Cerebral Infarction (Clinical) Flashcards
What is a stroke?
Sudden onset of focal or global neurological symptoms due to ischaemia or haemorrhage lasting more than 24 hours
How long does a TIA last?
- by definition lasts less than 24 hours
but. . most TIAs resolve within 60 minutes
Causes of ischaemic stroke?
- Large artery atherosclerosis
- Embolization (atrial fibrillation)
- Small artery occlusion
- Arterial dissection
- Venous sinus thrombosis
Non-modifiable risk factors for stroke?
- previous stroke / TIA
- Old age
- Being male
- Family history
- Hypertension
- Diabetes (?)
- Atrial Fibrillation
Modifiable risk factors for stroke?
- Hypertension
- Smoking
- High Cholesterol
- Diet (fat & salts)
- High BMI
- Alcohol
- Diabetes
Why are (Brodmann) areas of the brain and the homonculus important to remember in stroke?
Because infarction is localized and disability acquired should correspond to the region of the brain
Symptoms of Anterior Cerebral Artery occlusion?
Contra-lateral:
- paralysis of foot and leg
- Sensory loss over foot and leg
- Impairment of gait and stance
Symptoms of middle cerebral artery occlusion?
Contra-lateral:
- Paralysis of face / arm / leg
- Sensory loss face / arm / leg
- Homonymous hemianopia
- Gaze paralysis to opposite side
- Aphasia if on dominant (left) side
- Unilateral neglect and agnosia if on non-dominant side
What is a lacunar stroke?
Occlusion of the small penetrating arteries that provide blood to brains deep structures
Most common type of ischaemic stroke
What are some signs a lacunar stroke has occurred?
- Pure Motor Stroke
- Pure Sensory Stroke
- Dysarthria (clumsy hand syndrome)
- Hemiparesis
- Devoid of cortical syndromes like dysphagia / neglect / hemianopia
What brain structures could be affected by an occlusion in the posterior circulation (Basilar / PCA / Pontines)?
- Brainstem / Cerebellum / Thalamus
Symptoms of posterior circulation stroke affecting the brainstem?
- Coma / vertigo / nausea / vomiting / cranial nerve palsies / ataxia
- Hemiparesis / hemisensory loss
- Crossed sensory-motor deficits
- Visual field defects
What is a thrombectomy?
removal of the clot via insertion of a catheter through the femoral artery. Mesh cone expands from the catheter once at the target and collects the clot
What is thrombolysis?
dissolution of a blood clot via drug therapy. Effective within about 4.5 hours of stroke, but after that risk of cerebral haemorrhage appears to outweigh benefit
What is the most effective method of treating stroke?
- Thrombectomy
Can be given with thrombolysis
