Stroke Flashcards
(90 cards)
1
Q
Definition - Sudden/Gradual disturbance of cerebral function of vascular origin that either causes ____ or symptoms last over ___ hours
A
Sudden
Death
Over 24 hours
2
Q
What 4 things do you need to find out about the stroke
A
Type of stroke
Size of stroke
Laterality of stroke
Cause of stroke
3
Q
Driving rules following stroke
A
Advise patient not to drive for a month after the stroke but no need to tell the DVLA
4
Q
What are the 2 types of stroke
A
Haemorrhage
Ischaemia/infarct
5
Q
Haemorrhagic stroke - definition
A
Bleeding from an artery due to a rupture/leak
6
Q
Haemorrhagic stroke - causes
A
Structural abnormality - tumour
Hypertensive
Amyloid angiopathy
Subarachnoid haemorrhage
7
Q
Whats the most common cause of a non-traumatic subarachnoid haemorrhage
A
PKD (berry aneurysm)
8
Q
Infarct/ischaemia - more/less common than haemorrhage?
A
More common
9
Q
Infarct/ischaemia - definition
A
Interruption of cerebral blood flow due to a thrombus or embolus
10
Q
Infaract/ischaemia is more common in males/females?
A
Males
11
Q
Infarct/ischaemia - thrombotic stroke - most commonly affects which artery?
A
Middle cerebral artery
12
Q
Infarct/ischaemia - embolic stroke - most occlusions occur in the branches of which artery?
A
Middle cerebral artery
13
Q
Red thrombus
A
Cardioembolic clot
14
Q
White thrombus
A
Atheroembolic clot
15
Q
What is the most severe type of stroke?
A
Total Anterior Circulation Syndrome (TACS)
16
Q
A large/small area of brain is affected with a Total Anterior Circulation Syndrome (TACS)
A
Large area of brain affected
17
Q
Total Anterior Circulation Syndrome (TACS) - clinical features
A
Ipsilateral motor (hemiplegia) and/or sensory deficit involving at least 2 of: Face Arm Leg \+ Visual field defect: Homonymous hemianopia \+ Cortical dysfunction - dysphasia - neglect
18
Q
Partial Anterior Circulation Syndrome (PACS) - definition
A
Less severe than TACS as there is a smaller area of brain affected and therefore there are slightly less severe symptoms and signs
19
Q
Partial Anterior Circulation Syndrome (PACS) - clinical features
A
2 or 3 features present in TACS - hemiplegia - visual field defect - cortical dysfunction: dysphasia, dysphagia OR Isolated cortical dysfunction - dysphasia - weakness - pure motor/sensory signs less severe than in lacunar syndromes
20
Q
Lacunar Syndrome (LACS) - definition
A
Small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brainstem
21
Q
Which type of stroke has the best prognosis?
A
Lacunar syndrome
22
Q
Lacunar syndrome (LACS) - causes
A
Hypertension
Occlusion of a single deep penetrating artery
Blockage in the small branch of the arteries
23
Q
Lacunar syndrome (LACS) - clinical features
A
Pure motor hemiparesis OR pure sensory deficit of one side of the body OR an ataxic hemiparesis Affects any 2 of the following - face - arm - leg
NO visual field defect
It is either PURE motor or PURE sensory
24
Q
Posterior circulation syndrome (POCS) affects which 2 arteries
A
Vertebral arteries
Basilar arteries
25
Posterior circulation syndrome (POCS) - clinical features
Ipsilateral CN palsies with contralateral motor and/or sensory deficit
isolated homonymous hemianopia
cortical blindness
Cerebellar deficits without ipsilateral motor/sensory signs
Unilateral/bilateral motor and/or sensory deficits
26
Carotid artery disease - clinical features
Contralateral weakness or sensory loss
| If dominant hemisphere is affected then there may be aphasia or apraxia
27
Middle cerebral artery occlusion - clinical features
Weakness predominantly in contralateral face and arm
28
Anterior cerebral artery occlusion - clinical features
Weakness and sensory loss in contralateral leg
29
In most people, the RIGHT side of the brain is the dominant hemisphere. True or false?
