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Yr 3 NEURO > Condition- Stroke and TIAs > Flashcards

Condition- Stroke and TIAs Flashcards

1
Q

What is a stroke? How can they be classified?

A

Definition:

A rapidly developing focal disturbance of brain function of presumed vasular origin lasting more than 24hrs.

Classification:

anterior vs posterior stroke

Haemorrhagic vs infarction

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2
Q

List some causes of infarction strokes

A
  1. ATHROSCLEROSIS+ THROMOBOSIS
    • small vessels= lacunar infarcts
    • larger vessels= intracranial stenosis, carotid stenosis, aortic arch plaque
    • prothrombotic states- dehydration, thrombophilia
  2. EMBOLI:
    • AF, VSD (venous circulation), carotid artery atherosclerosis
  3. HYPOTENSION
    • If pressure is below auto-regulatory range for cerebral blood flow leads to infarction in watershed zone between cerbral artery territories
  4. OTHER
    • Vasculitis
    • Cocaine (arterial spasm)
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3
Q

List some conditions which increase the risk of ischaemic strokes caused by emboli

A
  • Carotid dissection
  • Carotid atherosclerosis
  • AF
  • From venous blood clots that pass through VSD or PFO
  • Prosthetic valve
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4
Q

List some risk factors for haemorrhagic strokes

A
  • Hypertension
  • Charcot-Bouchard microaneurysm rupture
  • Amyloid angiopathy- alzheimer’s, dementia, PD- causes fragile vessels
  • Arteriovenous malformations
  • Anticoagulant therapy
  • Less common: trauma, tumours vasculitis, haemorrhagic necrosis by tumour or by infection e.g. infective endocarditis- vegetations may embolise and digest cerebral blood vessels causing aneurysm–> rupture
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5
Q

Stroke is the ____ most common cause of death in western countries

A

Stroke is the 3rd most common cause of death in western countries

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6
Q

Describe the presenting symptoms of stroke

A

Sudden onset. Common symptoms:

  1. weakness
  2. visual impairment
  3. aphasia
  4. Impaired coordination

Symptoms grouped:

  • Altered consciousness: coma, confusion, seizures
  • (Thunderclap) Headache and neck stifness: (if carotid/vertebral artery dissection)
  • Facial weakness/asymmetry: can be contra/ipsilateral to limb paralysis, usually forehead sparing
  • Vision and Eyes: hemianopia, vertigo, diplopia
  • Speech and swallow: aphasia, dysphgia
  • Limb weakness/ loss of sensation
  • Ataxia
  • Other: Hearing impairment, nausea, vomitting
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7
Q

When taking a history from a patient with stroke which conditions should you ask about in their PMHx?

A

Ask about history of:

  • Ischaemic risks: MI, AF, carotid artery stenosis, recent neck trauma, past TIA
  • Haemorrhic risks: HT, menigsm signs, bleeding tendency/ anti-coag use
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8
Q

Unilateral facial weakness can be caused by caused by stroke and another condition. How do you differentiate between the two?

A
  • Test facial nerve functions
  • Bell’s is a LMN lesion on facial nerve/ facial nucleus
  • Bell’s affects whole of one side
  • while stroke affects one side but is usually forehead sparing
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9
Q

What would be the signs of an infarction affecting the anterior cerebral artery?

A

Remember anterior cerebral supplies the superior and medial parts of the cerebral hemispheres

  • Frontal lobe symptoms: cognitive impairment, distrubance of intellect, judgement and appropriate social behaviour (Phinease Gage symptoms)
  • Confusion
  • Hemiparesis: Motor and sensory deficits of lower limbs
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10
Q

What would be the signs of an infarction affecting the middle cerebral artery?

A

CLASSIC STROKE- FAST symtpoms

  • Facial weakness- contralateral side
  • Hemiparesis (motor corex)- contralateral upper limbs
  • Hemisensory loss (sensory cortex)- contralateral
  • Apraxia (post. parietal cortex)- difficulty planning motor tasks
  • Hemineglect (parietal)
  • Aphasia (Broca’s)- if L sided
  • Quadrantopia- if superior or inferior optic radiations are affected
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11
Q

What would be the signs of an infarction affecting the posterior cerebral artery?

A

Occipital lobe and Visual cortex affected

  • homonymous hemianopia (macula sparing if occipital)
  • visual agnosia
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12
Q

What would be the signs of an infarction affecting the anterior inferior cerebellar artery?

A
  • vertigo
  • ipsialteral araxia
  • ipsilateral deafness
  • ipsilateral facial weakness
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13
Q

What would be the signs of an infarction affecting the posterior inferior cerebellar artery (PICA)?

A

PICA- affected in lateral medullary syndrome

  • vertigo
  • ipsilateral ataxia
  • ipsilateral Horner’s syndrome
  • Ipsilateral hemisensory loss
  • Dysarthria
  • Contralateral spinothalamic sensory loss
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14
Q

If a patient has AF how could you assess their stroke risk (score)? and what are the criteria?

