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10 - Neuro Clinicals > Stroke > Flashcards

Stroke Flashcards

1
Q

Definition stroke

A

Sudden global or focal neurological deficits due to spontaneous hemorrhage or infarct of CNS irrespective of clinical duration of symptoms

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2
Q

Why is stroke an issue in Africa

A

Younger population affected
Higher death toll

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3
Q

Pathophysiology in stroke cerebral blood flow

A

Loss of autre regulation
Less than 50% tissue at risk
Less than 25% electrical failure
Less than 15% membrane failure and death

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4
Q

Cerebrovascular disorder leading to stroke

A

Atherosclerosis and arteriosclerosis
Hypertension
Cerebral amyloid
Arteritis
Vasculitis
Aneurysm
Vascular malformations

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5
Q

Vertebral and basilar arteries supply …

A

Brainstem
Mid brain
Cerebellum

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6
Q

Anterior cerebral artery supply

A

Frontal lobe
Parietal lobe

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7
Q

Middle cerebral

A

Parietal lobe
Frontal lobe

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8
Q

Posterior cerebral

A

Occipital lobe

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9
Q

4 Strokes syndrome

A

ACA - frontal lobe , altered mental state , contralateral lower extremity weakness
MCA - contralateral hemiparesis m ipsilateral hemianiopa,
PCA
Vertebrobasilae

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10
Q

Oxford subtypes of infarctive st

A

Total anetrior circulation infarct
Partial anterior circulation intact
Lacunar infarct
Posterior circulation infarct

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11
Q

Features of posterior circulation infarction syndrome

A

Ipssilateral cranail nerve palsy
Contralateral motor or sensory deficits

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12
Q

Features of pontine hemorrhage

A
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13
Q

Features of cerebellar hemorrhage

A
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14
Q

ASCO mnemonic in infarctive stroke

A

ASTHEROEMBOLIC

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15
Q

SMASHO mnemonic in hemorrhagic stroke

A

Amyloid
Hypertension

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16
Q

Non modifiable risk factor of stroke

A

Male gender
Age
Race black
Previous vascular event (MI, stroke, PVD)
Family history
SCdx
High fibrinogen

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17
Q

Modifiable risk factors

A

Obesity
Diet
Alcohol
Smoking
BP
Polycytemia

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18
Q

Modifiable risk factors

A

Smoking
Alcohol
Sedentary life style
Diet
Obesity
Stress
Cholesterol

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19
Q

Subtypes of ischemic stroke

A

Large artery atherosclerosis ( embolus, thrombus )

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20
Q

Specific causes of stroke in developing countries

A

Sickle cell disease
Snake bite
Infective endocarditis
Cerebral malaria
HIV
COVID
Chagas’ disease

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21
Q

Path to neuronal injury in ischemic stroke

A

Ischemia -> energy failure ( low ATP)-> cell depolarization (sodium and water influx) -> release of neurotransmitter ( glutamate , AMPA, NMDA) -> calcium influx into neurons -> activation of destructive process by enzymes

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22
Q

What is penumbra

A

Functionally impaired but still structurally viable tissue

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23
Q

Differential of stroke

A

ALS
Bell’s palsy
Benign postural vertigo
Cauda equina
Cavernous sinus thrombosis
Cerebral venous thrombosis
Dissection syndrome
Epidural hematoma
Head injury
meningitis
Migraine
Mutilple sclerosis
Spinal cord infarction

