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Year 4 General Medicine > Stroke > Flashcards

Stroke Flashcards

1
Q

aims of stroke management

A
  1. is the disability reversible with treatment? ie timeframe
  2. rehabilitation - how to help patient back to living their life
  3. how to prevent next stroke?
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2
Q

thrombolysis

A

<4.5hr

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3
Q

thrombolysis timeframe

what is used?

A

<4.5hr

recombinant tPA / alteplase

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4
Q

ischaemic stroke management

A

thrombolysis

thrombectomy

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5
Q

neuro plasticity

A

brain tissue surrounding damaged brain re learns how to perform certain action

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6
Q

stroke is a clinical diagnosis, true or false

A

true

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7
Q

3 hallmarks of stroke

A
  1. acute onset - when did it start?
  2. focal neurological deficit
  3. disrupted blood flow / vascular cause: ischaemia vs haemorrhage
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8
Q

D.Dx of stroke ie stroke mimics

A 
Bells palsy 
Migraine 
Todd's paresis (post-ictal) 
Hypoglycaemia 
acute on chronic: brain tumour, MS, bleeding
Functional - non consistent symptoms
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9
Q

how to differentiate between types of stroke

A

non-contrast CT head

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10
Q

which is more common, ischaemic or haemorrhagic stroke

A

ischaemic

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11
Q

risk of having a second event is extremely high immediately after the first event, true or false

A

true

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12
Q

intracranial haemorrhages are not all stroke, true or false

A

true

can get extra/subdural/subarachnoid haemorrhages which is not the same as a stroke

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13
Q

describe the bleeding in a haemorrhagic stroke

A

intracerebral haemorrhage causing compression

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14
Q

neurosurgery will reverse haemorrhagic stroke, true or false

A

false
not usually involved unless life threatening
it will still not reverse the disability

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15
Q

haemorrhagic stroke is the same as intracerebral haemorrhage

A

yes

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16
Q

causes of haemorrhagic stroke

A 
anticoagulants perpetuate blood loss 
hypertension 
arteriosclerosis 
amyloid angiopathy 
vasculitis - any layer of vessel wall 
AVM 
aneurysms (more likely to be SAH)
extravascular causes:
- bleeding into tumour
- abscess
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17
Q

arteriosclerosis vs atherosclerosis

A

arteriosclerosis - not intimal disease, disease of tunica media muscle layer, calcification leads to hardening of artery like a tendon, can snap and bleed
not necessarily a HTN disease, more ageing
atherosclerosis - intimal disease with plaque deposition and cholesterol