False
| - Left side is most dominant in 95% of people
30
Functions of the dominant hemisphere
Speech and language
Reasoning
Written language
Numeracy skills
31
Functions of the non-dominant hemisphere
Creativity
Music
Artistic awareness
Spacial orientation
32
If someone has a stroke affecting the RIGHT/LEFT side of the brain, they tend to have more disability from it
Left side = more disability
33
If someone has a stroke affecting the left side of the brain, it will affect the left side of the body. True or false?
False
| - affects right side of the body
34
Name 3 possible causes of stroke
Arteriosclerotic
Hypertension
Atrial fibrillation
35
What is the most common cause of stroke
AF
36
TIA - definition
Transient obstruction of blood flow causing a sudden onset of symptoms that typically last for an hour but not more than 24 hours
37
TIA - there is evidence of an acute infarction. True or false?
False
38
Stroke like features but episode lasts less than 24 hours. What is the likely diagnosis?
TIA
39
TIA is treated the same as a stroke. True or false?
True
40
TIA - clinical features
Lasts less than 24 hours
Cortical symptoms: facial or limb weakness, sensory disturbance
Speech abnormalities: dysphasia, dysarthria
Visual disturbance
CN involvement
Memory disturbance
41
What are the benefits of the rapid access neurovascular clinic (TIA) ?
Drastically reduces the incidence of a subsequent TIA or stroke
42
TIA - medical interventions
Statin
| Anti platelet drug (aspirin, clopidogrel)
43
Which scoring system is used to identify whether patients with a TIA are at low or high risk of developing subsequent cerebrovascular injuries?
ABCD2 score
44
Which scoring system weighs up how likely it is to have a stroke?
Rosier score
45
Stroke - clinical features vary between patients. Why is this?
Clinical features depend on the area of brain affected
46
Stroke - clinical features develop rapidly/slowly?
Rapidly
47
Stroke - clinical features
```
Speech disturbance
Vision disturbance
Facial weakness
Contralateral limb weakness or sensory loss
Cerebellar signs
```
48
Stroke - clinical features - speech disturbance
Dysarthria
- unclear articulation of speech that is otherwise linguistically normal
Dysphasia
- receptive (wernickes)
- expressive (brocas)
49
Stroke - clinical features - vision disturbance
Visual field defect
| Visual inattention
50
What is the most common visual field defect in a patient with a stroke?
Contralateral homonymous hemianopia
51
Stroke - clinical features - facial weakness - a stroke can affect the UMN/LMN of which CN ?
UMN of CN VII
52
Since a stroke affects the UMN of CNVII, on the affected side the patient will be unable to smile and raise eyebrows. True or false?
False
- will be unable to smile
- ability to raise eyebrows are preserved
53
what are these features suggestive of:
- sudden onset thunderclap headache
- N+V
- photophobia
- neck stiffness
Subarachnoid haemorrhage
54
Stroke - what differentiates between haemorrhage vs infarct type of stroke?
Imaging
| - Brain CT
55
Stroke - investigations - urgent imaging - what is the first line imaging investigation
Brain CT
56
Stroke - CT scan - haemorrhage
ACUTE blood shows up as white blobs on CT scan
57
Stroke - CT scan - infarct
```
darker changes (hypoattenuation)
- what you are actually seeing is increased water on the CT scan due to oedema from brain tissue injury
```
58
Stroke - CT scan - no bleed detected - what do you treat it as
Infarct
59
Stroke - if there are no abnormalities seen on CT scan then what investigation do you try?
MRI scan
60
If a patient presents around 1 week post stroke instead of acutely, it is better to do a CT scan / MRI scan?
MRI scan
61
What is the first line investigation to determine the aetiology of the stroke?
Carotid US scan
| - look for atherosclerosis
62
If there is an abnormality found on the carotid US scan, which investigation is carried out?
Angiogram
| - to identify location of vascular abnormality
63
A patients swallow may be affected due to their stroke. What is the risk they are at?
