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control > L15/16 - stoke and TIA > Flashcards

L15/16 - stoke and TIA Flashcards

(62 cards)

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1
Q

stroke

A

An abrupt interruption of blood flow to part of the brain, depriving brain tissue of oxygen and nutrients - within minutes, brain cells begin to die

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2
Q

cerebral ischaemic stroke

A

acute focal neurological dysfunction caused by focal infarction at single or multiple sites of the brain or retina

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3
Q

intacerebral haemorrhage

A

acute neurological dysfunction caused by haemorrhage within the brain parenchyma or in the ventricular system

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4
Q

mechanisms of ischaemic stoke pathophysiology

A

embolism
thrombosis
hyperfusion

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5
Q

cardioembolism

A

A clot can leave the heart and lodge in brain

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6
Q

mechanisms of cardioembolism

A
  • Rhythm abnormalities
  • Valvulopathies (valvular disease)
  • Pathology in chambers (clots inside chambers)
  • Aortic arch (damage in arch and clots can dislodge)
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7
Q

large artery embolism

A
  • atherosclerosis
  • > 50% narrowing
  • dissection
  • mural thrombus
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8
Q

small vessel disease

A

clots form in small vessels

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9
Q

causes of small vessel disease

A

hypertension

diabetes

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10
Q

hypoperfusion

A
  • Difficulty with supply of blood to the brain
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11
Q

mechanisms of hypoperfusion

A
  • low systemic perfusion pressure

- cardiac pump failure

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12
Q

aetiology of intracerebrla haemorrhage

A
  • Hypertension
  • Vascular malformations (aneurysm, AVN)
  • Amyloid angiopathy
  • Tumours
  • Drug abuse (cocaine)
  • Anticoagulant and thrombolytic therapy
  • Vasculitis
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13
Q

FAST

A

face
arms
speech
time

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14
Q

F in FAST

A

can they move their face?

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15
Q

A in FAST

A

can they raise their arms?

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16
Q

S in FAST

A

can they say hello and their name?

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17
Q

T in FAST

A

time to call 999

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18
Q

common stroke symptoms

A
  • Slurred speech
  • Facial droop
  • Acute unilateral loss of strength or/and sensation
  • Acute monocular or binocular visual loss (complete or incomplete)
  • Aphasia
  • Ataxia and or vertigo
  • Double vision
  • Sudden decrease in level of consciousness
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19
Q

ICH treatment

A
  • reverse anticoagulants if taking
  • aggressive blood pressure management
  • surgical options
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20
Q

within how long should you act on an ICH before it could be fatal

A

first 6 hours

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21
Q

how to treat a patient with a venous thrombos

A

blood thinners

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22
Q

example of thrmobolysis treatment

A

Alteplase

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23
Q

mechanical thrombectomy

A
  • a thin tube is inserted into an artery, usually in the groin
  • fed to the site of the clot in or near the brain
  • a decide is inserted through the tube to catch the clot and pull it out
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24
Q

thrombolysis

A

medication it dissolve clot

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25
stentriever
- place stent across occlusion and leave for 10 mins - reperfuse brain - most clots will lyse naturally
26
in which circulation is a thrombectomy more effective
anterior circulation
27
what % of strokes are due to infarction
85
28
what % of strokes are haemorrhagic
15
29
TIA
Neurological Deficit lasting less than 24 hours attributable to cerebral or retinal ischaemia (MINI STROKE)
30
length of TIAs
most TIAs last under 60mins
31
causes of TIA
SAME AS STOKE - Carotid artery disease / large artery disease - Cerebral small vessel disease - Cardiac embolism (moving clot)
32
what % of strokes are preceded by a TIA
20
33
TIA mimics
- Seizures - Syncope (loss of consciousness) - Hypoglycaemia - Migraine - Acute confusional states
34
positive symptoms
flashing lights, limb shaking, tingling...etc
35
negative symptoms
numbness, drooping...etc
36
what type of symptoms are observed in a TIA
negative
37
anterior circulation
internal carotid artery
38
posterior circulation
vertebral-basilar system
39
anterior circulation problems
dysphasia | amarausis fugax
40
amarausis fugax
- Person cannot see out of one of both eyes due to lack of blood flow to eyes - Cholesterol embolus in retinal artery (come up from carotid artery)
41
posterior circulation problems
- ataxis if cerebellum involved - diplopia - vertigo - bilateral symptoms if brainstem is affected
42
how to assess either circulation
- Visual field disturbance (hemianopia) - Hemiparesis - Hemisensory loss
43
paresis
muscular weakness
44
what is risk of TIA leading to stroke
5% of patients have a stroke after a week
45
how to score TIA
ABCD2
46
ABCD2
``` age BP Clinical features duration symptoms diabetes ```
47
age in ABCD2
1 if >60
48
BP in ABCD2
1 for 140/90
49
clinical features in ABCD2
2 for unilateral weakness | 1 for speech disturbances
50
duration in ABCD2
- 2 for >60 - 1 for 10-59 mins - 0 < 10 mins
51
diabetes in ABCD1
1 yes | 0 no
52
at what score of ABCDE2 do we start to worry
4 - moderate
53
treatment for TIA
polypill
54
polypill
combination of: - statins - aspirin - antihypertensives - folic acid
55
secondary vascular prevention
carotid endarterectomy
56
carotid endarterectomy
- removing ulcerated plaque
57
risk of carotid endarterectomy
- stroke/death 3-5% when opening the artery | - 12th nerve palsy
58
why can carotid endarterectomy result in death
possibility that the plaque will dislodge and travel to the brain when opening up the artery
59
why can carotid endarterectomy result in 12th nerve palsu
12th nerve is stretched when surgeon is opening up neck
60
why is there no point doing aarotid endarterectomy after about 4 weeks
The longer you get away from the time of the TIA, there is a risk As time goes on, plaques settle and if they have not had a stroke by then, they probably will not have one
61
most effective medication for TIA
aspirin as stops platelets working
62
which artery, if occluded, can a surgeon not get to
carotid

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