CLINICAL ASPECTS OF A STROKE Flashcards
(34 cards)
what is the 3rd most common cause of death?
stroke
what are symptoms of a stroke?
facial weakness arm weaness speech problems dizziness vertigo loss of vision memory loss etc
what is a stroke?
a sudden focal neurological deficit due to a vascular lesion that lasts longer than 24 hours
what is a transient ischaemic attack?
a focal deficit lasting from a few seconds to up tp 24 hours due to a temporary blockage of bloodflow to the brain with a complete clinical recovery
what types of symptoms would a frontal lobe stroke present with?
speech difficulties ataxia hemiparesis or hemiplegia personality changes incontinence
what symptoms would you expect with a parietal lobe stroke?
aphasia alexia hemiagnosia inferior quadrantanopia proprioception dysfunction apraxia Gerstmann syndrome
what is Gerstmann syndrome?
a lesion in the dominant parietal lobe that causes…
ibaility to write spontaneously
inability to distinguish between L and R
finger agnosia (inability to name fingers)
acalculia
what symptoms would you expect with a temporal lobe stroke
poor memory proaopagnosia impaired speech diffuclty with depth perception emotional or behavioural changes
what symptoms would you expect with an occipital lobe stroke?
homonomous hemianopia, central visual deficits, cortical blidness or anton syndrome (not being aware of own blindness)
what is a lacunar stroke?
a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked
what are the 2 major pathologies of stroke?
ischaemic stroke - blocked artery
haemorrhagic stroke - bursting of a blood vessel
whats the main cause of an ischaemic stroke?
atherosclerosis - plaques are very thrombogenic so can occlude a vessel or release emboli
what are causes of haemorrhagic strokes?
head injuries, coagulation disorders, hypertension, cerebral aneurysms or cerebral amyloid angiopathy
what is cerebral amyloid angiopathy?
proteins called amyloid build up on the walls of the arteries in the brain.
what is the ischaemic penumbra?
the hypoperfused tissue around the ischaemic core in which blood flow is too low to maintain electrical activity but is sufficient to preserve ion channels so if it is saved quickly with re-perfusion, function may return
what are the symptoms of an anterior carotid artery occlusion?
contralateral hemiplegia hemisensory distubrance homonymous hemianopia deteroiration in consciousness gaze palsy, global aphasia
what are the 2 mechanisms of cell death in an ischaemic stroke?
Na+ build up - water follows = swelling
Ca2+ build up - creates oxygen free radicals which damage mitochondrial and lysosomal lipid membranes
what are the 2 main causes of lacunar infarcts?
lipohyalinosis - build up of hyaline in arterioles wall -> hypertrophy of tunica media -> progressive narrowing of arterioles until blood stops
microatheromatoma - narrowing of blood vessels due to debris accumulation within walls
what are stroke risk factors?
>55 years biologically male black individuals of african descent migraine headaches with aura genetics haematological disorders e.g. multiple myeloma, SC, plycythemia vera hypertension diabetes heart disease high cholesterol smoking physical inactivity cocaine abuse
what are the signs of lacunar stroke
contralateral , mostly motor or senaory defects
e.g. pure motor stroke = internal capsule lesion
pure sensory stroke = thalamus lesion
what are the signs and symptoms of a MCA stroke?
contralateral paresis, sensory deficit, inability to understand and produce speech, hemispatial neglect, homonymous hemianopsia, deviation of eye to damaged side
what are signs of PCA stroke?
homonymous hemianopsia
cortical blidness if lesion is bilateral
dilated pupil
imapired memory and altered consciousness (thalamus)
wallenberg syndrome, dizziness, nystagmus, speech and swallowing difficulties, facial sensory loss, horners sign, ataxia, loss of pain/temp/sensation in limbs
what would be the signs and symptoms of a basilar/vertebral artery stroke?
dizziness, gait, vision disorder, dysarthria, dysphagia, locked in syndrome
what medication can we give to treat an ischaemic stroke?
thrombolytic enzymes e.g. rtPA if caught within 4.5 hours
antiplatelet therapy e.g. aspirin or clopidogrel
