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Finals: Medicine > Stroke > Flashcards

Stroke Flashcards

1
Q

Define a stroke

A

Represents a sudden interruption in the vascular supply of the brain

It is characterised by sudden onset of rapidly developing focal or global neurological disturbance, which lasts > 24 hours or leads to death

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2
Q

What is the other name for a stroke

A

cerebrovascular accident

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3
Q

Why does a loss of oxygen supply lead to irreversible damage in the brain

A

The neural tissue of the brain is completely dependent on aerobic metabolism (it cannot do anaerobic metabolism)

Hence a loss of oxygen supply lead to irreversible damage in the brain

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4
Q

There are two main types of strokes.

What are they

A

Ischaemic and Haemorrhagic

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5
Q

Why type of stroke is most common

a) Ischaemia
b) Haemorrhagic

A

Ischaemic Stroke (most common – 85%)

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6
Q

What happens in the brain for an Ischaemic stroke to occur

A

Occurs as a result of occlusion of the blood vessels that supply the brain parenchyma leading to infarction (tissue necrosis secondary to ischaemia)

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7
Q

What happens in the brain for an Haemorrhagic stroke to occur

A

The result of weakening of the cerebral vessels leading to cerebral rupture causing bleeding/haematoma formation within the brain parenchyma, ventricular system or subarachnoid space

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8
Q

What is the direct and indirect cause of he clinical deficits associated with haemorrhagic stroke

A

Clinical deficit is caused directly by neuronal injury

Indirectly by cerebral oedema (this peaks at day 5 following symptom onset)

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9
Q

Haemorrhagic stroke classification can be subdivided further.

Name these subdivision

A

Intracerebral haemorrhage (ICH) – most common

Subarachnoid haemorrhage (SAH)

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10
Q

What is the essential problem that causes an ischaemic stroke

A

‘Blockage’ in the blood vessel stops blood flow

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11
Q

What is the essential problem that causes a haemorrhagic stroke

A

Blood vessel ‘bursts’ leading to reduction in blood flow

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12
Q

What proportion of strokes are ischaemic

A

85%

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13
Q

What proportion of strokes are haemorrhagic

A

15%

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14
Q

Name some of the modifiable risk factors for stroke

A
  • Cigarette smoking
  • Obesity
  • Hypercholesterolaemia (high serum cholesterol)
  • Hypertension
  • Combined contraceptive pill
  • Sedentary lifestyle
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15
Q

Name some of the non-modifiable risk factors for stroke

A
  • Cardiovascular disease comorbidities e.g, angina, myocardial infarction and peripheral vascular disease
  • Age (>65 years old)
  • Male gender
  • Atrial fibrillation (5 x greater risk)
  • Previous stroke or TIA
  • Diabetes mellitus
  • Hypercholesterolaemia
  • Carotid artery disease
  • Thrombophilia
  • Sickle cell disease
  • Vasculitis
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16
Q

Define the term “Transient Ischaemic Attack (TIA)”

A

It is transient neurological dysfunction secondary to ischaemia without infarction

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17
Q

How long will it take for most symptoms of the Transient Ischaemic Attack (TIA) to resolve?

A

Within 1 hr

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18
Q

Define the term “ischaemia”

A

Refers to the reduction/lack of blood flow to the tissue

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19
Q

Define the term “Infarction “

A

Refers to the cellular changes that can occur as a result of reduced/no perfusion to the tissue

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20
Q

Name the four key features of stroke

A
  • Sudden weakness of limbs
  • Sudden facial weakness
  • Sudden onset dysphasia (speech disturbance)
  • Sudden onset visual or sensory loss
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21
Q

Patients with what kind of stroke are more likely to present with global features such as headache and altered mental status.

A

haemorrhagic stroke

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22
Q

Name some of the clinical features associated with haemorrhagic stroke

A
  • Headache
  • Altered mental status
  • Nausea & Vomiting
  • Hypertension
  • Seizures
  • Decrease in the level of consciousness
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23
Q

Ischaemic Strokes are classified by what classification scale

A

Bamford/Oxford classification

24
Q

Anterior cerebral artery supplies what lobes

A

Part of the frontal and parietal lobe.

