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Flashcards in Stroke Deck (32)
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1

Stroke definition?

Acute onset of focal neurological symptoms and signs due to disruption of blood supply

2

Stroke effects?

People don't often die from initial stroke but can come out of it severely disabled

3

How many types of stroke? and what are they called?

Ischaemic
Haemorrhagic

4

Reason for haemorrhagic stroke?

Raised BP
Weakened blood vessel wall due to structural abnormalities
-aneurism
-Atriovenous malformation
Inflammation of vessel walls (vasculitis)

5

Reason for ischaemic stroke?

Thrombotic- clot blocking artery at site of occlusion

Embolic- Clot blocking artery has traveled to artery, it occludes from somewhere more proximal in arteries or heart

Hypoperfusion- Due to reduced blood flow due to stenosed artery rather than occlusion of artery

6

Non-modifiable risk factors for stroke?

Age
Family History
Gender
Race- south Asians
Previous stroke

7

Potentially modifiable risk factors for stroke?

Hypertension
Smoking
Hyperlipidaemia
Smoking
Prior history of TIA
Atrial fibrillation
Diabetes
Congestive heart Failure
Alcohol excess
Obesity
Physical Inactivity
Poor socioeconomic status

8

Smoking________ risk of ischaemic stroke

Doubles

9

What type of stroke are statins recommended for?

Ischaemic

10

Rarer causes of stroke?

Homocysteinemia
Vasculitis,
Antiphospholipid antibody syndrome
Protein S, C, Antithrombin III deficiency
Paradoxical embolism(venous clot to arterial side) through patent foramen ovale
Pulmonary AV shunts(these are openings large enough between arterial and venous circulations)
Genetic- Factor V Leiden mutation, common prothrombin mutation, MELAS, CADASIL,Fabry’s disease
Cardioembolic- mural thrombi, infective endocarditis, myxoma
Cervical artery dissection

11

Behavioral modification of stroke prevention?

Diet
Exercise
Smoking cessation
Weight control

12

Approach to managing stroke?

Present- fixing the problem? thrombolysis or thrombectomy in ischaemic stroke

Stopping further strokes in future - identify and treat cause

Helping patient adjust to disability- rehab

13

Questions to ask when managing a stroke?

Is it a stroke?
What kind?
Cause?
Appropriate secondary prevention?

14

What conditions does a stroke mimic?

Hypoglycaemia
Seizure - part of brain may not function temporarily after
Migraine
Metabolic- hyperglycaemia or Hyponatremia
Brain tumors- space occupying lesions
Functional hemiparesis

15

Only way of differentiating between different types of stroke?

Brain Imaging

16

Types of brain imaging for stroke?

CT brain +- angiography
MRI with DWI +-angiography
MRI with SWI (looks for old bleeds)

17

Arheroebolism?

embolism from a thrombus forming on a atherosclerotic plaque- platelet rich clots

infarcts in same side as
affected carotid artery

18

Cardioembolism?

Embolism from a clot formed in the heart(usually left atrium)
- clotting factor rich clots
infarcts in more than one arterial territory, bilateral

19

Tests to see for atheroembolism?

Carotid scanning
CT/MRI angiography of aortic arch

20

Tests to see for carioembolism?

Echocardiogram
ECG
24 hour 5 day ECG monitor tests
AF

21

Investigating cause of bleeding in haemorrhagic stroke?

Hypertensive- deep in brain usually
If young, not hypertension and superficial haemorrhage- aneurism
Multiple haemorrhages- vasculitis, moya moya disease

22

Reversing disability in ischaemic stroke?

Thrombolysis - up to 4.5 hours from onset of symptoms
Thrombectomy- Up to 6 hours from symptom onset

23

How thrombolysis works?

Clot forms
tPA injected intravenously
Blood clot dissolves
Restored blood flow

24

When are thrombectomies indicated?

Large arterial proximal occlusions

25

Process of thrombectomy?

Blood clots restricts blood to affected area of brain

Stent retriever is navigated to side of blocked blood vessel. Retriever is advanced through clot and expands and integrates into it

Retriever and clot are retracted into catheter and removed

26

Surgical management of stroke?

-Haematoma evacuation
-Relief of raised intracranial presure : obstructive hydrocephalus, large total MCA infarctions
-Carotid endarterectomy

27

Explain TIAs?

Patients who present like a stroke but within a few minutes are better
Temporary neurological symptoms due to occlusion of artery stopping blood flow - because arteries are capable of dissolving clots
Risk of TIA after stroke

28

TIA definition?

focal neurological symptoms that resolve within 24 hrs

29

Investigations used to find causes of thrombosis or embolism in ischaemic stroke?

Blood tests- glucose, lipids, thrombophillia
Assess for hypertension

30

What does medical management to prevent next stroke depend on?

What caused it