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Neurology > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the three main types of stroke?

A

Ischaemic stroke
Intracerebral haemorrhage
Subarachnoid haemorrhage

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2
Q

What are the signs of right brain large vessel ischaemic stroke?

A

Right gaze preference

Neglect

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3
Q

What are the signs of left brain large vessel ischaemic stroke?

A

Left gaze preference

Aphasia

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4
Q

Describe the clinical signs of middle cerebral artery ischaemic stroke?

A

More arm weakness than leg weakness
If in the left MCA then aphasia
If in right MCA then neglect, topographical difficulty, apraxia, constructional impairment and anosognosia

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5
Q

Describe the clinical signs of anterior cerebral artery ischaemic stroke?

A

More leg weakness than arm weakness with a poor grasp

Muteness, perseveration and abulia

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6
Q

Describe the clinical signs of posterior cerebral artery ischaemic stroke?

A

Hemianopia, memory loos/confusion, Alexia

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7
Q

Describe brocca’s aphasia

A

Non-fluent speech but with comprehension of language

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8
Q

Where is brocca’s area situated?

A

Left posterior inferior frontal gyrus

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9
Q

Describe Wernicke’s aphasia

A

Fluent speech but no comprehension of language

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10
Q

Where is Wernicke’s aphasia?

A

Posterior part of the superior temporal gyrus on dominant (usually left) side

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11
Q

What are the risk factors for small vessel ischaemic stroke?

A 
Hypertension
Hyperlipidaemia
Diabetes mellitus
Tobacco use
Sleep apnoea
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12
Q

Brainstem ischaemic stroke usually results in a combination of cranial nerve abnormalities and crossed motor/sensory findings. These can include…?

A 
Double vision
Facial numbness and/or weakness
Slurred speech
Difficulty swallowing
Ataxia
Vertigo
Nausea and vomiting
Hoarseness
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13
Q

What are the possible causes of intracerebral haemorrhage?

A 
Hypertension
Aneurysm
AV malformation
Bleeding into tumour
Hypocagulable state
Haemorrhagic ifnarction
Iatrogenic
Other
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14
Q

Where in the brain does hypertensive intracerebral haemorrhage typically occur?

A

Basal ganglia
Cerebellum
Pons

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15
Q

Describe the presentation of hypertension intracerebral haemorrhage

A

Abrupt onset of symptoms with acute decompensation and smooth progression. Typically patient is awake and often stressed

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16
Q

What symptoms commonly occur in cerebellar haemorrhage?

A 
Vomiting
Ataxia
Eye deviation toward opposite side of the bleed
Small sluggish pupils
Altered mental status
17
Q

Describe the clinical features of a pontine haemorrhage

A

Pin point but reactive pupils
Abrupt onset of coma
Decerbate. posturing or flaccidity
Ataxic breathing pattern

18
Q

What investigation is most commonly used to diagnose a stroke?

A

Non-contrast CT

19
Q

A GCS score of what level requires intubation?

A

8 or less

20
Q

Why are stroke patients labelled nil by mouth until a swallow assessment is completed?

A

These patients have a high aspiration risk

21
Q

How soon after the onset of symptoms of ischaemic stroke should tissue plasminogen activator be administered?

A

4.5 hours

22
Q

What are the contraindications to the use of tissue plasminogen activator in stroke?

A 
Haemorrhage
Systolic BP >185 or diastolic >110
Recent surgery/trauma/stroke
Coagulopathy
Seizure at onset of symptoms
Age
Glucose <2.2
NIHSS score of >21
23
Q

What anticoagulation should be used in patients with a high risk TIA or minor ischaemic stroke?

A

Dual anti platelet therapy for 10-21 days

24
Q

What anticoagulation should be used in patients with a low risk TIA or other ischaemic stroke?

A

300mg OD aspirin until discharge then clopidogrel thereafter

25
Q

What anticoagulation should be used in patients with an ischaemic stroke or TIA and AF?

A

NOAC or warfarin

26
Q

The size of infarction in ischaemic stroke increases with hypoglycaemia. T/F?

A

True

27
Q

Hyperglycaemia is an independent risk factor for haemorrhage when stroke is treated with tPA. T/F?

A

True

28
Q

When should antihypertensives be considered in the treatment of intracerebral haemorrhage?

A

Systolic bp >150

29
Q

When should antihypertensives be considered in the treatment of ischaemic stroke?

A

Systolic BP 180-200

Neurology (10 decks)

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