Cerebrovascular disease Flashcards
(49 cards)
Define a stroke.
Insufficient blood supply to a part of the brain due to ischaemia (insufficient blood supply) or haemorrhage (bleeding).
Give 3 signs of a stroke.
Face - they cannot smile
Arms - they cannot lift their arms up
Slurred speech
(t)
What investigations would you do if you suspect someone has had/ is having a stroke?
Head CT - shows decreased density (darkness) which means oedema
Investigate primary cause - carotid duplex USS, echocardiogram, CXR (enlarged left atrium)
Which arteries and lobes may be affected if someone presents with leg weakness and sensory loss, gait apraxia, akinetic mutism, drowsiness and incontinence?
Anterior cerebral artery - supplies frontal areas of the brain which affect cognition
(lecture 23.3.18)
What is akinetic mutism?
Decrease in spontaneous speech and movement, stupurous state - frontal areas of the brain which affect cognition are affected.
Patient has right-sided leg and arm weakness, hemianopia, dysarthria, dysphasia and sensory loss. What part of the brain may be affected?
Left middle cerebral artery - supplies frontal, temporal and parietal areas.
Symptoms will be contralateral to the stroke.
You can also get facial droop.
Patient has homonymous hemianopia, cortical blindness, visual agnosia, prosopagnosia and dyslexia. What part of the brain may be affected?
Posterior cerebral artery - supplies temporal, parietal and occipital areas. Optic radiations travel through the posterior part of the brain. Primary visual centres. Headaches can sometimes be a symptom.
What could cause vertigo, nausea and vomiting?
Posterior circulation stroke affecting the basilar artery which supplies the brainstem, cerebellum and midbrain.
What is visual agnosia?
Visual agnosia = struggling to interpret visual information.
How are strokes classified?
Oxford stroke classification: 4 categories: Total anterior circulation stroke Partial anterior circulation stroke Posterior circulation stroke Lacunar circulation stroke
What are the main arteries of the anterior circulation?
Anterior cerebral
Middle Cerebral
Posterior cerebral.
A patient has dysarthria, speech impairment, facial paresis, and nausea. What part of the circulation is affected?
Posterior circulation - vertebral and basilar arteries. They may also have visual disturbance and altered consciousness.
Describe the acute management of stroke.
CT scan ASAP (act FAST - time is brain). Rule out haemorrhagic stroke.
Aspirin 300mg unless haemorrhagic
Thrombolysis eg streptokinase, 4.5 hours post-onset. Contraindications: recent surgery; brain aneurysm.
What is a lacunar stroke?
The most common type of stroke, resulting from occlusion of small penetrating arteries that supply the brain’s deep structures.
Give 3 risk factors for ischaemic and haemorrhagic stroke
85% ischaemic, 15% haemorrhagic.
Both: increasing age, hypertension, alcohol.
Ischaemic: Race, sex, TIA, diabetes
Haemorrhagic: Previous stroke, illicit drugs, anticoagulation therapy.
(PTS)
Describe the supportive management of stroke.
Nil by mouth due to aspiration risk.
IV hydration to decrease risk of cerebral oedema
Blood glucose 4-11mmol/L
Do not treat BP until a week after stroke.
Which arteries supply the cerebellum?
Anterior Inferior Cerebellar Artery, PICA and Superior Cerebellar Artery
What is a likely cause of sudden onset headache?
Subarachnoid haemorrhage. There is a ‘spider’ on the CT scan.
What is a TIA?
Transient ischaemic attack: the sudden onset of focal CNS phenomena due to temporary occlusion of part of the cerebral circulation. Symptoms last <24h. Often precede a first stroke.
(OHCM)
What is used to predict risk of stroke after a TIA and prompt referral?
ABCD2 score:
Age >60
BP >140/90
Clinical features - unilateral weakness (2 points), speech disturbance
Duration of symptoms - >1h 2 points; 10-59 min 1 point
Diabetes
Describe the secondary prevention of stroke.
Manage diabetes, HTN, AF.
Start statins 48h after stroke
Antiplatelet therapy- first aspirin then clopidogrel.
What are the surgical therapies for stroke?
Ischaemic - thrombectomy
Haemorrhagic - surgical evacuation of haematoma, endovascular coiling or clipping.
Describe the management of a TIA.
Assess risk of stroke using ABCD2. Control CVS risk factors - aim for <140/85mmHg, not 120/80; stop smoking; reduce BMI Antiplatelet therapy Warfarin indicated if cardiac emboli (OHCM)
Patient has weakness, sensory loss and visual disturbance lasting 30 minutes. What would this be apart from a TIA?
Hypoglycaemia
Migraine aura (symptoms spread and intensify over minutes)
Focal epilepsy (twitching and jerking)
Hyperventilation