25
What are the clinical features associated with an anterior cerebral artery ischaemic stroke
* Unilateral weakness and/or sensory deficit on the contralateral face, arms and/or legs * Homonymous hemianopia: visual field loss on the same side of both eyes * Higher cerebral dysfunction: dysphasia, visuospatial dysfunction e.g., neglect, agnosia
26
What are the clinical features associated with an middle cerebral artery ischaemic stroke
* Contralateral hemiparesis and sensory loss – upper extremity \> lower * Contralateral homonymous hemianopia (visual field loss on the same side of both eyes) * Aphasia (inability to comprehend speech, occurs if it affects left/dominant hemisphere) * Visuospatial problems * Apraxia (inability to create speech, occurs if it affects the right/non-dominant hemisphere)
27
Middle cerebral artery supplies what lobes
Supplies a large proportion of the lateral surface of each brain hemisphere including the internal capsule and basal ganglia
28
Posterior cerebral artery supplies what lobes
Supplies the occipital lobe and inferior proportion of the temporal lobe as well as some deep structures (e.g. thalamus).
29
What are the clinical features associated with a posterior cerebral artery ischaemic stroke
- Contralateral homonymous hemianopia with macular sparing - Memory deficits - Several visual defects – lack of depth, hallucinations
30
Broca’s area is responsible for ____ speech a) Fluent b) The understanding of
a) Fluent
31
Wernicke’s area is responsible for ____ speech a) Fluent b) The understanding of
Wernicke’s area is responsible for **the understanding of** speech
32
A lesion in the Broca’s area results in \_\_\_\_\_ a) Expressive dysphasia b) Receptive dysphasia
A lesion in the Broca’s area results in **a) Expressive dysphasia**
33
A lesion in the Wernicke’s area results in \_\_\_\_\_ a) Expressive dysphasia b) Receptive dysphasia
A lesion in the Wernicke’s area results in **b) Receptive dysphasia**
34
What is the name of the tool used in the community to recognise stroke
FAST tool
35
What is the name of the tool used in the hospital to recognise stroke
ROSIER
36
ROSIER tool to recognise stroke is based on what factors?
Clinical scoring tool based on clinical features and duration
37
Stroke is likely if the patient scores what on the ROSIER tool
\> 0
38
What is the gold standard investigation for stroke
Non-contrast CT head scan
39
Why is neuroimaging needed urgently if there is a suspection of stroke
Urgent imaging as patient may be suitable for thrombolytic therapy to treat early ischaemic strokes
40
If CT scan is contraindicated for whatever reason what is the next best neuroimaging modality for stroke
MRI scan of head
41
What are the key CT features of an ischaemic stroke
May appear normal in the first few hours of the stroke - areas of low density in the grey and white matter will develop over time
42
What are the key CT features of a haemorrhagic stroke
Areas of hyperdense material (blood) surrounded by low density (oedema)
43
What is the first line management for a patient with a stroke
ABCDE assessment - making sure they are haemodynamically stable
44
At what GCS does a patient need intubated to protect their airways
GCS \< 8
45
What is the management of a haemorrhagic stroke
Management depends on the extent of bleeding and the suitability for neurosurgical interventions Potentially neurosurgical input (particularly for larger bleeds) Most small bleeds, there is no requirement for neurosurgical intervention. Managing underlying risk factors (see secondary prevention of stroke)
46
What are the potential neurosurgical interventions for managing a large haemorrhagic bleed
Includes use of decompressive hemicraniectomy in those meeting specific clinical criteria or suboccipital craniotomy for posterior fossa bleeds
47
What is the initial management of an ischaemic stroke
Loading dose aspirin (300mg) and consider: ## Footnote \<4.5 hrs from symptom onset: thrombolysis \< 24 hrs from symptom onset: thrombectomy
48
What drug is used in Thrombolysis of ischaemic stroke
Alteplase
49
What is Alteplase
Alteplase is a tissue plasminogen activator that rapidly breaks down clots and can reverse the effects of a stroke
50
Name three contraindictors against thrombolysis use in ischaemic stroke
Neurosurgery last 3 months Active internal bleeding (hence done only after CT has excluded haemorrhagic stroke) Onset of Symptoms \> 4.5 hrs
51
What is the thrombolysis window for ischaemic stroke
Onset of symptoms \< 4.5 hrs Limited benefit beyond this time with increased bleeding risk
52
Name a post thrombolysis complication
Intracranial or systemic haemorrhage
53
What is involved in thrombectomy
Involves mechanical removal of the clot causing the ischaemic stroke in specialist centres by the interventional neuroradiology team
54
What is the timeframe in which thrombectomy can be used in the management of patients with ischaemic stroke
Not used after 24 hours from the onset of symptoms
55
Name some of the secondary preventions for strokes
- Clopidogrel 75mg once daily (alternatively dipyridamole 200mg twice daily) - Atorvastatin 80mg should be started but not immediately - Carotid endarterectomy or stenting in patients with carotid artery disease - Treat modifiable risk factors such as hypertension and diabetes
56
Following a stroke, patients who drive a car or motorcycle should be advised to stop driving for how long?
One month
57
Name the 5 parts of managing a patient with a stroke
**Part 1: Stablising the patient (ABCDE assessment)** **Part 2: Imaging with non contrast CT head scan** **Part 3: Intervention** Haemorrhagic stroke - consider neurosurgical intervention Ischaemic stroke - loading dose aspirin (300mg) and: \<4.5 hrs from symptom onset: thrombolysis \< 24 hrs from symptom onset: thrombectomy **Part 4: Secondary prevention** **Part 5: Stroke rehabiliation**

Finals: Medicine (91 decks)

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