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Neurology > Stroke Week > Flashcards

Stroke Week Flashcards

1
Q

what percentage of TIAs will show damage on MRI

A

50%

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2
Q

how long does a true TIA last

A

less than an hour

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3
Q

which subtype of stroke is most common

A

ischaemic

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4
Q

what happens in ischaemic stroke

A

blood clot stops the flow of blood to an area of the brain

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5
Q

what happens in haemorrhagic stroke

A

weakened/diseased blood vessels rupture

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6
Q

stroke risk increases in women:

A
  • pregnancy
  • have preeclampsia
  • birth control
  • use HRT
  • have migraines with aura and smoke
  • have AF
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7
Q

stroke - FAST

A
  • Facial weakness
  • Arm weakness
  • Speech problems
  • Time to call 999
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8
Q

what is dysphasia

A

impairment of language processing

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9
Q

anterior cerebral artery/middle cerebral artery features

A
  • hemiparesis
  • hemisensory loss
  • hemianopia (affects optic tract)
  • dysphasia (left MCA)
  • sensory/visual inattention/neglect (right MCA)
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10
Q

Lacunar syndromes (perforating arteries) features

A
  • pure motor stroke
  • pure sensory stroke
  • sensorimotor stroke (less likely than a pure one)
  • clumsy hand dysarthria (slight weakness and clumsiness of the hand with slurred speech)
  • ataxic hemiparesis (ataxia and usually mild hemiparesis affecting the same side)
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11
Q

what does ataxia mean

A

without coordination

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12
Q

what does the posterior circulation supply?

A
  • brainstem, cerebellum
  • occipital lobes
  • medial temporal lobes
  • posterior part of the deep hemisphere, mainly the thalamus
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13
Q

posterior circulation stroke features

A

hemianopia (occipital cortex)

brainstem and cerebellar:
- hemiparesis/hemisensory loss
- ataxia
- dysarthria
- due to cranial nerve nuclei involvement - vertigo, diplopia, facial nerve palsy, tongue palsy, dysphagia

bilateral symptoms - basilar artery syndrome

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14
Q

how are strokes classified in Oxford Stroke Classification?

A

TACS, PACS, LACS, POCS

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15
Q

What does TACS stand for?

A

Total Anterior Circulation Syndrome

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16
Q

in the oxford stroke classification, what is the most severe type of stroke?

A

TACS

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17
Q

what is the number one cause of stroke

A

high BP

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18
Q

what does PACS stand for

A

Partial Anterior Circulation Syndrome

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19
Q

what percentage of PACS patients are alive and independent at 1 year?

A

55%

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20
Q

what happens in Lacunar Syndrome (LACS)?

A

small infarcts in the deeper parts of the brain and in the brainstem

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21
Q

what causes Lacunar syndrome

A

occlusion of a single deep penetrating artery

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22
Q

lacunar syndrome prognosis

A

best of all the strokes, 60% of patients alive and independent at 1 year

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23
Q

what does POCS stand for

A

Posterior Circulation Syndrome

24
Q

give examples of stroke mimics

A
  • subdural/ extradural haematoma
  • seizure/ postictal signs
  • migraine
  • space occupying lesion
  • metabolic disturbance (glucose!)
  • peripheral vestibular issue
  • functional neurological disorder
25
Q

does a history of cognitive impairment point you more towards a stroke diagnosis or away from it?

A

away

26
Q

main causes of ischaemic stroke

A
  • large artery disease
  • cardioembolic
  • lacunar
27
Q

main causes of haemorrhagic stroke

A
  • hypertensive
  • cerebral amyloid angiopathy
28
Q

what is the ischaemic core?

A

area of brain which has developed necrosis.

cerebral blood flow <20%

29
Q

penumbra meaning

A

area of brain with reduced cerebral flow, but also getting supply of O2 and glucose from collateral arteries.