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24
Q

Stroke scale defintion

A

Quantity measure of stroke related deficit
NIHSS

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25
Scale of ranking stroke
0- no symptoms 1- no significant disability 2- slight disability 3- overeats disability 4- modesevere disability 5- severe disability
26
Imaging techniques used
Structure - CT , MRI Function- PET SPECT , EEG , MEG
27
Why do Imaging in stroke ?
Hemorrhage or infarct ? Large vessel occlusion ? Reduced tissue perfusion ? Irreversible damage ? Salvageable tissue ?
28
Early neuroprotection in stroke
Maintain homeostasis by Treat severe hypertension Maintain blood sugar Early fluid and energy replacement Swallowing assessment Tx fever and antipyretic Treatment of infection Early mobilization and rehab
29
Steps in anti platelet therapy
Confirm with ct scan 300-75mg aspirin in infarct Aspirin + early mobilisation in DVT
30
Hypertension treatment in strok
Reduce slowly ACEi, ARBs, diuretics
31
Contraindication for thrombolysis therapy in stroke
32
What is tPA
In early presentation of stroke patient (4-5h)
33
Determinants of hogh stroke mortality in Ghana
Health seeking behavior of African Inadequate facilities Late institution of neruoprotectine measures Complications of stroke s Lack of imaging facilities Lack of multidisciplinary teams Low awareness , treatment and control of hypertension Primordial
34
Clinical Classification of strokes from anterior carotid circulation and posterior carotid circulation
Total anterior circulation stroke TACS Partial anterior circulation stroke PACS Lacunar stroke LACS Posterior circulation stroke POCS
35
2 types of hemorrhage leading to stroke
Intracerebral hemorrhage Subarachnoid hemorrhage
36
Main neuroimaging techniques used to detect stroke
CT scan (baseline ) MRI when uncertainty of diagnosis CT angiography /CT perfusion for characterization of ischemia
37
Vascular imaging techniques used in stroke
Ultrasound Doppler for carotid and vertebral arteries in the neck Transcranial Doppler MR angiography CT angiography
38
Blood tests done in stroke
Blood glucose - diabetes mellitus TGs , cholesterol - Hyperlipidemia FBC - polycythemia ESR & Immunology - ANCAs for vasculitis Genetic testing for CADASIL - cerebral autosomal dominant arteriopathy with subcortical infarct and leucoencephalopathy
39
Investigation technique used only in subarachnoid hemorrhage
Lumbar puncture
40
Cardiovascular investigation in stroke
ECG Echocardiography
41
Possible neurological presentation of stroke patient
Unilateral Weakness - sudden, rapidly progressive , UMN weakness of face , increased tone Speech disturbance - dysphasia ( frontal and parietal lobe), dysarthria Visual deficit Contralateral Visuospatial dysfunction Ataxia - cerebellum damage Headache (severe mostly in SAH ) Seizure Coma especially in SAH or intracerebral hemorrhage
42
Mortality of stroke over a month
20%
43
Morbidity of stroke over a month
1/2with physical disability
44
Main cause of cerebral infarction in stroke
Secondary thromboembolic disease to atherosclerosis
45
Main type of secondary thromboembolic dx leading to infarctive stroke
Cardiac embolism 20% Thrombosis in situ 20% Rare causes - endocarditis, vasculitis , cerebral venous dx
46
Disease causes of intracerebral hemorrhage
Complex small vessel disease with disruption of vessel wall Amyloid angiopathy Impaired blood clotting Vascular anomaly Substance misuse
47
Differentials of structural stroke
Primary cerebral tumor Metastatic cerebral tumor Extradual / subDural hematoma Demyelination Peripheral nerve lesions Cerebral abscess
48
Differentials of functional stroke
Todds paresis Hypoglycemia Migrainous aura Focal seizures Manières dx Conversion disorder Encephalitis
49
TACS common symptoms
Hemiparesis Higher cerebral dysfunction Hemisensory loss Homonymous hemianopia
50
TACS commonest cause
Middle cerebral artery occlusion
51
PACS commonest symptoms
Isolated motor loss Isolated higher cerebral dysfunction Mixture of higher cerebral dysfunction and motor loss
52
Main cause of PACS
Occlusion of branch of middle cerebral artery or anterior cerebral artery
53
LACS commonest symptoms
Pure motor stroke Pure sensory stroke Sensory motor stroke No higher cerebral dysfunction or hemianopia
54
LACS commonest cause
Thrombotic occlusion of small perforating arteries
55
POCS main symptoms
Homonymous hemianopia Cerebellar dysfunction Cranial nerve syndromes
56
POCS commonest cause
Occlusion in vertebral basilar or posterior cerebral artery
57
What is progressing stroke
Stroke with focal neurological deficit worsenin after the patient first present
58
What is a complete stroke
Focal deficits persists and is not progressing
59
1st Step in management of stroke
Bedside test swallowing for safe medications, food, hydration
60
Management of ischemic stroke
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10 - Neuro Clinicals (6 decks)

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