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Year 3 Elderly Medicine > 9 - Acute Stroke > Flashcards

9 - Acute Stroke Flashcards

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1
Q

How long does a focal injury to the CNS have to last in order to fit the criteria for a stroke

A

> 24 hours

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2
Q

What are the two main causes of a stroke.

A

Infarction
Haemorrhage

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3
Q

What are clinically silent strokes?

A

When there is evidence of CNS injury on neuroimaging but no neurological deficit

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4
Q

What is a transient episode of neurological dysfunction - caused by focal brain, spinal cord or retinal ischaemia - without acute infarction?

A

TIA

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5
Q

How long do TIAs last?

A

<24 hours

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6
Q

What are the RF for stroke?

A
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7
Q

What is a focal neurological deficit?

A

A problem with nerve, spinal cord or brain function that affects a specific location (e.g. right arm, left face) or speech, vision or hearing.

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8
Q

What are the biggest risk factors for stroke?

A

Age
Hypertension
AF

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9
Q

What percentage of Ps with stroke have AF?

A

20%

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10
Q

If a P has AF and doesn’t have anticoagulation, how does this increase their stroke risk?

A

increased x5

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11
Q

Which risk score is used to determine the risk of stroke in Ps with AF?

A

CHADVASC

(CHA2DS2VASc)

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12
Q

What is the rough proportion of ischaemic and haemorrhagic strokes?

A

Roughly - 4/5ths are ischaemic and 1/5th are hemorrhagic

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13
Q

What are the main causes of ischaemic stroke?

A

Large artery atherosclerosis 20%
Cardioembolism 20%
Small vessel disease 25%

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14
Q

Name 4 types of ischaemic stroke

A

Total anterior circulation infarction (TACI)

Partial anterior circulation infarction (PACI)

Posterior circulation infarction (POCI)

Lacunar infarction

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15
Q

How do TACI and PACI present - which arteries are normally involved.

A

Both can present with hemiplegia +/- hemisensory loss, hemianopia, higher cerebral dysfunction (aphasia, neglect)

TACI - usually ICA or MCA occlusion

PACI - usually a branch artery occlusion

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16
Q

How does a POCI present?

A

Altered consciousness
Cerebellar or brain stem syndromes
Hemianopia

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17
Q
A
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18
Q

How does different cerebral anatomy affect patients?

A

Means that different types of strokes may present differently if the anatomy is different.

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19
Q
A
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20
Q

What are the clinical features of an anterior circulation stroke?

A
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21
Q

What are the clinical features of a posterior circulation stroke?

A
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22
Q

What are the clinical features of a lacunar infarct?

Study These Flashcards
A

Because lacunar infarcts are small - you often get an isolated deficit.

23
Q

Name three types of intra-cerebral haemorrhage

Study These Flashcards
A

Deep cerebral haemorrhage - often small and associated with HT

Lobar haemorrhages - usually larger

Cerebellar haemorrhage

25
What are the RF for intra-cerebral haemorrhage?
Hypertension AVM Cerebral amyloid angiopathy
26
How do intra-cerebral haemorrhages present?
Often severe stroke sx Often headache and reduced LOC Can have rapid progression - may decompensate in front of you.
27
What is the prognosis of an intra-cerebral haemorrhage?
50% mortality at 1m
28
How do we diagnose a stroke?
29
What questions do we need to ask in a Hx for stroke?
30
What exams do we do for stroke Ps?
ABCDE GCS Neurological exam - deficit? NIHSS (National Institutes of Health Stroke Scale)
31
What imaging can be done for suspected stroke?
Non-contrast CT CT Angiogram CT perfusion MRI
32
What things can mimic a stroke?
33
How are acute ischaemic strokes managed?
34
What anti-platelet tx is given for acute ischaemic stroke?
35
What is the window for thrombolysis?
4.5 hours within symptom onset
36
What are the criteria for thrombectomy?
37
How is intra-cerebral haemorrhage managed?
38
What supportive management can be given for stroke?
39
Which is the most commonly ordered scan for stroke?
Non-contrast CT
40
What is CT angiography used for in stroke Ps?
To identify Ps suitable for thrombectomy
41
What is cerebral amyloid angiopathy?
Amyloid is deposited in the blood vessels predisposing to haemorrhage and various congenital conditions
42
Which artery do most strokes affect?
Middle cerebral artery
43
What is the most common thrombolysis Tx?
IV Alteplase (tissue plasminogen activator) Total dose = 0.9mg/kg (max 90mg)
44
The infarcted region is surrounded by a swollen ischaemic area that doesn't function but is structurally intact. What is this called? What happens to this area following thrombolysis?
Ischaemic penumbra It can regain function following revascularization after thrombolysis (if lucky)
45
When is thrombolysis CI?
Rapidly improving stroke Minor sx Persistent HT Pregnancy Platelets <100k Glucose <2.8 or >26.2 INR >1.7 on warfarin PTT raised on heparin Stroke or head trauma in past 3m Prior Hx of intracranial haemorrhage Major surgery in past 14 days LP in last 7 days
46
What percentage of Ps who have TIAs will go on to have strokes?
30% - 1/3 of these in the first year
47
What pathology is associated with significant risk of recurrent stroke during the weeks following a TIA or stroke? How is it treated?
High-grade symptomatic carotid stenosis Carotid endarterectomy or carotid stenting
48
Which is the most common location for an intracerebral haemorrhage?
Putamen (35-50%)
49
What are the clinical features of subarachnoid haemorrhage?
Sudden, very severe headache (often occipital) Associated vomiting, photophobia & neck stiffness Seizures Altered consciousness or coma Beware sentinel headaches - 1-2w prior to the major bleed
50
When scanning for blood on CT - is it immediately visible?
No = may not be visible in the first 12 hours, often have to rescan
51
What is the cause of a subarachnoid haemorrhage?
An intracranial aneurysm (dilation of a cerebral BV which ruptures)
52
53
What lines the ventricles? What does this produce?
Choroid plexus Produces CSF
54

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