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Yr 5 neuro > stroke > Flashcards

stroke Flashcards

(48 cards)

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1
Q

where is brocas area

A

inferior frontal gyrus

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2
Q

where is wernickes area

A

superior temporal gyrus

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3
Q

does the ACA supply the medial or lateral brain

A

medial hence lower limb affected > upper limb

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4
Q

what are the signs of a lacunar stroke

A

-lacunar stroke affects the lenticulostriate arteries which supply the basal ganglia / internal capsule
-so get purely sensory, purely motor, sensorimotor or ataxic hemiparesis

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5
Q

where do the pontine arteries come off

A

the basilar artery

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6
Q

what happens in a stroke affecting the PICA arteries

A

lateral medullary stroke where there is ipsilateral face problems and contralateral limb

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7
Q

what is the management of acute stroke with regards to aspirin

A

aspirin 300mg can be started straight away if a haemorrhagic cause is ruled out

if thrombolysis is done it should be started after 24 hours

300mg is then continued for two weeks before clopidogrel 75mg is started

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8
Q

long term management of stroke

A

clopidogrel 75mg, statin 80mg, lifestyle, antihypertensives

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9
Q

what is a PACS stroke highly suggestive of

A

am embolus causing a stroke

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10
Q

how may a POCS present

A

cranial nerve palsy, bilateral motor or sensory deficit, gaze palsy, cerebellar dysfunction or isolated homonymous hemianopia with macular sparing

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11
Q

RF for stroke

A

previous TIA, Afib, carotid artery stenosis and HTN

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12
Q

what ROSIER score indicates that a stroke is likely

A

> 0

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13
Q

firstline investigation for stroke

A

CT non contrast
-may then do a CT angiogram to see if the patient is suitable candidate for thrombectomy

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14
Q

timelimit for thrombolysis

A

4.5 hr

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15
Q

time limit for thrombectomy

A

6 hr (but can be 24 if imaging shows there is a a good amount of salvageable brain tissue)

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16
Q

TOAST classification for the aetiology of stroke

A

1) large artery atherosclerosis
2) small vessel occlusion
3) cardioembolism
4) other determined cause
5) other undetermined cause

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17
Q

Ddx for stroke

A

hypoglycaemia, TIA, migraine, delirium, MS, bells palsy

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18
Q

what is capsular warning syndrome

A

stereotyped symptoms (TIA) which indicate high risk of stroke

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19
Q

when do you do a carotid endarterectomy

A

if the stenosis is >50%

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20
Q

Contrainidcations to thrombolysis

Study These Flashcards
A

active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
UNCONTROLLED HTN

21
Q

what is the MX for a hemorrhagic stroke

Study These Flashcards
A

anticoagulant reversal, lower BP, refer to neurosurgery

22
Q

DVT prophylaxis after strokes

Study These Flashcards
A

NICE recommend 30 days IPC

23
Q

Complications of stroke

Study These Flashcards
A

continence problems, fatigue, constipation, raised ICP, infections (UTI and resp), pain, mood disorder

24
Q

what are the three broad categories of stoke recovery

Study These Flashcards
A

1) early high functioning plateau
2) early low functioning plateau
3) delayed and medium functioning plateau

25
what are some poor prognostic factors of stoke
receptive dysphasia, cognitive dysfunction
26
what is the driving restriction after stroke
4 weeks with normal license and 1 year with HGV license
27
what is a level 1 rehab unit
highly complex, requires longer lengths of stays, high numbers of specialist stage and access to specialist facilities
28
what is a level 2 rehab unit
a step down from level 2
29
what are some key points of the rehab process
-screen for problems like pressure area risk, continence problems, swallow problems, mobility and functional status -regular goal setting meetings -set goals -manage complications -assess changes to cognitive, emotional and behavioural function
30
definition of a TIA
onset of neurological symptoms which resolve within 24 hours and there is no evidence of any tissue death
31
do you need to do any imaging for TIA
no - but if pt is on anticoagulant do a CT to check for bleeding
32
When should pt be seen in specialist TIA clinic
within 24 hrs if presenting within a week, within a week if presenting > 7 days post symptoms
33
what imaging can you do post TIA
1) diffusion weighted MRI to look at the vascular territory effected or may do a carotid doppler
34
what are the driving rules post TIA
people who have TIA should not drive for one month (but do not need to tell DVLA) people who have multiple TIAs over 3 months --> DVLA should be told and they should not drive for 3 months
35
what normally causes a TIA
an embolus
36
what other investigations would you do for a TIA
ECG (see if there is Afib causing embolus) CBG clotting lipids
37
what two things do you screen for when someone has a TIA
afib and carotid stenosis
38
when do you not give aspirin after a TIA
if the person has a bleeding disorder or if they already are on an anticoagulant
39
how long do you give dual antiplatelt for after TIA
up to 21 days (initially a loading dose of 300mg of both aspirin and clopidogrel, then 75mg for 21days ) - then you just give clopidogrel mono therapy 75mg daily
40
what is webers syndrome
midbrain stroke - ipsilateral third nerve lesion and contralateral hemiparesis
41
if someone can't have 75mg clopidogrel longterm after a stroke / TIA, what should they be given instead
aspirin 75mg
42
why is prasugrel CONTRAINDICATED for any stroke / TIA patient
it has unacceptable bleeding risks
43
a third generation COCP gives a greater risk of what
VTE
44
what score is used to assess the risk of bleeding when on anticoagulation
ORBIT
45
if someone has uncontrolled severe HTN and has an ischaemic stroke what should be done
lower BP first
46
what does ORBIT score show
bleeds per 100 patient years
47
when should a patient with Afib have their anticoagulation started after a stroke or TIA
after 2 weeks immediately for TIA
48
how to remember webers syndrome, lateral pontine syndrome (AICA) and lateral medullary syndrome (PICA)
Webers - midbrain stroke so get CNIII palsy and contralateral body AICA - affect the pons - ipsilateral face and contralateral body + facial paralysis and deafness PICA - affect the medulla - ipsilateral face and contralateral body but may have more problems with swallowing (as CNIX and X affecteD)

Yr 5 neuro (6 decks)

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