Nervous System > Cerebral Infarction > Flashcards

Cerebral Infarction Flashcards

(34 cards)

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1
Q

Define stroke

A

Sudden onset of focal or global neurological symptoms cause by ischaemia or haemorrhage and lasting more than 24hrs

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2
Q

Define TIA

A

Term used if the symptoms resolve within 24 hours

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3
Q

Name six causes of an ischaemic stroke

A
  • Large artery atherosclerosis
  • Cardioembolic
  • Small artery occlusion
  • Undetermined/cryptogenic

Rare causes
• Arterial dissection
• Venous sinus thrombosis

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4
Q

Name three causes of haemorrhage stroke

A

• Primary intracerebral haemorrhage
• Secondary haemorrhage
o Subarachnoid haemorrhage
o Arteriovenous malformation

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5
Q

What are the two types of strokes?

A

Ischaemic and haemorrhagic

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6
Q

What is the incidence and impact of stroke?

A
  • 150 000 new strokes/year in UK
  • 67 000 deaths/year in UK
  • Stroke risk increases with age
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7
Q

Name four non-modifiable risk factors for stroke

A
  • Previous stroke
  • Elderly
  • Male
  • Family history
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8
Q

Name six modifiable risk factors for stroke

A

• Hypertension

  • Smoking
  • Cholesterol
  • Diet, high BMI, sedentary
  • Alcohol
  • Diabetes
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9
Q

How does hypertension impact risk of stroke?

A
  • Stroke risk is related to blood pressure level
  • Chronic hypertension worsens atheroma and affects small distal arteries
  • Hypertension is a major risk factor for haemorrhagic strokes as well
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10
Q

How does smoking impact risk of stroke?

A
  • 2-fold increase risk of cerebral infarction

* 3-fold increase risk of sub-arachnoid haemorrhage

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11
Q

How does diabetes impact risk of stroke?

A

Increases incidence of stroke up to 3-fold in both sexes.

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12
Q

How do lipids impact risk of stroke?

A
  • Increase serum lipids increase stroke risk due to blood vessel wall atheroma
  • Increase plasma level of low density lipoprotein (LDL) results in excessive amounts of LDL within the arterial wall
  • Hypertension, cigarette smoke and diabetes contribute to LDL-C deposition in arterial walls
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13
Q

How does alcohol impact risk of stroke?

A
  • Small amounts of alcohol decrease stroke risk

* Heavy drinking increase risk 25-fold

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14
Q

What are other risk factors?

A
  • Impaired cardiac function – recent heart attack, atrial fibrillation
  • Oral contraceptives (+hormone replacement therapy) with a high oestrogen content – progesterone-only are ok.
  • Hypercoagulable states – malignancy, genetic
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15
Q

Describe the pathophysiology of ischaemic stroke

A
  1. Failure of the cerebral blood flow to a part of the brain, caused by an interruption of the blood supply to the brain
    • Can be transient (as in TIA)
    • Results in varying degrees of hypoxia
  2. Hypoxia stresses the brain cell metabolism. This is especially important in the ischaemic penumbra. If prolonged, the hypoxia -> anoxia (no oxygen).
  3. Anoxia -> infarction (complete cell death, leading to necrosis). This is a stroke.
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16
Q

How does further damage occur after a stroke?

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A
  • Oedema – depending on the size + location of the stroke

* Secondary haemorrhage into the stroke

17
Q

What three cerebral arteries form the anterior circulation of the brain?

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A
  • Internal carotid arteries
  • Anterior cerebral artery (ACA)
  • Middle cerebral artery (MCA)
18
Q

What three cerebral arteries form the anterior circulation of the brain?

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A

• 2 vertebral arteries -> 1 basilar
• 3 cerebellar arteries
Posterior cerebral artery (PCA

19
Q

What are the effects of an anterior cerebral artery occlusion?

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A

Contralateral
• Paralysis of foot and leg
• Sensory loss over foot and leg
• Impairment of gait and stance

20
Q

What are the effects of a middle cerebral artery occlusion?

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A

• Contralateral
o Paralysis of face/arm/leg
o Sensory loss face/arm/leg
o Homonymous hemianopia
• Gaze paralysis to the opposite side
• Aphasia if stroke on dominant (left) side
• Unilateral neglect and agnosia for half of external space if non-dominant stroke (usually right side)

21
Q

What are the effects if an occlusion of the middle cerebral artery occlusion occurs in the right hemisphere?

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A

Left hemiplegia, homonymous hemianopia

Neglect syndromes (agnosia):
• Visual agnosia 
• Sensory agnosia 
• Anosagnosia (denial of hemiplegia)
• Prosopagnosia (failure to recognise faces)
22
Q

What type of stroke occurs if a branch of the MCA supplying basal ganglia is occluded?

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A

Lacunar stroke

23
Q

What are the symptoms of a lacunar stroke?

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A
  • Devoid of cortical signs – i.e. no dysphasia, neglect, hemianopia
  • Pure motor stroke
  • Pure sensory stroke
  • Dysarthria – clumsy hand syndrome
  • Ataxic hemiparesis
24
Q

What structures are supplied by the posterior circulation?

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A
  • Brainstem
  • Cerebellum
  • Thalamus
  • Occipital lobe
  • Medial temporal lobe
25
What are the symptoms of brainstem dysfunction?
* Coma, vertigo, nausea, vomiting, cranial nerve palsies, ataxia * Hemiparesis, hemisensory loss * Crossed sensori-motor deficits * Visual field deficits
26
What are the investigation for stroke?
* Bloods - FBC, glucose, lipids, ESR * CT or MRI - infarct vs haemorrhage * ECG * Echo * Carotid doppler USS - stenosis * Cerebral angiogram/venogram - vasculitis * Hypercoagulable blood screen
27
What are three aims of therapies for acute ischaemia?
* Restore blood supply * Prevent extension of ischaemic damage * Protect vulnerable brain tissue
28
What is the acute treatment for stroke?
1. Thrombolysis (Tissue Plasminogen Activator – TPA) But, if they have contraindications, they should be offered: 2. Aspirin 3. Intra-arterial therapy/thrombectomy
29
What are five different treatments for secondary prevention of stroke?
* Antihypertensives * Anti-platelet * Lipid lowering agents * Warfarin for AF * Carotid endarectomy NNT of 3
30
What does management strategies for stroke after an episode involve?
* Prevention of stroke recurrence * Prevention of complication related to stroke * Rehabilitation * Re-integration into community
31
Name five objectives of stroke care
* Reduce mortality * Reduce residual disability amongst survivors * Improve psychological status of patients and care-givers * Improve patient/care giver knowledge * Maximise quality of life
32
What is the criteria for TPA use?
* < 4.5hrs from symptoms onset * Disabling neurological deficit * Symptoms present > 60 mins * Consent obtained
33
What is the exclusion criteria for IV TPA?
``` Anything that increases the possibility of haemorrhage: • Blood on CT scan • Recent surgery • Recent episodes of bleeding • Ataxic hemiparesis • Coagulation problems • BP > 185 systolic or > 110 diastolic • Glucose < 2.8 or > 22mmol/L ```
34
Name different staff on a stroke unit
* Clinical staff * Stroke nurses * Physiotherapists * Speech and language therapists * Occupational therapists * Dietitian * Psychologist * Orthoptist
Nervous System
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