Risk of aspiration
64
If swallow screen results are abnormal, who is the patient referred to?
Speech and language therapist
65
Acute management of stroke
Thrombolysis
| Antiplatelets
66
Acute management of stroke - thrombolysis - examples
Anteplase
| tissue plasminogen activator (IV)
67
Acute management of stroke - thrombolysis - what is the time limit
Must be given less than 4.5 hours from onset of symptoms
68
It is safe to thrombolyse someone who has had a bleed.. True or false?
False
69
Acute management of stroke - anti platelets
300mg aspirin given after stroke (infarct)
70
Acute management of stroke - anti platelets are given in both infarct and haemorrhages?
False
| - just infarcts
71
Acute management of stroke - anti platelets - CT must be done first to exclude a haemorrhage. True or false?
True
72
Acute management of stroke - anti platelet - best route of administration?
Orally
73
Acute management of stroke - thrombolysis - post thromolysis, patients should be given anti platelets immediately. True or false?
False
| - given anti platelets after 24 hours
74
Why is there a risk of getting a DVT and subsequently PE from a stroke ?
Due to immobility
75
Heparin is useful post stroke for DVT prevention. True or false?
False
| - there is a risk of haemorrhage with heparin
76
Secondary prevention management of stroke - medications
BP management
Cholesterol management
Diabetes control
Anti-thrombotic therapy
77
Secondary prevention management of stroke - medications - anti-thrombotic therapy
Anti-coagulants
- give if cardioembolic/ if patient has AF
- re-introduced after 2 weeks following a major stroke
Antiplatelets
- if not cardioembolic
- use clopidogrel
78
Statin cannot be used in cardioembolic / non-cardioembolic disease?
cardioembolic
79
What is the commonest cause of ischaemic stroke?
AF
80
Which scoring system is used for patients with AF to determine their risk of having a stroke?
CHADSVASc score
81
Score of 0 - is any intervention required?
NO
82
Score above 0 - is any intervention required?
Oral anti-coagulants
83
A man presents with a weak, numb left arm and leg. It is decided that this is due to an occlusion. Which vessel is likely occluded?
Right anterior cerebral artery
- The anterior cerebral artery supplies the frontal and medial part of the cerebrum. Occlusion causes a weak/numb contralateral left with arm symptoms. The face is spared
84
A women presents following a stroke with a movement loss on her left side, there is also sensory loss. It affects her left arm and face. On examination she appears to have lost vision in both eyes on the left upper and lower quadrants. What is the likely occluded vessel?
Right middle cerebral artery
- The middle cerebral artery supplies the lateral hemisphere. This causes contralateral hemiparesis, hemisensory loss, contralateral homonymous hemianopia due to the involvement of the optic radiations If the dominant hemisphere is affect it can cause dysphasia If the less domains hemisphere is affect it can cause visuospatial disturbance
85
Occlusion of which artery would present with contralateral homonymous hemianopia with macula sparing?
Posterior cerebral artery
86
A women presents with a history of persistent headaches, seizures, weakness of all movements of her left foot. The tone is reduced however has an increase in her reflexes. It is thought this is a lesion, where is the likely lesion?
Right cortex
- The cerebral cortex is the outer layer of neural tissues. Cortical lesions can cause weakness in hands of feet that may present with normal or reduced tone. It however does have increased reflex (upper motor neurone sign).
Cortical lesions affect the contralateral side
87
Contralateral hemiparesis is caused by a lesion where?
Internal capsule lesions cause contralateral hemiparesis
88
A man presents with a left hemiplegia with his right eye depressed and pointing outwards. Where is the likely location of this lesion?
Right brainstem lesion.
- CN palsy (III - XII) implies the brain stem is affected on the side of the palsy
89
```
Which of the following drugs is given to the majority of patients ASAP after an ishcaemic stroke and continued for 2 weeks?
Aspirin
Clopidogrel
Atorvastatin
Warfarin
LMWH
```
Aspirin 300mg
90
How long (hours) after stroke onset can thrombolysis be administered?
Within 4.5 hours of stroke onset
