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Flashcards in Stroke Deck (27)
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1

Stroke definition

Acute, focal, neurological deficit of cerebrovascular origin that persists >24h

2

Transient ischaemic attack definition

Acute, focal neurological deficit of cerebrovascular origin that persists <1h
MRI: no signs of cerebral infarction
High risk of stroke within 4w of a TIA

3

Amaurosis fugax definition

Sudden transient loss of vision in one eye
Often occurs with TIAs
Can be 1st clinical sign of inferior cerebral artery stenosis
Can occur due to ocular disease, migraine

4

Irreversible risk factors for ischaemic stroke

Age
Personal/family history
Hyper-coagulable states
AF

5

Reversible risk factors for ischaemic stroke

Hypertension
Hypercholesterolaemia
DM
Smoking
Alcohol
Poor diet
Low exercise
Increased weight
Endocarditis
Migraine
Polycythaemia
APL syndrome
Vasculitis
Amyloidosis

6

Risk factors for haemorrhagic stroke

Family history
Uncontrolled hypertension
Vascular abnormalities: aneurysms, atriovenous malformation, hereditary haemorrhagic telangiectasia
Coagulopathies/anticoagulant therapy
Recent heavy alcohol intake

7

Types of cerebral ischaemia

Regional infarction: thrombosis/embolus in large vessels, usually cortical areas

Lacunar infarction: microinfarcts caused by arteriosclerosis, ususally sub-cortical, can be asymptomatic --> pseudoparkinsonism/vascular dementia

Global ischaemia: infarcts at arterial boundary zones due to severe hypotension (watershed infarct)
Severe: cortical laminar necrosis in 24h = vegetative state

8

Zones of cerebral ischaemic damage

Infarct core: tissue almost certain to die
Oligaemic periphery: tissue that will survive due to collateral supply
Ischaemic pneumbra: tissue in between

9

Clinical features of ischaemic stroke

Contralateral limb weakness/hemiplegia: first flaccid, then hyperreflexia, weakness recovers gradually over weeks/months
Facial weakness
Higher dysfunction
Visual disturbances
Epileptic fit (rare)

10

Higher dysfunction in ischaemic stroke

Expressive aphasia: Broca's
Receptive aphasia: Wernicke's
Apraxia: difficulty performing tasks despite intact motor function
Asterognosis: inability to recognise objects, persons, sounds, shapes or smells despite senses/memory being intact
Inattention: inability to attend to stimuli despite intact senses

11

Subarachnoid haemorrhage clinical presentation

'Thunderclap headache': comes on in seconds, high intensity, often occipital, during transient hypertension
Vomiting: post-headache
Photophobia
Increasing drowsiness/coma
Focal signs: may help locate lesion, may reflect raised ICP / cerebral vasospasm
Neck stiffness
Kernig's sign +ve
Papilloedema: + retinal haemorrhages
Prior 'sentinel headache': small warning leak from offending aneurysm

12

Subarachnoid haemorrhage predisposing abnormalities

Berry aneurysm (70%)
Arteriovenous malformations (AVM - 10%)
No lesion found (20%)

13

Berry aneurysm locations

Developmental (not congenital)
In circle of Willis and adjacent arteries...
Anterior communicating artery (most common)
Posterior communicating artery: at bifurcation from inferior cerebral artery
Middle cerebral artery: at bi/trifurcation

14

Berry aneurysm risk factors

Polycystic kidney disease
Family history
Smoking
Hypertension
Ehlers-Danlos/Marfans

15

Arteriovenous malformation pathology

Congenital collection of abnormal arteries/veins
10% rebleed annually
Can cause focal epilepsy

16

Subarachnoid haemorrhage complications

Death: 30%
Re-bleed: vasospasm clot from aneurysm holds for 3-4 days, AVMs rebleed within a few years
Hydrocephalus: fibrosis in the CSF pathway
Cerebral vasospasm: severe - delayed ischaemic damage

17

Acute subdural haematoma cause & presentation

Severe acceleration-deceleration head injury with co-existing brain damage
Young
Dilated pupil
No lucid interval before decreased GCS

18

Subacute/spontaneous subdural haematoma risk factors

Spontaneous/minor trauma

Elderly: cortical atrophy stretches brittle veins
Alcohol abuse: clotting is reduced
Coagulopathies

19

Subacute/spontaneous subdural haematoma presentation

Symptoms/signs of raised ICP develop around 3w after start of bleed, often fluctuant
Headache
Drowsiness
Confusion
Focal neurological signs
Eventually: stupor & coma

20

CT presentation of acute subdural haematoma

Classical crescenteric shape with increased density (white)
Conforms to contour of the skull
May be accompanying midline shift & compression of ventricles

21

CT presentation of chronic subdural haematoma

Blood becomes more radiolucent (dark)
Assumes lentiform shape similar to an extradural haematoma

22

What is seen on LB of a subarachnoid haemorrhage?

Blood or yellowish blood (xanth)

23

What is the criteria for a total anterior circulartions stroke (TACS)?

All 3 of:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

24

What is the criteria for a partial anterior circulation stroke (PACS)?

2 of the following:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

25

What is the criteria for lacunar syndrome (LACS)?

1 of the following:

Pure sensory stroke
Pure motor stroke
Senori-motor stroke
Ataxic hemiparesis

26

What is the criteria for a posterior circulation syndroem (POCS)?

1 of the following:

Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia

27

How is an acute, subacute and chronic subdural haemorrage classified?

Acute 2-3 days
Subacute 3-14 days
Chronic 15