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ENT, neuro, eyes > Stroke > Flashcards

Stroke Flashcards

1
Q

Hemianospia vs homonymous hemianopia?

A

Neglect is the inattention of visual space unilaterally
Homonymous hemianopia is physical visual loss to same half of both eyes

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2
Q

Differenve in exam hemianospia vs homonymous hemianopia?

A

Test - HH would not see finger waggle on one side consistently
Neglect - can see individual finger waggle on both sides but not at the same time

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3
Q

3 criteria of stroke

A

Unilateral weakness
Homonymous hemianopia
Higher cerebral functions eg dysarthria (UMN signs)

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4
Q

TACS vs PACs criteria

A

TACS - all 3
PACS - 2/3

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5
Q

Lacunar stroke signs

A

NOT cortical
Ataxia
Dysarthria
Motor or sensory

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6
Q

Storke mimics to check

A

Hyponatremia, calcemia, glycaemia

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7
Q

When does the NIHSS score indicate thrombolysis?

A

<4 or >25

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8
Q

What is the difference between neglect and homonymous hemianopia?

A

Neglect is attention problem to one side of body - can’t see two fingers wiggling at same time
HH is physical vision loss to the same side on both eyes - can’t see one finger waggle on one side of body in BOTH eyes

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9
Q

Stroke symptoms if ACA affected

A

Contralateral hemiparesis and sensory loss
Lower extremity >upper

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10
Q

Middle CA symptoms of stroke

A

Contralateral hemipareseis and sensory loss
Upper extremity >lower extremity
Controlateral HH, aphasia

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11
Q

Posterior cerebral artery symptoms

A

Contralateral HH w macular sparing
Visual agnosia

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12
Q

What is webers syndrome

A

Branches of PCA that supply midbrain stroke

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13
Q

Symptoms of webers syndrome

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

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14
Q

What is wallenberg syndrome + what affected in it

A

Lateral medullary syndrome - posterior inferior cerebellar artery stroke

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15
Q

Symptoms of wallenberg syndrome

A

Ipsilateral - facial pain and temperature loss
Contralateral limb/torso pain and temp loss
Ataxia, nystagmus

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16
Q

What is lateral pontine syndrome

A

Anterior inferior cerebellar artery stroke

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17
Q

Lateral pontine syndrome symptoms

A

Similar to wallenbergs but also ipsilateral facial paralysis and deafness
Sudden onset vertigo and vomitting

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18
Q

What artery stroke causes amourosis fugax

A

Retinal/opthalmic artery

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19
Q

Basilar artery stroke causes

A

Locked in syndrome

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20
Q

Lacunar stroke features

A

Present with isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
Strong ass w HPTN
Basal ganglia, thalamus + internal capsule

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21
Q

Causes of stroke

A

85% ischaemic - thrombosis infarcts, cerebral emboli
8.3% IC haemorrhage
5.4% SA haemorrhage
1.2% undefined

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22
Q

WHICH LOBES SUPPLIED BY WHCIH ARTERIES IF HAVE TIME

A
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23
Q

What is malignant middle cerebral artery syndrome

A

Younger ischaemic patients if large MCA infarct
Significant oedma -> brain cimpression
May need craniotomy

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24
Q

What is the area around an infarct that is salvageable but critically endagenered in a stroke

