Tues Flashcards
large vessel atherosclerosiss stroke
carotid artery stenosis
atherosclerosis then goes to smaller cerebral artery
causes of ischeamic stroke
large vessel atherosclerosis
cardio embolic
15% of strokes are haemorrhagic.
rare- vasculitis
cardio embolic stroke
atrial fibrillation there is stasis of blood flow in the left atrium
so thrombus in LA then goes to brain
Haemorrhagic stroke
rupture of a cerebrospinal artery.
total anterior circulation infarct (TACI)
A TACI involves the anterior AND middle cerebral arteries on the affected side
total anterior circulation infarct symptoms
Contralateral hemiplegia/hemiparesis, AND
Contralateral homonymous hemianopia, AND
Higher cerebral dysfunction (e.g. aphasia, neglect)
partial anterior circulation infarct (PACI)
anterior OR middle cerebral artery on the affected side.
partial anterior circulation infarct symptoms
Contralateral hemiplegia or hemiparesis, AND
Contralateral homonymous hemianopia
OR
higher cerebral dysfunction ONLY
lacunar infarct (LACI)
small deep perforating arteries, supplying internal capsule or thalamus.
lacunar infarct symptoms
pure motor stroke, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis or dysarthria-clumsy hand syndrome.
posterior circulation infarct (POCI)
vertebrobasilar arteries and associated branches (supplying the cerebellum, brainstem, and occipital lobe).
posterior circulation infarct symptoms
Cerebellar dysfunction, OR
Conjugate eye movement disorder-can’t move eyes together
OR
Bilateral motor/sensory deficit, OR
Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit, OR
Cortical blindness/isolated hemianopia.
posterior stroke syndromes
basilar artery occlusion
Anterior inferior cerebellar artery
Wallenberg’s syndrome
Weber’s syndrome/medial midbrain syndrome
Anterior inferior cerebellar artery
lateral pontine syndrome
pontine cranial nerve nuclei.
Basilar artery occlusion
locked in syndrome (quadriparesis/both arms and legs with preserved consciousness and ocular movements), loss of consciousness, or sudden death.
Wallenberg’s syndrome
lateral medullary syndrome) causes ipsilateral Horner’s syndrome,
ipsilateral loss of pain and temperature sensation on the face,
and contralateral loss of pain and temperature sensation over the contralateral body.
Weber’s syndrome/medial midbrain syndrome
paramedian branches of the upper basilar and proximal posterior cerebral arteries): causes an ipsilateral oculomotor nerve palsy and contralateral hemiparesis.
acute stroke management
Alteplase (tissue plasminogen activator) within 4.5 hours of symptom onset and with no contraindications to thrombolysis
Mechanical Thrombectomy can be performed in patients with anterior circulation strokes and some post
contraindications to thrombolysis
recent head trauma, GI or intracranial haemorrhage, recent surgery, acceptable BP, platelet count, and INR >1.7
ipsilateral carotid artery stenosis more than 50%
carotid endarterectomy.
chronic stroke management
lower hypertension 2 weeks post
Clopidogrel 75 mg
high dose atorvastatin 20-80
ischaemic stroke secondary to atrial fibrillation chronic stroke management
warfarin (target INR 2-3. or a direct oral anticoagulant (such as Rivaroxaban or Apixiban) 2 weeks post-stroke.
Haemophillia A which clotting factor
8
right sided inferior homonymous quadrantanopia - in stroke affects what
left parietal lobe
