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Cardiovascular System > Stroke > Flashcards

Stroke Flashcards

1
Q

What is it a stroke?

A

A neurological deficit ( loss of function) of sudden onset and lasting more than 24 hours. It is of vascular origin.

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2
Q

Describe the circulation in the head

A

Carotid aa. supplies anterior circulation

Vertebro-basilar supplies posterior circulation

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3
Q

How can haemorrhage cause a stroke?

A

Blood builds up in the white matter and compresses brain tissue

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4
Q

If a stroke is small but affects deep white fibres what will the result be?

A

Can cause major deficit as the fibres are packed close together

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5
Q

What are the causes of a stroke?

A 
Occlusion due to thrombus or clot 
Disease of vessel wall 
Disturbance of normal blood due to infection (increases WBC)
Rupture of vessel wall - haemorrhage 
Carotid stenosis 
Cardioembolic
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6
Q

What can a carotid stenosis cause a stoke?

A

Bifircation of a vessel is a common place for atheroma to develop due to turbulent blood flow

If it partially occludes vessel, perfusion can still occur and leads to formation of a thrombus which can detach and occlude another vessel (embolism)

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7
Q

How does a cardioembolic stroke occur?

A

AF dislodges clots in LA and the thrombus travels to brain and occludes vessel

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8
Q

What are the symptoms of a stroke?

A 
Loss of:
Power
Sensation 
Speech (dysphasia)
Vision 
Coordination
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9
Q

What are the two types of strokes?

A

haemorrhagic or ischaemic

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10
Q

What investigations should be carried out for stroke?

A 
Blood: FBC, lipids
ECG
CT - identify haemorrhage (shows blood)
MRI - shows area of infarct  
Carotid doppler 
Echo
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11
Q

What are the treatment options?

A

Thrombolysis
Hemicraniotomy
Carotid endarectomy for carotid stenosis

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12
Q

What is the use of hemicraniotomy

A

For <60yrs who suffer an acute MCA territory ischaemic stroke complicated by massive cerebral oedema

Surgical decompression by hemi offered within 48hr

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13
Q

How does a stroke occur?

A

Damage to part of the brain due to blockage of vessels by thrombus or embolus, or haemorrhage due rupture of vessels

Tissue then does not receive adequate O2 nutrition -> necrosis

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14
Q

What is a transient ischaemic attack?

A

A neurological deficit of sudden onset and vascular origin that last less than 24hours

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15
Q

What is aphasia/dysphasia?

A

Language disorder marked by deficiency in the generation of speech

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16
Q

What can be found in the history of a stroke?

A 
Time of onset 
Witnesses
Headache
Vomiting
Neck stiffness
Photophobia (suggest haemorrhage)
Loss of consciousness 
Fit 
Incontinence
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17
Q

What are the findings on clinical examination?

A 
Motor (clumsy or weak limbs)
Sensory (loss of feeling)
Speech (dysarthria/dysphasia)
Neglect/visuospatial problems
Vision: loss in one eye, or hemianopia
Gaze palsy

Ataxia
Vertigo
Incoordination
Nystagmus

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18
Q

What is Nystagmus?

A

A condition in which the eyes make repetitive and uncontrolled movements - sign of stroke

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19
Q

Dysarthia vs aphasia

A

Dysarthia - weakened muchness around mouth

Dysphasia - problem finding words.

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20
Q

What are three circulations in the brain?

A

Anterior circulation
Posterior circulation
Circle of Willis

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21
Q

What is the frontal lobe responsible for?

A

Judgement, foresight and voluntary movement

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22
Q

What is the parietal lobe responsible for?

A

Comprehension of language

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23
Q

What is the occipital lobe responsible for?

A

Vision

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24
Q

What is the function of the brain stem?

