Stroke Flashcards
Stroke definition: _____ onset with focal neurological signs due to disrupted _____, with symptoms lasting longer than ____ hours
Stroke definition: ACUTE onset with focal neurological signs due to disrupted BLOOD SUPPLY, with symptoms lasting longer than 24 hours
TIA definition: symptoms last less than ____ hours, ischaemia without infarction
TIA definition: symptoms last less than 24 hours, ischaemia without infarction
What is a crescendo TIA?
2 or more TIAs within 1 wk
Give 5 differentials for a stroke
- Metabolic eg hypoglycemia
- SOL
- Intoxication
- Wernicke’s encephalopathy
- Bell’s palsy
- Demyelination
- Herpes encephalitis
- Post ictal eg Todd’s paresis
- Traumatic head injury
- Hemiplegic migraine
“The ability of the brain to remodel itself, allowing other areas of the brain to take over the function of the lost cells” is the definition of what
Neuroplasticity
What are the 2 types of strokes? What percentage of strokes to each represent?
85% ischemic
15% haemorrhagic
What is the classification system for ischaemic stroke? Name each type of stroke within the classification system
TOAST
- Large vessel
- Small vessel
- Cardioembolic
- Other
- Cryptogenic
Large vessel ischaemic strokes are due to ______. Do they effect cortex or deep brain? Would they cause an anterior or posterior circulation stroke?
Large vessel strokes due to atherosclerosis, effect cortex (therefore cause cortical signs), cause anterior circulation strokes
Small vessel ischaemic strokes are also called what? Do they effect cortex or deep brain? What type of vessels are involved?
Small vessel strokes = lacunar strokes. Effect deep brain (therefore no cortical signs), effect perforator arteries (small branches of large vessels, don’t communicate with each other)
Name 3 causes of cardioembolic strokes
AF, endocarditis, mechanical heart valve
What is a paradoxical embolism?
Right to left shunt through septal defect or patent foramen ovale
(Associated with anterior circulation strokes)
What is a watershed infarct?
Due to hypoperfusion eg sudden drop in BP in sepsis
What type of stroke can be due to neck trauma, fibromuscular dysplasia or occur spontaneously?
Carotid artery dissection
Does antiphospholipid syndrome and thrombophilia cause arterial or venous clots?
APS = arterial and venous Thrombophilia = venous
Vasospasm strokes occur as a result of what?
Post SAH (after 4-10 days)
Haemorrhagic strokes can be divided into 2 types, name them
SAH and intracerebral haemorrhage
What type of stroke are the following things risk factors for?-AF
- Blood thinners
- ADPKD
- Cavernous malformation
- Bleeding disorder
- Metabolic syndrome
- AF = ischaemic
- Blood thinners = haemorrhagic
- ADPKD = haemorrhagic
- Cavernous malformation = haemorrhagic
- Bleeding disorder = haemorrhagic
- Metabolic syndrome = ischaemic
What are the criteria for TACS total anterior circulation stroke?
Homonymous hemianopia + motor + higher cortical deficit
(Motor = 2/3 of arm/face/leg)
Higher cortical deficit could be: dysphagia, dysphasia, dyscalculia, dyspraxia, personality change, hemispatial neglect, new cognitive impairment, agnosia etc)
(these are large vessel strokes)
What are the criteria for PACS partial anterior circulation stroke?
2/3 of: homonymous hemianopia OR motor OR higher cortical deficit
OR isolated higher cortical deficit
What are the criteria for LACS lacunar syndrome?
Purely motor OR purely sensory OR purely sensorimotor or ataxic hemiparesis
(No cortical signs)
(Often face/hand)
What type of stroke has the worst prognosis?
TACS
A stroke that causes a pure hemiparesis is difficult to distinguish the cause because ….
Could be small vessel internal capsule (MCA branches) or large vessel primary motor cortex
(If just leg/arm = cortical, if face / hand = lacunar)
A stroke effect the pons would be the result of TACS or PACS or LACS or PACS …?
LACS
Pons supplied by pontine arteries (branches of basilar artery)
What is the criteria for POCS?
Brainstem infarct or isolated homonymous hemianopia
Brainstem disturbance: vertigo, dysarthria, ataxia