A

CHADS VASc score

  • Congestive heart failure
  • Hypertension
  • Age >75
  • DM
  • Stroke, TIA, TE
  • Vascular disease
  • Age 64-75
  • Sex Categroy: female
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15
Q

What would be the signs of an infarction affecting the basillar cerebellar artery?

A
  • cranial nerve pathology
  • impaired consciousness
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16
Q

Signs of a stroke affecing the cerebellar system and state the mnemonic used to remember this

A

DANISH

  • Dysdiochokinesia
  • Ataxia
  • Nystagmus
  • Intention Tremor
  • Slurred/staccato speech
  • Hypotonia
17
Q

How could you asses the risk of a haemorrhagic stroke due to anti-coagulant overuse

A

Using th HASBLED Score

18
Q

How could you assess the risk of a stroke post TIA?

A

Using the ABCD2 score

19
Q

Which investiagtions would you conduct to investigate whether a patient has a stroke?

A
  • Urgent Non-contrast CT scan: to detect haemorrhages and areas of iscahemia
  • MRI: higher sensitivity for infarction
  • Bedside: pulse and BP to check for AF or hypertension
  • Bloods: blood clotting profile- thrombophilia, blood glucose
  • ECG/24hr- to check for arrhythmias
  • Echo: to ID cardiac thrombus, endocarditis and other sources of embolism
  • Carotid doppler US- key for TIA: check for carotid artery disease and cervical artery disease
  • CT angiogram: detect dissections, intracranial stenosis
20
Q

What can be identified on this CT scan of this patient? What could cause this?

A

Can see darkening of L cerebral hemisphere (temporal lobe)

Ischaemic stroke

This is because ischaemia and infarction causes cell death and the cells become more radioluscent as they become liquified.

This patient presented with hemi-sensory defects as well as aphasia

21
Q

What can be identified on the CT scan of this patient? What could have caused this?

A

Can see a more radioopaque region which is caused by accumulation of blood

Likely to be haemorrhagic stroke

22
Q

How would you manage a patient with a high CHAD VASc score to prevent stroke?

A

Use oral anticoagulants (warfarin) as prevention

23
Q

If a patient has recenly had a stroke (<4.5hrs ago) how would you manage them?

A
  • CT scan- exclude haemorrhage
  • IV rtPA (ALTEPASE)
  • Aspirin 24hrs later
  • Do CT angiography and check for large vessel occlusion (can do Endovascular thrombectomy = stent retrieval of thrombus)
24
Q

If a patient has had a stroke (>4.5hrs ago) how would you manage them?

A
  • aspirin 300mg OD to prevent further thrombosis
  • Heparin for VTE prophylaxis
  • Subsequent management (card)
25
Q

How would you assess carotid artery stenosis and under which cicumstancs would surgical intervention could be offered?

A

Would do Carotid doppler to check

If stenosis >70% Carotid endarterectomy

26
Q

How would a TIA be managed?

A
  • PRIMARY INTERVENTION
    • Antiplatelet: aspirin or clopidogrel
    • High dose statin
  • SECONDARY PREVENTION
    • Lifestyle mods
    • AF management (warfarin)
    • Statins
    • Anti-HTs
    • carotid endaaerterctomy
27
Q

How would you manage stroke in the post acute phase?

A
  • VTE prophylaxis- heparin BD + compression stockings
  • GCS monitoring
  • SALT assessment
  • Early mobilisation
  • Control of RFs:
    • Lifestyle mods
    • Carotid endaerterectomy
    • Warfarin if AF
    • Clopidogrel if non-AF
28
Q

List some potential complications of stroke..

A
  • DVT
  • aspiration pneumonia
  • seizures
  • delirium
  • Cerebral oedema
29
Q

Which out of haemorrhagic and ischaemic stroke has the worse prognosis?

A

Haeomrrhagic

30
Q

What is a TIA?

A

A rapidly developing focal disturbance of brain function of presumed vascular origin which resolves completely within 24hrs

31
Q

List some risk factors for a TIA

A
  • Heart disease- valvular disease, AF, ischaemic
  • Peripheral arterial disease- carotid stenosis
  • Polycythaemia rubra vera
  • COCP
  • Clotting disorders
32
Q

What is the most commonc cause of a TIA

A
  • EMBOLIC not usually thrombotic
  • Most common source of emboli= atherosclerosis
33
Q

How long do episodes of a TIA usually last?

A

TIAs usually 10-15min but can be anything from a few mins to 24hrs

34
Q

What might you need to rule out to conclude that the patient had TIA

A
  • no headache
  • no seizure
  • no epilepsy
  • no positive symptoms: seizure, migraine, conversion disorder, or dystonia

Yr 3 NEURO (26 decks)

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