Stroke Flashcards by Susannah Bath

what are some possible causes of haemorrhagic stroke

hypertension 
tumour
bleeding disorder
vascular malformation 
amyloid angiopathy

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what is a TIA

symptoms last less than 24 hours

interruption to the blood supply causing loss of neurological function

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what are some possible mechanisms for ischaemic strokes

cardioembolism
large vessel atherothrombosis
small vessel disease
hypoperfusion

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what is a watershed stroke

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

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what is the blood supply of the anterior brain

middle cerebral artery
anterior cerebral artery
striate arteries

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what does diplopia mean

double vision

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what does ataxia mean

loss of full control of body movements

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

hemianopia

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

airway, breathing, circulation

clarify the history
check medical history
check the signs

exclude stroke mimics

level one investigations

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what is the OCSP Classification of strokes

total anterior circulation syndrome
2 partial anterior circulation syndrome
3 lacunar syndrome
4 posterior circulation syndrome

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what can you examine

•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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what are the features of LACS (lacunar syndrome)

pure motor or pur sensory, sensorimotor, ataxic hemiparesis

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what are the features of POCS (posterior circulation syndrome)

brainstem, cerebellar and/ or homonymous hemianopia

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what are the features of TACS

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

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

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

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what is agraphaesthesia

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

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what is alexia

loss of ability to read

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what is the ABCD2 stroke risk calculator

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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what mnemonic is used to remember stroke mimics

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

what is somatisation

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

what are red flags

no history 
no risk factors
no imaging abnormality 
young age
seizures
unusual headache

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

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

what 3 factors should you attempt to discover on clinical assessment

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

how can you breifly assess risk of reccurent stroke

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

what investigations can you do after a stroke

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

what are the indications for urgent head imaging

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

what is papilloedema

optic disc swelling caused by raised intracranial pressure

what does SDH stand for

subdural haematoma

what might you find on a head CT

``` bleed tumour SOL subdural haematoma early ischaemia ```

what is diffusion weighted imaging

mixture of T2 weighted and diffusion weighting

what is apparent diffusion coeficient

pure diffusion of water on MRI

describe how DWI/ADC changes after a stroke

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

when are antihypertensives indicated after ischaemic stroke

when MABP is above 130 mmhg

What blood pressure should you aim for following haemorrhagic stroke

less than 140 mmHg

what drug should you give for persistantly elevated BP

IV labetolol avoid abrupt falls in BP

how do you treat raised intercranial pressure

mechanical hyperventilation mannitol decompressive hemicraniectomy

what are the advantages of MRI over CT

sensitive diagnostic aids management prognostic

how do you treat acute strokes

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

how is a SAH managed

``` •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 ```

what antithrombotics can be used in secondary prevention

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

how do you manage blood pressure as part of secondary prevention

Target BP

how do you manage cholesterol post stroke

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)

describe longer term management for stroke pts

* 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

what is the modified rankin scale

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

describe stroke outcomes

* 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