FN: Stroke: Causes and investigation Flashcards Preview

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Flashcards in FN: Stroke: Causes and investigation Deck (15):
1

Definition

Rapid onset, focal neruological deficit due to a vascular lesion lasting >24hrs

2

Pathogenesis

Infarction due to ischaemia (80%) or intracerebra haemorrhage (20%)

3

Ischaemic strokes 2 types

Atheroma (large e.g. MCA) or small vessel perforators (lacunar)

Embolism:
1. Cardiac (30% of strokes):AF, endocarditis, MI
2. Atherothromboembolism e.g. from carotids

4

Haemorrhage (20%)

1. High BP
2. Trauma
3. Aneurysm rupture
4. Anticoagulation
5. thrombolysis

5

Rarer Causes

1, Watershed stroke: sudden drop in BP e.g. sepsis
2. CArotid artery dissection
3. Vasculitis: PAN, HIV
4. Cerebral vasospasm secondary to SAH
5. Venous sinus thrombosis
6. Anti-phospholipid syndrome, thrombophilia

6

Risk Factors

Hypertension
Smoking, DM, raised lipids, FH
Cardiac AF

7

Cardiac causes of stroke

AF:4.5%/yr
External cardioversion:1-3%
Prosthetic valves
Acute MI: esp. large anterior
Paradoxical systemic emboli
Cardiac surgery
Valve vegetations

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Investigations

ID risk factors for further strokes

9

HTN

Retinopathy
Nephropathy
Bigh heart on CXR
(Dont treat acutely)

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Cardiac emboli

ECG ± 24hr tape: AF
Echo: mural thrombus, hypokinesis, valve lesions, ASD, VSD (paradoxical emboli)

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Carotid artery stenosis

Dopper US ± angio
Endarterectomy beneficial if >70% symptomatic stensosi

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Bleeding/thrombotic tendency

Thrombophilia screen
Thrombocytopenia

13

Hyperviscosity

Polycythaemia
SCD
Myeloma

14

Metabolic

High or low glucose
Raised lipids
Hyperhomocystinaemia

15

Vasculitis

Raised ESR
ANA

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