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MD4001 Pathology > Stroke > Flashcards

Stroke Flashcards

1
Q

what are some possible causes of haemorrhagic stroke

A 
hypertension 
tumour
bleeding disorder
vascular malformation 
amyloid angiopathy
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2
Q

what is a TIA

A

symptoms last less than 24 hours

interruption to the blood supply causing loss of neurological function

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3
Q

what are some possible mechanisms for ischaemic strokes

A

cardioembolism
large vessel atherothrombosis
small vessel disease
hypoperfusion

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4
Q

what is a watershed stroke

A

ischaemia in the border between the territories of two major arteries in the brain

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5
Q

what is the blood supply of the anterior brain

A

middle cerebral artery
anterior cerebral artery
striate arteries

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6
Q

what does diplopia mean

A

double vision

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7
Q

what does ataxia mean

A

loss of full control of body movements

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8
Q

what is the medical name for blindness in one half of the field of vision

A

hemianopia

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9
Q

what are the steps for an emergency room assesment of a stroke

A

airway, breathing, circulation

clarify the history
check medical history
check the signs

exclude stroke mimics

level one investigations

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10
Q

what is the OCSP Classification of strokes

A
  1. total anterior circulation syndrome
    2 partial anterior circulation syndrome
    3 lacunar syndrome
    4 posterior circulation syndrome
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11
Q

what can you examine

A

•BP and pulse measurement in 2 arms
•Conscious level (GCS; document breakdown)
•Cardiac and carotid bruits
•BM/blood glucose value
•Neck stiffness/meningism (Kernig’s/Brudzinski signs)
•Abnormal or involuntary movements
•Any seizure-like activity
•Skin rash/infarcts e.g. vasculitic, papular rash
•Specific neurological
-eye movements (gaze preference,fixed deviation)
-speech, visual fields, inattention, motor & sensory
-gait assessment

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12
Q

what are the features of LACS (lacunar syndrome)

A

pure motor or pur sensory, sensorimotor, ataxic hemiparesis

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13
Q

what are the features of POCS (posterior circulation syndrome)

A

brainstem, cerebellar and/ or homonymous hemianopia

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14
Q

what are the features of TACS

A

triad of hemiparesis (or hemisensory loss), dysphasia, homonymous hemianopia

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15
Q

what are the features of PACS (partial anterior circulation syndrome)

A

2 of the features of TACS or isolated dysphasia or parietal lobe signs
(inattention, agnosia, apraxia, agraphaesthesia, alexia)

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16
Q

what is agraphaesthesia

A

loss of orientation of skin sensations, pt is unable to understand letters traced across the skin

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17
Q

what is alexia

A

loss of ability to read

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18
Q

what is the ABCD2 stroke risk calculator

A

7 points score to predict early stroke risk post TIA
•Age [60 or above;=1]
•Blood pressure [systolic > 140 and/or diastolic =/> 90; =1]
•Clinical features [unilateral weakness = 2; speech disturbance w/o weakness = 1; other = 0]
•Duration of Symptoms in mins [=/> 60 =2; 10-59 =1;

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19
Q

what mnemonic is used to remember stroke mimics

A 
five S
seizures
sepsis
syncope
SOL (space occupying lesion)
somatisation
20
Q

what is somatisation

A

the manifestation of psychological distress by the presentation of bodily symptoms.

21
Q

what are red flags

A 
no history 
no risk factors
no imaging abnormality 
young age
seizures
unusual headache
22
Q

what things should you not overlook during a history taking for a stroke

A

evolution of symptoms
maximum deficit
drugs: newly prescribed, oral contraceptives, recreational

23
Q

what 3 factors should you attempt to discover on clinical assessment

A

localisation of lesion
likely vascular or non vascular aetiology
mechanism of vascular event

24
Q

how can you breifly assess risk of reccurent stroke

A

recurrent events in the past
long duration of TIA
concomitant vascular risk factors
high risk of cardioembolism e.g. AF