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18
Q

types of intracerebral haemorrhages

A

peripheral /lobar haemorrhage

deep haemorrhage - more likely to be secondary to HTN

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19
Q

which carotid artery is concerned with the brain

A

ICA

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20
Q

where do the vertebral arteries arise from

A

subclavian arteries

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21
Q

where is the circle of willis found

A

CSF / subarachnoid

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22
Q

importance of circle of willis

A

collateral circulation to brain

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23
Q

large vessel occlusion almost always ischaemic

A

embolic
do it again
looks for source of embolus
ECG, scan…

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24
Q

what is affected in lacunar stroke

A

small infarcts from perforating arteries

thrombus

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25
TIA
autothrombolyse
26
large vessel occlusion
cortical involvement
27
small vessel infsarcts
deep
28
how to differentiate between large and small vessel infarct
cortical involvement | large - cortical involvement
29
cortical signs
functions served by cerebral cortex
30
dominance
right vs left | deals with communication
31
examples of cortical dysfunction
dysphasia
32
dysarthria
slurring of speech | not a neurological in origin, it is physical
33
dysphasia
due to brain damage | difficulty in communication
34
loses ability to understand
receptive dysphasia 'fluent' can talk back to you fluently but not the correct content
35
loses ability to express themselves
expressive dysphasia can understand you and follow instructions but grammatically incorrect non fluent
36
agnosia
failure to recognise an object despite having intact motor, sensory and visual sensation
37
apraxia
knowing it is a pen but unable to use it
38
right hemisphere sided cortical infarct
neglect - left side doesnt exist, only right side, sitting up straight feels like pushing changes in personality sensory inattention inattention - failure to pick up
39
subtle signs of RHS
3D spatial disorientation changes in personality
40
TACS
embolic
41
lacs
physically disabled but able to communicate
42
PACS
EMBOLIC
43
LACS
intact cortex
44
POCS
vertebrobasilar system
45
TOAST classification for ischaemic strokes and TIA
1. cardioembolic - AF 2. large vessel atheroembolic - atherosclerosis 3. small vessel - thrombotic disease 4. infarcts due to other determined causes: dissection, hypoperfusion, vasospasm, paradoxical embolism, venous infarct 5. cryptogenic - unknown cause
46
Watershed stroke
border
47
what is a venous infarct
gradual onset, diffuse symptoms with inclear origins essentially a DVT in the veins of the brain more likely to be haemorrhagic need anticoagulation venous sinus clogging
48
paradoxical embolism as a cause of stroke is treated with thrombolysis, true or false
true
49
TIA is a stroke mimic?
NO | TIA is a stroke
50
difference between TIA and stroke
TIA - no disability | stroke - disability
51
what is a TIA
transient neurological symptoms without brain damage
52
TIAs need urgent investigation and management?
yes!
53
commonest cause of AF
HTN
54
Investigations for stroke
``` bloods - FBC, U+E, LFT, lipids, glucose, clotting ECG carotid doppler ambulatory monitoring ECHO ```
55
> ? stenosis of carotid arteries qualify for carotid endarterectomy
>70%
56
when would you do a carotid endarterectomy for a patient with stroke/TIA
within 2 weeks of event | otherwise no benefit
57
drugs for secondary prevention of stroke
``` antiplatelets anticoagulants statins anti hypertensives DM lifestyle MDT ```
58
What type of strokes would you use antiplatelets as secondary prevention for
ischaemic stroke - large vessel atheroembolic - small vessel
59
types of antiplatelets used for stroke prevention
aspirin clopidogrel dipyridamole
60
antiplatelet therapy post stroke
2 weeks of 300mg aspirin | then 75mg clopidogrel lifelong
61
3 causes of stroke you would give anticoagulants to
cardioembolic paradoxical embolic infarct venous infarcts
62
types of anticoagulants
warfarin | DOACs - dabigatran, apixiban, rivaroxiban, edoxiban
63
INR of __ can still be thrombolysed
INR <1.5 can receive thrombolysis
64
a patient on a DOAC automatically are excluded from thrombolysis, true or false
true
65
what test can monitor warfarin
INR
66
which one gives you predictable anticoagulation, warfarin or DOACs
DOACs
67
warfarin/DOACs have variable dosing
warfarin has variable dosing
68
warfarin/DOACs have fewer drug interactions
DOACs have fewer interactions
69
prothrombin complex is used to reverse which anticoagulation?
warfarin
70
delay start of anticoagulation depending on size of infarct, true or false
true if there is no/small infarct, you can start it straight away if it is larger, then there is a greater risk of haemorrhagic conversion
71
which antihypertensives are thought to be effective in HTN for stroke
ACEI/ARBs | thiazide diuretics
72
CT is better/worse at picking up acute stroke whereas MRI is better/worse at picking up acute stroke
CT better for acute stroke | MRI better for old stroke haemorrhage
73
when the brain tissue is ischaemic, you lose the grey white interface, true or false
true
74
when you have large infarcts, it may be normal to have haemorrhagic transformation
yes
75
what is the main thing to rule out on imaging for stroke
haemorrhage
76
dense vessel
thrombus in blood vessel
77
deep infarct with sparing of the cortex
lacunar stroke

Year 4 General Medicine (16 decks)

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