A

Penumbra

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25
What is a thalamic stroke
Bleed ruptures into ventricles
26
Management of brainstem/PCS stroke
Urgent CT angiogram of basilar artery and mechanical thrombectomy considered
27
What causes total anterior circulation stroke
Proximal MCA or ICA occlusion
28
What are the clinical features of a Total anterior circulation syndrome stroke
Hemiparesis AND Higher cortical dysfunction (dysphasia or visuospatial negelect) AND homonymous hemianopia
29
Clinical features of a partial ACS stroke
Isolated higher cortical dysfunction OR Any 2 of hemiparesis, higher cortical dysfunction, hemianopai
30
What artery blockage causes a PACS
Branch of MCA occlusion
31
Clinical features of a Posterior circulation syndroem/POCS
Isolated hemianopai (PCA), brainstem or cerebellar syndromes
32
What blood vessel occlusion can cause POCS
Vertberal, basilar, cerellar or PCA vessels
33
Clinical features of lacuna syndrome - LACS
Pure motor stroke OR pure sensory OR sensorimotor OR ataxic hemiparesis OR clumsy hand-dysarthria
34
What vessels can be occluded in lacuna syndrome
MCA/ICA occlusion
35
What symptoms would you expect to see in an ICA blockage
Aphasia - neglect non dominant hemisphere Contralateral HH, motor/sesnory loss to face, arm, leg Conjugate ispilateral eye deviate
36
Symptoms of MCA stroke
Aphasia or neglect Contralateral HH, motor/sensroy loss to face/arm > leg eg UPPER BODY symptoms
37
ACA stroke symptoms
Apathy, abulia, disnhibition Conjugate eye deviation Contralateral motor/sensory loss leg >arm eg LOWER body
38
PICA stroke symptoms
Ipsilateral palatal weakness, horners syndrome Wallenberg syndrome Ipsilateral ataxia Decreased pain/temp contralteral body
39
AICA stroke symptoms
Ipsilateral deafness Facial motor/sensory loss Limb ataxia Pain/temp contralteral body reduced
40
Basilar stroke symptoms
Altered consciousness Oculomotor abnoamlaties Facial paresis Ataxia Quadraperesis
41
Who to call if someone presenting with stroke
ED, stroke, radiology, neurosurgery , thrombolysis if suspicion
42
What score is used to reognise stroke in acute symptom onset cases
Rosier - recognition of stroke in emergency room
43
Questions on the Rosier score
Negative scores Loss of consciousness or syncope? Seizure activity? Positive scores New acute onset or wake from sleep of asymmetric face, arm or leg weakness (1 point each), visual field defect, speech disturbance
44
What bedside test is important to do in stroke presentation
BM - <3.5 treat urgently and reassess
45
What score on ROSIER means stroke is likely
>0 -2 to +5 possible
46
Time frame for treating ischaemic stroke with alteplase
Within 4.5 hours of onset of stroke symptoms Rule out IC haemorrhage w CT head
47
Contraindications to thrombolysis in stroke
Anticoag use prev 24 hour unless INR <1.7 or on warfarin HPTN>185/110 DESPITE lowering Platelets<100 or bleeding tendency Prev history IC bleed Recent ischaemic stroke or major surgery Trivial non disabling or rpaidly resolving symptoms
48
What is the NIHSS score
Assesses motor, global and sensory deficits and scores
49
What score on NIHSS relates to whcih severity
0 = none 0-4 = minor stroke 5-15 = moderate stroke 16-20= mode to severe stroke >21 = severe
50
What arteris are proximal large arteries and why is this significant
Terminal bit ICA proximal MCA basilar artery ->1/3 of strokes but <30% thrombolysis is effective in these
51
What use in proximal large artery occlusions
Mechanical thromextomy within 6 hours of onset
52
Anticoag to use in stroke
300mg aspirin ASAP within 24 hours for 2 weeks or until discharge Alteplase - confirm no haemorrhage CT head 24 hrs then aspirin 300mg Long term - 75mg clopidogrel OD
53
MOA clopidogrel
P2Y12 inhibtior - ADP receptor - platelet activation and fibrin cross linking)
54
What is Malginant MCA infarct
TACS w progressive neuro deterioration due to progressive oedema, raised ICP and cerebral herniation
55
Primary causes of haemorrhagi stroke
HPTN and cerebral amyloid angiopathy
56
Which cause is more likely in haemorrhagic stroke based on findings
HPTN in deep portions cerebral hemisheres eg putamen, thalamus, pons, cerebellum CAA - older patients w lobar bleeds
57
What use in CAA investgiatons
MRI Boston criteria - evidence of mutliple haemorrhages/microbleeds
58
Haemorrhageic stroke secondary causes
- underlying vascular bnormlaities - AV malformation, aneurysm (blood in temporal lobe and sylvian fissure) - Cavernoma - abnormal clump og blood vessles - Coagulopathies - Oral anticoagulants - Non cerebral thrommbolytic drugs - Systemic diseases - Rare causes eg cerebral VTE, illicit drugs - amphetamines - Cancer
59
What is most useful predictor for severity of stroke
ICH volume >60ml one cerebral hemisphere cant be compesnated -> cerebral herniation and death
60
ICH score criteria
GCS score 3-4 (2) , 5-12, 13-15 (0) ICH volume < or >30 IVH yes or no Infratentorial origin ICH yes or no Age >80 or <80 0-6 total potnetial score
61
What does ICH score measure
30 day mortality likely hood from haemorrhagic stroke
62
Acute care for ICH
1 - rapid anticoagulation reversal 2 - Intensive BP lowering to 130-40 (if BP>150 and within 6 hrs onset) Immediate referral to neurosurgery if sutibale
63
Patients for neurosurgery referral
good premorbid function and any of GCS>9, posterior fossa ICH, obstructed 3rd or 4th ventricle, haematoma>30ml
64
Predictors of haematoma expansion
ICH volume >30 and IVH Spot sign on CT High blood glucose LowGCS/NIHSS High BP High score in 9 and 24 point and PREDICT A+B models Coag - low fibrinogen, high D dimer and INR Elevated WCC, IL-6, CRP Time interval from onset of symptoms <6 hours
65
What investigation is more sensitive for TIA and used in clinic
MRI brain diffusion weighted and blood sensitive sequeneces - SWI
66
What is todds paresis
Focal weakness in part or all of body after seizure, can last up to 48 hours
67
Stroke diagnosis investigations
- Bloods - FBC, ESR, LFTs, lipids, Hba1c, TSH, coag - Brain scan - CT/MRI - extracranial vessel imaging - carotid doppler - ECG+/- cardiac imaging
68
TIA secondary precention
- Control BP - Antiplatelets - clopidogrel 75mg - Cholesterol reduction - atorvastatin - Lifestyle advice
69
What do in symptomatic carotid artery stenosis
Urgent carotid endartectomy
70
What is most frequent cause of stroke in yuong people
Cervical artery dissection
71
Who is cerebral venous sinus thrombosis seen in
Young women 20-35
72
Features of cerebral venous thrombosis
Headache and stroke like symptoms Risk - prothrombotic tendency, local infection eg sinusitis, dehydration or widespread malignancy, seizures
73
Investifation fro central venous sinus thrombosis
CT venography or MR

ENT, neuro, eyes (34 decks)

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