Stroke Flashcards
(32 cards)
What is the definition of a stroke?
Clinical syndrome of vascular origin characterised by rapidly developing signs of focal or global cerebral dysfunction, lasting over 24 hours.
What is a transient ischaemic attack (TIA)?
< 24 hours of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia, without infarction.
What proportion of strokes are ischaemic?
80%
What are the main causes of ischaemic stroke?
- Atherosclerosis (most common)
- Embolic (e.g. AF causing embolus, thrombus)
- Dissection.
What proportion of strokes are haemorrhagic?
20%
What are the main causes of haemorrhagic stroke?
- Uncontrolled hypertension (most common)
- Anticoagulation
- Ruptured aneurysm
- Trauma/falls.
List risk factors for stroke.
- Previous stroke/TIA
- Atrial fibrillation,
- Carotid artery stenosis
- Hypertension
- Diabetes
- Raised cholesterol
- Family history
- Smoking
- Obesity
- Vasculitis
- Thrombophilia
- COCP in smokers/migraine with aura.
What are the typical features of TIA?
Rapid onset, Most resolve within 1 hour.
What is capsular warning syndrome?
TIA affecting capsule
- over 3 episodes of sensory/motor sx
- Increased risk of stroke within 7 days
What are common features of stroke presentation?
Sudden onset:
* Unilateral limb or facial weakness
* Dysphasia
* Visual defects
* Sensory loss
* Ataxia and vertigo (posterior circulation).
How does UMN facial weakness present in stroke?
Facial weakness with sparing of the frontalis muscle.
What is Broca’s aphasia?
Non-fluent, expressive aphasia – patients understand language but struggle to speak.
What is Wernicke’s aphasia?
Fluent but meaningless speech – patients speak gibberish and can’t comprehend language.
What is a TACS?
Total anterior circulation stroke (proximal MCA/ICA)
with:
2 cortical dysfunctions (e.g. dysphasia, visual neglect)
+ Homonymous hemianopia
+ hemiparesis
What is a PACS?
Partial anterior circulation stroke (branch MCA)
with: 1 cortical dysfunction
1 motor/sensory deficit.
What is a LACS?
Lacunar stroke (small vessel, e.g. lenticulostriate branches)
with: Pure motor, Pure sensory, Mixed motor and sensory
No cortical dysfunction.
What is a POCS?
Posterior circulation stroke (vertebral, basilar, cerebellar, PCA)
with: Visual impairment, Cerebellar signs.
cerebellar signs
D - dysdiadocokinesia
A - ataxia
N - nystagmus
I - intention tremor
S - slurred speech
H - hypotonia
What are some common stroke mimics?
Hypoglycaemia
Sepsis
Drug/alcohol intoxication
Syncope
Migraine with aura
Focal seizures
MS
Bell’s palsy
Functional neurological syndrome
Encephalitis
Hypertensive/Wernicke’s encephalopathy
space-occupying lesions.
What imaging is used in suspected stroke?
Non-contrast CT - look at parenchyma
CT angiography of brain - Haemorrhage
Carotid imaging (USS/CT/MRI angio),
Diffusion-weighted MRI for TIA.
What cardiac investigations are done in stroke?
- ECG/24hr tape (for AF),
- Echocardiogram (e.g. HFrEF).
What blood and vascular tests might be done?
- Thrombophilia screen,
- Angiography.
What are common complications of stroke?
- Continence issues
- Fatigue
- Swallowing problems (aspiration pneumonia, nutrition, hydration)
- Hearing and cognitive dysfunction,
- Depression
- Pain (neuropathic/MSK)
- ADL and mobility issues (pressure sores, infections, VTE, constipation)
- Recurrent stroke
- Raised ICP.
Which professionals are part of the stroke MDT?
- Stroke team
- Nurses
- SALT, Dieticians
- PT/OT
- Social services
- Optometry
- Psychology
- Orthotics.
