Stroke Flashcards by Elizabeth Stevens

What are the main cerebrovascular problems?

Thromboembolic infarction
Cerebral and cerebellar haemorrhage
Subarachnoid haemorrhage

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Most common causes of stroke?

Ischaemic

arterial embolism
arterial thrombosis of an atheromatous artery

Haemorrhage into the brain
Venous infarction
Carotid or vertebral artery dissection
Fat or air embolism

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Modifiable risk factors for stroke?

Hypertension
Smoking
Sedentary lifestyle
Excessive alcohol 
Hypercholesterolaemia 
Diabetes
AF
Arrhythmias

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Non-modifiable risk factors of strokes?

Age
Gender (male)
Family history
Previous stroke

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What is the maximum time a TIA can last?

24 hours

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What normally happens in a TIA?

Microemboli form causing temporary ischaemia to the region

Autoregulation of the brain vasculature prevents any infarction developing

Can also be caused by a small intracranial haemorrhage

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Common symptoms of a TIA?

Hemiplegia
Aphasia
Loss of vision in one eye
Transient global amnesia

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What are people who have suffered a TIA more at risk of?

Stroke

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Where is the most common occlusion of an artery in a stroke and what does this affect?

Middle cerebral artery

Internal capsule

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What are the common clinical features of a stroke?

Contralateral hemiparesis/hemiplegia

Aphasia

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What is a TACS and what has been occluded?

Total anterior circulation stroke (20%)

A proximal occlusion such as internal carotid or proximal middle cerebral infarct

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What is the consequence of a TACS?

Large volume infarct of superficial and deep territories

High mortality

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Clinical presentation in TACS?

Contralateral hemiparesis
Possible hemianaesthesia
Contralateral hemianopia
Higher cerebral dysfunction - cortical signs such as dysphasia and dyspraxia

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What is a PACS? What is occluded?

Partial anterior circulation stroke
Occlusion of middle cerebral artery branch
-causes a restricted infarct

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Clinical presentation of PACS?

Restricted motor deficit - face, arm or leg only

Isolated cortical signs

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What is a LACS and which arteries are affected?

Lacunar stroke

Single perforating artery to basal ganglia or pons

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Clinical presentation of a LACS stroke?

Pure motor or pure sensory, sensorimotor, ataxic hemiparesis

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Which vessels does a POCS affect?

Posterior circulation

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Clinical presentation of POCS?

Brainstem
Cerebellar, brainstem or occipital involvement
Complex

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Most common cause of a POCS?

Thrombosis

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Which type of stroke is often silent and under-diagnosed?

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LACS

How can location be found out (without doing a CT)

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Neurological symptoms

body parts affected
modalities involved

What are positive and negative symptoms?

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Positive - pain, pins and needles

Negative - would indicate stroke: loss of power, speech, sensation

What symptoms would suggest a haemorrhagic cause?

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Haemorrhagic: headache, seizure

Differential diagnosis of stroke?

Hypoglycaemia, other metabolic disturbance Migrainous aura Space occupying lesion Demyelination Labyrinthine disorders

If the dominant half is affected, what do patients often present with?

Dysphagia Dysgraphia (inability to write coherently) Dyslexia

If the non-dominant half of the cortex is affected, what do patients tend to present with?

Visuospatial disorder | Neglect

Investigations to do in suspected stroke?

``` Head CT ECG BM FBC INR ```

Criteria for giving thrombolysis after a stroke?

Within 4.5 hours of documented onset Thromboembolic No bleeding risk (not on warfarin) Over 18

Management of stroke where thrombolysis is not suitable?

Aspirin Management in acute stroke unit Rehabilitation

Secondary prevention for stroke?

Long-term anti-hypertensives Anti-platelets - clopidogrel Anticoagulants in those with AF

What are the two syndromes after an infarct of the brainstem?

Lateral medullary syndrome (Wallenberg's): occlusion of posterior inferior cerebellar artery - vertigo with cerebellar and other signs Locked-in syndrome

What happens in vascular dementia? | Signs?

Multiple infarcts causing generalised intellectual loss Get eventual dementia, pseudobulbar palsy and shuffling gait

Common causes of intracerebral haemorrhage?

Degeneration of penetrating arteries from rupture of micro-aneurysms - commonly leads to a massive bleed Deposition of myeloid around cerebral vessels in the elderly

Main risk factor for intracerebral haemorrhage?

Hypertension

Common sites of intracerebral haemorrhage?

Basal ganglia Pons Cerebellum Subcortical white matter

Common presentation of intracerebral haemorrhage?

Dramatic with a severe headache

Risk factors for subarachnoid haemorrhage?

Male Hypertension Atheroma Other diseases

Presentation of subarachnoid haemorrhage at the base of the brain?

``` Thunderclap headache Sentinel headache Loss of consciousness Often instantly fatal Arterial spasm causes ischaemia and infarction ```

Management of a haemorrhagic stroke?

Possible neurosurgery to remove a clot Anti-hypertensives

Prognosis of haemorrhagic stroke?

Poor

Blood supply to the spinal cord?

Single anterior spinal artery (supplies anterior 2/3rds, motor) - artery of Adamkiewicz reinforces it in thoracolumbar area Paired posterior spinal cord arteries - posterior columns

What are spinal artery infarcts normally caused by?

Intrinsic spinal vessel disease - SLE - arteritis - atherosclerosis Aortic disease - aneurysm - trauma - dissection - atherosclerosis ``` Aortic surgery Sickle cell disease Hypertension Cardiac emboli Tumours compressing on spinal cord Decompression sickness Disc herniation ```

Presentation of ischaemic spinal vessel disease?

Acute Very painful Fever - red flag, suggests - bacterial meningitis - epidural/subdural abscess - granuloma - viral illness

Differential diagnosis of ischaemic spinal disease?

Mass lesion eg tumour, granuloma, haematoma, herniated disc Intraspinal haemorrhage Acute inflammatory demyelinating polyneuropathy eg Guillaim-Barré syndrome Sarcoidosis, TB, syphilis

Management of ischaemic spinal artery disease?

Identify and treat underlying cause Manage vascular risk factors Prognosis normally poor

What is the pathology behind the decorticate response?

Connections between thalamus and cortex are lost, isolating the cortex from the lower brain and spinal cord

What does the decorticate response look like?

Lower limbs extended and upper limbs are flexed

What is the pathology behind the decerebrate response?

Damage to lower parts of the brain or brainstem leads to complete loss of descending inhibition on descending motor tracts

What does the decerebrate response look like?

Complete extension of upper and lower limbs and head

Stroke Flashcards

(50 cards)