25
Q

what investigations can you do after a stroke

A 
ECG (24hr), echo 
cholesterol, autoimmune and thrombophilia screen 
carotid doppler
CT/MRI brain 
cerebral angiography
26
Q

what are the indications for urgent head imaging

A

depressed level of consciousness
unexplained progressive or fluctuating symptoms
papilloedema
neck stiffness, fever
history of trauma
indication for thrombolysis or anticoagulant
history of anticoagluant or bleeding tendency

27
Q

what is papilloedema

A

optic disc swelling caused by raised intracranial pressure

28
Q

what does SDH stand for

A

subdural haematoma

29
Q

what might you find on a head CT

A 
bleed
tumour 
SOL
subdural haematoma 
early ischaemia
30
Q

what is diffusion weighted imaging

A

mixture of T2 weighted and diffusion weighting

31
Q

what is apparent diffusion coeficient

A

pure diffusion of water on MRI

32
Q

describe how DWI/ADC changes after a stroke

A

initially high signal DWI, low ADC
1-2 weeks DWI stays high and ADC returns to normal
2 weeks DWI decreases and ADC becomes high

33
Q

when are antihypertensives indicated after ischaemic stroke

A

when MABP is above 130 mmhg

34
Q

What blood pressure should you aim for following haemorrhagic stroke

A

less than 140 mmHg

35
Q

what drug should you give for persistantly elevated BP

A

IV labetolol

avoid abrupt falls in BP

36
Q

how do you treat raised intercranial pressure

A

mechanical hyperventilation
mannitol
decompressive hemicraniectomy

37
Q

what are the advantages of MRI over CT

A

sensitive
diagnostic
aids management
prognostic

38
Q

how do you treat acute strokes

A

300mg/d in ischaemic stroke
thrombolysis if haemorrhagic stroke excluded
endovascular treatment/mechanical thrombectomy
surgery if hydrocephalus
anticoagulation in AF, once bleed is excluded

39
Q

how is a SAH managed

A 
•CT brain/ lumbar puncture if CT normal looking for bilirubin & xanthochromia. Cerebral angiogram
•Management:
-airway: intubate if severe hypoxaemia
-fluid: 3L of 0.9% NaCl per 24 hrs
-BP: keep MAP
40
Q

what antithrombotics can be used in secondary prevention

A

Clopidogrel or Aspirin + Dipyridamole. In atrial fibrillation: Warfarin or NOAC (dabigatran, rixaroxaban, apixaban)

41
Q

how do you manage blood pressure as part of secondary prevention

A

Target BP

42
Q

how do you manage cholesterol post stroke

A

If total cholesterol > 4.0 mmol/l (or LDL-C > 2.5mmol/l [100 mg/dl], treat with statin e.g. Simvastatin (but caution in ICH or history of cerebral haemorrhage)

43
Q

describe longer term management for stroke pts

A
  • 6 mths after stroke, over 50% survivors need some help with their ADL; 15% communication impairment and 53% motor weakness
  • Psychosocial and support needs reviewed on regular basis
  • Potential issues: Communication, mobility, driving, depression, pressure sores, sepsis, nutrition, post-stroke seizure, shoulder pain, cognitive impairment & behavioural problem
44
Q

what is the modified rankin scale

A

0- no symptoms
1- no significant disability despite symptoms
2- slight disability, but able to independantly live
3- moderate disability but able to walk unaided
4- moderately severe disability, unable to walk/ attend bodily functions without help
5- severe disability requiring constant nursing care and attention
6- dead

45
Q

describe stroke outcomes

A
  • Mortality: 2ndcommonest cause of death wordwide. 20-30% in the first month; ischaemic stroke mortality up to 40%, haemorrhagic stroke mortality up to 70%
  • Disability in survivors: 1/3 near independent, 1/3 severely disabled and 1/3 independent with support. Commonestcause of adult disability
  • High risk developing stroke after TIA: up to 20% within first month with highest risk within first 72 hrs

MD4001 Pathology (23 decks)

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