Stroke Tutorials Flashcards
(56 cards)
What % of strokes occur in those >65?
75%
What % of people will die in the first year after a stroke?
1/3rd
What % of people will remain dependent on others after surviving a stroke?
50%
What is the WHO definition of stroke?
Rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting =>24h or leading to death with no apparent cause other than vascular
Define TIA
Brief episode of neurological dysfunction caused by focal brain or retinal ischaemia with clinical symptoms typically lasting less than 1h and without evidence of acute infarction
In which period of time do the majority of TIAs resolve in?
60 minutes
How does the length of a TIA correlate with symptom resolution?
<15% chance of complete resolution of symptoms if TIA lasts >1h
What are the two major categories of stroke? What is their prevalence?
Ischaemic - 85%
Haemorrhagic - 15%
- 70% primary ICH
- 30% secondary haemorrhage, e.g. SAH, AVM
What sort of things may cause a stroke?
Intracranial atherosclerosis Carotid plaque with atherogenic emboli Aortic arch plaque Cardiogenic emboli AF Valve disease Penetrating artery disease (lacunar stroke) Flow reducing carotid stenosis Carotid dissection Left ventricle thrombi
Where do the carotids mostly supply?
Most of the hemispheres and cortical deep white matter
Where does the vertebro-basilar system supply?
Brainstem, cerebellum, occipital lobe
What are the functions of the temporal lobe?
Primary auditory receptive area
Comprehension of speech (dominant) - Wernicke’s area
Visual, auditory and olfactory perception
Important role in learning, memory and emotions
What are the functions of the frontal lobe?
High level cognitive functions, e.g. abstraction, concentration reasoning Memory Control of voluntary eye movement Motor control of speech in dominant hemisphere Motor cortex Urinary continence Emotion and personality Broca's area
What are the functions of the parietal lobe?
Sensory cortex Sensation (touch, pressure, position) Awareness of parts of body Spatial orientation + visuospatial information (non-dominant hemisphere) Ability to perform learned motor tasks
What are the functions of the occipital lobe?
Primary visual cortex
Visual perception
Involuntary eye movement
What is the main function of the cerebellum?
Balance and coordination
What are the functions of the brainstem?
Swallowing, breathing, heartbeat, wakefulness
What is Broca’s area essential for?
Language pronunciation, production and articulation
Why are small strokes in the deep white matter so bad?
All the fibres are packed closely together so small strokes can result in large deficits
What is the brainstem composed of?
Midbrain, pons, medulla
What are some clinical presentations of stroke?
Sudden onset loss of function:
- Motor (clumsy/weak)
- Sensory
- Speech (dysarthria/dysphagia)
- Neglect/visuospatial problems
- Vision (loss in one eye (amaurosis fugax) or hemianopia)
- Gaze palsy
Ataxia, vertigo, incoordination, nystagmus
What are some key things to remember about the symptoms of stroke?
Symptoms come on rapidly
Symptoms depend on area of brain affected
Abnormal movements after stroke are unusual
Positive visual phenomena probably = migraine
Severe headache after stroke unusual
What is the most commonly used clinical classification of strokes?
Oxford community stroke project classification
What causes a TACS?
Total anterior circulation syndrome
Caused by blockage/bleed from main artery to one of the hemispheres
