

what are characteristics sof total anterior circulation TACS?

A

20% of strokes

patient usually has weakness, sensory deficit homonymous hemianopia
higher cerebral dysfunction

27
Q

what are the characteristics of partial anterior circulation? PACS

A

35% strokes

2 of 3 TAACS criteria or restricted motor/sensory deficit

28
Q

what are caracteristics of lacunar strokes? LAC

A

20% strokes

pure motor (commonest)
complete or incomplete weakness of 1 side

pure sensory
sensory symptoms, same distribution

sensorimotor
combination of the above

ataxic hemiparesis
hemiparesis and ipsilateral cerebellar ataxia
small infarcts in basal ganglia or pons.
intrinsic disease of single basal perforating artery

29
Q

what are charactristics of posterior circulation? POCs

A

25% strokes

affecting brainstem, cerebellar or occipital lobes

frequently complex presentation, may include
bilateral motor/sensory deficit 
disordered conjugate eye movement 
isolated homonymous hemianopia 
ipsilateral cranial nerve palsy with
 contralateral motor/sensory deficit 
coma 
disordered breathing 
tinnitus 
vertigo 
Horner’s
30
Q

what type of stroke has the highest mortality at one year?

A

TACs

31
Q

what type of stroke has the smallest mortality at one year?

A

LACs

32
Q

what type of stroke has the highest recurring rate at one year?

A

POCs

33
Q

risk factors for stroke

A

Modifiable
High blood pressure
Atrial fibrillation

Non-modifiable
Age
Race
Family history

34
Q

what are the investigations for stroke?

A

blood tests: full blood count, lipids

ECG

35
Q

what imaging would you use for stroke?

A

CT scan
MRI scan
carotid doppler

36
Q

whats better a CT or mri snd why?

A

CT
Quick
Shows up blood

MRI scan
Takes up to 30 minutes
Claustrophobic
Shows up ischaemic stroke better that CT does

37
Q

how can you harm someone with a stroke?

A

Alteplase
Cause unexpected bleeding either in the brain if tissue has established damage
If brain tissue already dead restoring blood supply is not going to help
Or bleeding elsewhere (e.g. Gut)

38
Q

whats the first thng a patient with a stroke should have to treat?

A

0.9 mg/kg intravenous rt-PA

39
Q

should patients with suspected stroke have priority over others for ambulance etc?

A

yes

40
Q

contraindications to thrombolysis?

A

Age
Most RCTs have excluded those under 16 and over 80 yrs
Licence currently limited to <80yr
Stroke outcomes worse anyway in over 80s
Greater age perceived as greater risk of bleeding
Lots of case series reporting good outcomes in older patients treate

41
Q

what surgery would you do for a patient that has had a stroke?

A

thrombolysis

42
Q

what is the majority age of stroke patients?

A

over 65

43
Q

how do you tell the difference between haemorhage and infarct on a scan?

A

in a ct scan, black image is infarct as there is more fluid

white image is haemorrhage

44
Q

how often is a stroke ischaemic and how often is it haemorrhage?

A

85% ischaemic

15% haemorrhage

45
Q

whats the difference between haemorrhage stroke and ischaemic stroke?

A

haemorrhage/blood leaks into brain tissue

ischaemic: clot stops blood supply to an area of the brain

46
Q

what are the main causes for ischaemic strokes?

A

large artery atherosclerosis
cardioemboic (atrial fibrilation)
small artery occlusion

1st year systems (74 decks)

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