A

Swallowing, breathing, heartbeat

25
What does the carotid artery supply?
Most of the hemispheres and critical deep white matter
26
What does the vertebra basilar system supply?
the brain stem, cerebellum and occipital lobes
27
What is the function of the cerebellum?
Coordination
28
What is the function of the motor cortex?
Movement
29
What is the function of the Broca's area?
Speech
30
What is the function of the temporal lobe?
Intellectual and emotional functions
31
What is a lacunar stroke?
An ischemic stroke when the small arteries deep within the brain becomes blocked
32
How can a carotid dissection cause a stroke?
Separation of the layers on the vessel wall, allowing blood to enter and compress truth artery channels resulting in a total artery occlusion and form a thrombus
33
What can you tell from the symptoms about the stroke?
``` Which side of brain is affected If in the brainstem If cortex is involved If lesion is in the deep white matter What blood vessel in involved ```
34
Where has the occlusion occurred in a cortical stroke?
Cortex
35
Why is it important to localise the stroke?
Confirms stroke diagnosis All better selection of imaging Gives an indication of cause Gives indication of prognosis
36
How can vision suggests the location of lesion?
Type of visual eye defect gives indication
37
What are the 4 subtypes of strokes?
Total anterior circulation stroke Partial anterior circulation stroke Lacunar stroke Posterior circulation stroke
38
What are the three visual field defects?
``` Unilateral field loss Bitemporal hemianopia (tunnel vision) Homonymous haemianopia (can't see on one side) ```
39
Describe effect of a total anterior circulation stroke
Weakness, sensory deficit Homonymous hemianopia Higher cerebral dysfunction (dysphasia, dyspraxia) Usually due to occlusion of proximal middle cerebral artery or internal carotid artery
40
Describe the effect of a partial anterior circulation stroke
2/3 of TACS criteria or restricted motor/sensory deficit | Occlusion of branches of middle cerebral artery
41
What are the different types of lacunar strokes?
Pure motor Pure sensory Sensorimotor Ataxic hemiparesis - in basal ganglia or pons Often silent - undiagnosed
42
What is the presentation of a posterior circulation stroke?
``` Affect brainstem, cerebellar or occipital lobes, may include: Bilateral sensory/motor deficit Homonymous hemianopia Cranial nerve palsy Coma Disordered breathing Tinnitus Vertigo Horner's ```
43
What is important to remember about the symptoms of a stroke?
Symptoms come on rapidly | Symptoms depend on which part of the brain is affected
44
What are modifiable risk factors of stroke?
Atrial fibrillation | High blood pressure
45
What are non-modifiable risk factors for stroke?
Age Race FH
46
CT vs MRI
CT: quick and shows blood MRI: 30 mins and shows ischaemia better
47
What is the purpose of carrying out a carotid doppler?
Looks at vessels
48
Why can an echo be useful?
Looking for clots in the heart
49
Why can an ECG be useful?
Detecting irregularities in heart rhythm — such as atrial fibrillation — that can lead to the forming of blood clots that can later get flow to the brain
50
What is the importance of stroke units?
``` Better prognosis of patient: Mobilise ASAP Concentrate of simple tasks i.e. swallowing Early therapy Expertise ```
51
What is the aim of thrombolysis?
To restore perfusion before cell death occurs
52
What are the risks of haemorrhage occurring after thrombolysis?
``` Depends on: Infarct size Vessel occlusion Diabetes BP Age Stroke severity Tissue changes If already on anti platelets ```
53
What is an invasive method to enable reperfusion?
Clot retrieval
54
What are the contradictions to thrombolysis?
Age - licenced for <80yrs
55
What is a hemicraniectomy?
The surgical removal of half of the cranium to enable brain surgery
56
What fraction of people who have a TIA will go on to have an acute stroke?
1/3
57
How can people who have TIAs reduce risk of recurrent stroke?
Early treatment for prevention
58
What drugs are given for secondary prevention of a stroke?
Aspirin 75mg or Clopidogrel 75mg Statin BP drugs, even if BP in normal range

Cardiovascular System (37 decks)

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