Stroke Flashcards Preview

Long Case - Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (7)
Loading flashcards...
1

Pathophysiology of stokes

Ischaemic - 85%
- large arthersclerosis + thromboembolic
- Cardioembolic
- Lacunar (thrombus in situ)
- More likely if carotid bruit, AL, past TIA, IHD

Hameorrhagic 15%
- Hypertension
- berry aneurysm
- Coagulopathy eg. APLS
- AV malformation
- More like meningism, severe headache and coma within hours

Subarachnoid 5% - sudden severe headache
Other = Watershed infarct - after sudden drop in BP

2

History and exam findings anterior circulation

Anterior circulation:
Internal Carotid Artery
- hemiparesis and hemianaesthesia on opposite side
- homonymous hemianopia
- dysphasia

Ant Cerebral artery
- Hemiparesis L>R
- Sensory loss legs only
- personality, mood, behaviour change

Middle cerebral artery
- Left MCA =R sided weakness involving lower face and arm > leg with dysphasia
- Right MCA = L sided weakness involving lower face and arm > leg with visual and/or sensory neglect

3

History and exam findings Posterior circulation and vertebrobasilar

Posterior cerebral artery
- homonymous hemianopia
- parietal deficits= spacial skills, recognition
- temporal deficits = memory, mood, aggression

Vertebrobasilar arterial system
Midbrain
- 3rd and 4th cranial nerve deficit same side
- weakness and sensory loss opposite side
Pons
- 5th 6th CN palsy same side
- weakness and sensory loss opposite side
Medulla
- 9 10 11 Cn palsy same side
- weakness and sensory loss opposite side
Cerebellum
-DASHING
=dysdiadochokinesia (loss of RAM) and dysmetria (overshoot/under), ataxia, slurred speech, hypotonoa, intention tremor, nystagmus, gait abnormality

4

Differential diagnosis?

- migranes with focal seizures
- seizures with poti-ictal paresis
- haemorrhage into SOL
- MS
- Drug overdose
- Head injury
- Hypoglycaemia

5

Investigations

Bloods: FBC, UEC, BSL, Lipids, Coags
- thrombophilia screen if < 50
ECG: ?AF
Imaging:
- CT or MRI
- Carotid USS
- ECHO

6

Management

Primary prevention:
control risk factors: HTN, DM, Lipids, low Exercise, diet, smoking

Acute Ischaemia:
- airway
- BP - autoregulation lost
- BSL
- CT brain ASAP
= Thrombolyse (within 4.5h) +/- thrombectomy <6h for AC and <24H if PC
exclusion:
- HTN 185/110
- recent stroke
-recent MI
-recent surgery/trauma (30 days)
Clopidogrel + Aspirin
DVT prophylaxis
Driving restriction

Acute Haemorrhage:
-stop antithrombotics
-reverse anticoag
- neurosurg

7

Secondary Prevention?

Clopidogrel 70mg daily
Control HTN
Statins 40mg regardless of lipids
Smoking cessation
Consider carotid endarterectomy if >70% stenosed
If in AF consider anticoag once stable (not too fast though to avoid haemorrhagic transformation)