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Nervous System > Lecture 10.1: Stroke > Flashcards

Lecture 10.1: Stroke Flashcards

1
Q

What is a Stroke?

A

Brain injury caused by the sudden disruption of blood flow to the brain which can be due to Infarction or Haemorrhage

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2
Q

What is an Infarction?

A

Tissue death or necrosis due to inadequate blood supply to the affected area

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3
Q

What is a Haemorrhage?

A

Acute loss of blood from a damaged blood vessel

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4
Q

What percentage of Strokes are due to infarctions? What are the 2 types of infarctions?

A
  • 85%
  • 50% thrombotic
  • 35% embolic
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5
Q

What percentage of Strokes are haemorrhagic?

A

10%

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6
Q

What percentage of Strokes are due to Subarachnoid Haemorrhage?

A

5%

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7
Q

What is a Thrombus?

A

A blood clot formed in situ within the vasculature impeding blood flow

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8
Q

What is an Embolus?

A

Blood clots, fatty deposit or air bubble carried in the blood stream that lodges in a vessel

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9
Q

What is a Primary Haemorrhage?

A

Escape of blood from a ruptured vessel with no structural anomaly

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10
Q

What is a Secondary Haemorrhage?

A

Escape of blood from a ruptured vessel with aneurysm, vascular malformation or tumour

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11
Q

What is a Teritary Haemorrhage?

A

Escape of blood from a ruptured vessel with haemorrhagic transformation of an infarction

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12
Q

What is a Transient Ischaemic Attack (TIA)?

A

Focal CNS disturbances caused by vascular events that last <24hrs and with no lasting deficit, “mini stroke” is caused by a temporary disruption in the blood supply to part of the brain

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13
Q

Clinical Symptoms of Stroke in Anterior Circulation (5)

A
  • Left hemisphere - Language trouble
  • Right hemisphere – Neglect
  • Weakness
  • Partial visual loss
  • Numbness
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14
Q

Clinical Symptoms of Stroke in Posterior Circulation (4)

A
  • Blindness
  • Diplopia
  • Bilateral weakness
  • Vertigo
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15
Q

Modifiable Risk Factors of Strokes (8)

A
  • Hypertension
  • Cardiac Diseases (AF)
  • Diabetes
  • High Cholesterol
  • TIA
  • Physical Inactivity
  • Smoking
  • High Intake of Alcohol
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16
Q

Investigations for Stroke (9)

A
  • ECG: Atrial Fibrillattion or flutter
  • Echo: Check for clots
  • Ultrasound of the carotid artery < 70% stenosis
    management with medication
  • 70% symptomatic - Carotid endarterectomy / Stent
  • HBA1C
  • Lipid profile
  • CBC
  • Coagulation profile
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17
Q

Carotid Artery Stenosis Treatment

A
  • Surgery with angioplasty and a stent
  • Lifestyle Changes
  • Medication
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18
Q

What is Ischaemic Penumbra?

A

Defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core

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19
Q

Penumbra Imaging

A
20
Q

Acute Management of a Stroke (4)

A

▪ CT Brain
▪ Thrombolysis (within 4.5hours)
▪ Clot Retrieval
▪ Swallow Protection (NBM)

21
Q

Why is a CT Brain done during Stroke Management

A
  • Excludes haemorrhages and stroke mimics (e.g.
    tumour)
22
Q

Ongoing Management of a Stroke (6)

A
  • Admission to specialist stroke units
  • Medication (aspirin 300mg daily for 2 weeks then
    75mg daily)
  • Speech and Language Assessment (SALT)
  • Nutrition (screen for malnutrition)
  • Blood Pressure
  • Blood Glucose Level
23
Q

Issues with CT Brain in Acute Stroke Management

A

Acute infarcts not visible in the acute phase

24
Q

Long-Term Management of Strokes (4)

A
  • Physiotherapy
  • Occupational Therapists
  • Carotid Endarterectomy
  • Modification of Risk Factors
25
Q

Non-Modifiable Risk Factors of Strokes (4)

A
  • Age
  • Sex
  • Race
  • Family History
26
Q

What is a Thrombectomy with the use of a stent retriever?

A

A stent retriever is a cylindrical device that consists of a self-expanding stent mounted on a wire and deployed within a catheter

27
Q

Symptoms of Stroke based on Blood Vessel: Anterior Cerebral Artery

A
  • Leg&raquo_space; arms (Legs affected more)
  • Urinary incontinence
28
Q

Symptoms of Stroke based on Blood Vessel: Middle Cerebral Artery

A
  • Face, speech
  • Arms» legs (arms, hand affected more than legs)
29
Q

Symptoms of Stroke based on Blood Vessel: Posterior Cerebral Artery

A

Problem in vision

30
Q

Symptoms of Stroke based on Blood Vessel: Pons

A

Locked in syndrome

31
Q

Symptoms of Stroke based on Blood Vessel: Vertebrobasilar Arteries

A
  • Syncope
  • Ataxia
32
Q

Middle Cerebral Artery Damage: If Dominant Hemisphere is Affected

A
  • Speech and Contralateral
  • Weakness
  • Gerstmann Syndrome
33
Q

Middle Cerebral Artery Damage: If Non-Dominant Hemisphere is Affected

A
  • Hemineglect Syndrome
  • Speech Preserved
34
Q

What happens in Broca’s Aphasia?

A
  • Meaningful but broken speech
  • Frustrated patient
35
Q

What happens in Wernicke’s Aphasia?

A
  • Fluent speech but meaningless
  • Patient not frustrated
36
Q

What is Hemineglect Syndrome?

A

Neglects one half of everything including himself

37
Q

What is Gerstmann Syndrome?

A

A rare neurological disorder that results from damage to a specific area of the brain known as the left parietal lobe in the region of the angular gyrus

38
Q

What are the Symptoms of Gerstmann Syndrome? (4)

A
  • Impairment in performing calculations (acalculia)
  • Discriminating their own fingers (finger agnosia)
  • Writing by hands (agraphia)
  • Impairment of distinguishing left from right (left-
    right disorientation)
39
Q

How do long do TIA symptoms last?

A

The effects last a few minutes to a few hours and fully resolve within 24 hours

40
Q

What does FAST stand for in Strokes?

A

Facial drooping
Arms
Speech
Time

41
Q

TIA Scoring (8 Factors that contribute to scoring)

A
  • Age >60years = 1 point
  • BP >140 / >90 = 1 point
  • Any weakness = 2 points
  • No weakness but speech disturbance = 1 point
  • 60mins+ = 2 points
  • 10-59mins = 1 point
  • <10mins = 0 points
  • Diabetic = 1 point
42
Q

What is the score of a Low-Risk TIA?

A

1-3 (or over a week since symptoms)

43
Q

How to treat a Low-Risk TIA? (3)

A
  • Aspirin 300mg daily
  • Specialist assessment within a week
  • Address risk factors immediately
44
Q

What is the score of a High-Risk TIA?

A

Score 4+

45
Q

How to treat a High-Risk TIA? (6)

A
  • Aspirin 300mg daily
  • Specialist assessment within 24hrs
  • Neuroimaging
  • Carotid Imaging
  • ECG
  • ECHO
46
Q

What is done in a workup for TIAs? (7)

A
  • ECG
  • ECHO
  • Carotid Doppler
  • Diffuse Weighted MRI
  • CBC
  • Blood Glucose
  • Lipids

Nervous System (18 decks)

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