30
Q

what is the ischaemic cascade

A

a series of biochemical reactions that are initiated in the brain and other aerobic tissues after seconds to minutes of ischaemia

31
Q

ischaemic cascade detail

A

switch from aerobic to anaerobic metabolism

accumulation of lactic acid

Na/K channel dysregulation - cytotoxic oedema

Na/K channel dysregulation - increase Ca within neuron:
1) excitotoxicity
2) degradative enzymes
3) formation of radicals

Mitochondrial apoptotic factors

32
Q

when does vasogenic oedema start

A

4-6 hours after ischaemia

33
Q

post stroke inflammation

A
  1. ischaemia
  2. damage-associated molecular patterns
  3. inflammation: macrophages/immune response
  4. anti-inflammatory
  5. liquifactive necrosis
34
Q

TOAST 5 types of ischaemic stroke

A
  • large artery atherosclerosis
  • cardioembolism
  • small vessel disease
  • stroke of other determined aetiology
  • stroke of undetermined aetiology
35
Q

which TOAST is most common (type of ischaemic stroke)

A

large artery atherosclerosis

36
Q

what is small artery disease stroke caused by

A

lipohyalinosis (thickened vessel wall with luminal narrowing)

37
Q

NIHSS score and severity

A

1-4 mild
5-15 moderate
16-20 moderate to severe
21-42 severe

38
Q

what is the time frame for getting thrombolysis in stroke

A

within 4.5hrs after onset of symptoms

39
Q

what is thrombolysis in stroke

A

lysis (break up) of clot by tissue plasminogen activator (usually TNK (tenecteplase))

40
Q

what is the goal of thrombolysis

A

aim to restore flow and save penumbra

41
Q

name some contraindications of thrombolysis

A
  • previous intracerebral haemorrhage or infarct
  • dose of DOAC in the last 24-48hrs
  • pregnancy
  • recent head injury/stroke/surgery
  • severe comorbidities
  • seizure
  • platelets below 100, severe anaemia
  • severe hypertension (can be treated first)
42
Q

is old age a contraindication for thrombolysis in stroke

A

no

43
Q

complications of thrombolysis

A
  • haemorrhage
  • anaphylaxis (very rare)
  • angioedema
44
Q

what puts patients at higher risk of angioedema as a complication of thrombolysis

A

being on ACEi

45
Q

if it’s appropriate (e.g. ischaemic stroke) and there are no contraindications, when should thrombectomy be offered in stroke

A

asap, and within 6hrs of symptom onset

46
Q

primary intracerebral haemorrhage - lobar vs deep

A

lobar - may be more related to cerebral amyloid angiopathy
deep - may be more related to effects of blood pressure

47
Q

hyperacute stroke management steps

A
  • urgent imaging
  • thrombolysis/thrombectomy
  • BP lowering
  • Stroke unit care
  • swallow assessment, nutrition and hydration
  • secondary prevention medication
48
Q

ASPECTS score - what would a normal brain score?

A

10
(would lose a point for each area damaged)

49
Q

what % of ischaemic strokes are large vessel occlusion?

A

10%

50
Q

anterior cerebral artery stroke associated effects

A

Contralateral hemiparesis and sensory loss,
lower extremity > upper

51
Q

middle cerebral artery stroke associated effects

A

Contralateral hemiparesis and sensory loss,
upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

52
Q

posterior cerebral artery stroke associated effects

A

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

53
Q

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain) stroke associated effects

A

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

54
Q

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome) stroke associated effects

A

Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

55
Q

Anterior inferior cerebellar artery (lateral pontine syndrome) stroke associated effects

A

Symptoms are similar to Wallenberg’s(Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus), but:
Ipsilateral: facial paralysis and deafness

56
Q

Retinal/ophthalmic artery stroke associated effects

A

Amaurosis fugax

57
Q

Basilar artery stroke associated effects

A

‘Locked-in’ syndrome

Neurology (12 decks)

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