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Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (27)
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1
Q

Two main pathological processes which lead to stroke?

A

Infarction

Haemorrhage

2
Q

Aetiology of infarction?

A

Emboli (cardiac or carotid)
Thrombosis
Hypotension, e.g. in sepsis

3
Q

Main cause/risk factor for haemorrhagic stroke?

A

Hypertension

4
Q

Which functional areas of the brain are affected infarctions in the territory of:

a) anterior cerebral
b) middle cerebral
c) posterior circulation
d) small vessel

A

a) motor cortex, frontal lobe
b) motor cortex, somatosensory cortex, parietal lobe, optic radiations (causing quadrantanopia)
c) occipital lobe, cerebellum, cranial nerves
d) pons, internal capsule, thalamus, basal ganglia

5
Q

Signs which indicate intracerebral haemorrhage rather than infarction? (4)

A

Headache, meningism, nausea and vomiting, seizures

6
Q

Main investigation in suspected stroke?

A

Urgent brain imaging (CT or MRI) to exclude haemorrhage

7
Q

Indications for thrombolysis?

A

Patient is within 4.5hrs of symptoms onset, aged 18-80 years and no contraindication exists (e.g. haemorrhage on CT)

8
Q

Agent used for thrombolysis, and dose?

A

recombinant tissue plasminogen activator e.g. alteplase 0.9mg/kg over one hour

9
Q

When should antiplatelets be used? What agent?

A

In acute ischaemic stroke where haemorrhage has been excluded. Aspirin 300mg

10
Q

Which investigation is essential to carry out as soon as possible?

A

Formal swallow assessment

11
Q

Who should be considered for carotid endarctectomy?

A

Patients with non-disabling stroke/TIA, if carotid artery is found to be stenosed on carotid Doppler ultrasound +/- CT/MRI angiography

12
Q

Tool which can be used to assess suspected stroke?

A

ROSIER

13
Q

Stroke mimics? (7)

A
Hypoglycaemia
Migraine
Space occupying lesion
Post-ictal
Intracerebral haemorrhage
Bell's palsy
Non-organic/functional
14
Q

Which antiplatelets are used in secondary prevention?

A

Aspirin and dipyridamole

15
Q

When should warfarin be used for anticoagulation?

A

In patients with risk of venous embolism e.g. with persistent/paroxysmal AF, prosthetic valves

16
Q

Prognosis of a stroke which presents with loss of consciousness?

A

Poor prognosis, however LOC is an uncommon presentation of stroke

17
Q

Contraindications to thrombolyis? (2)

A

Recent stroke within 3 months

Current haemorrhagic stroke

18
Q

Gait abnormality in stroke?

A

Hemiplegic gait- steps are slower and leg is dragged in an arc

19
Q

What clinically defines large vessel occlusion in stroke?

A

Loss of higher cortical functions e.g. speech, personality

20
Q

Investigations aimed towards finding the underlying cause of a stroke? (5)

A

Basic bloods esp lipids and glucose
ECG- atrial fibrillation, signs of previous ischaemia, left ventricular hypertrophy
Carotid artery Doppler
Holter monitoring
Echocardiogram- atrial dilatation if longstanding A fib

21
Q

Definition of stroke?

A

Acute onset of a focal neurological deficit due to obstruction of blood flow to the brain

22
Q

Small vessel (lacunar) stroke is usually caused by what process?

A

Thrombosis (rather than emboli)

23
Q

Symptoms which should raise suspicion of stroke?

A

Unilateral weakness which is initially flaccid
Unilateral sensory loss
Homonymous hemianopia
Dysphasia

24
Q

Definition of TIA?

A

Sudden onset of focal neurological deficit lasting less than 24 hours

25
Q

What score is used to stratify stroke risk in patients who have had a TIA?

A

ABCD2 score

A= age
B= blood pressure
C= clinical features
D= diabetes mellitus
D(2)= duration of symptoms
26
Q

Prevention of stroke in patients with TIA? (2)

A

Clopidogrel 300mg loading dose, followed by 75mg daily

Control of BP/lipids/diabetes

27
Q

In cardio-embolic stroke, when should anticoagulation be commenced and what is the rationale behind the delay?

A

14 days. Reduces risk of haemorrhagic transformation