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Neuro 3 > Understanding Stroke > Flashcards

Understanding Stroke Flashcards

1
Q

Stroke definition

A

Sudden loss of blood flow to the brain tissue causing ischaemia and infarction

“sudden onset of focal or global neurological symptoms caused by ischemia or haemorrhage and lasting more than 24h”

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2
Q

TIA definition

A

Temporary onset of focal or global symptoms that resolve within 24h

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3
Q

What are the msot common types of ischaemic stroke?

A

1.Large artery atherosclerosis (Carotic)
2. Cardioembolic (af)
3. small artery occlusion (lacunae)

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4
Q

What are the types of hemorrhagic stroke?

A

Primary or secondary (eg subarachnoid/ateriovenous malformation)

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5
Q

Proportions of haemorrhagic ovs ischaemic stroke

A

haemorrhagic = 15%
Ischaemic = 85%

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6
Q

What coilour is blood in ct

A

white like bone

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7
Q

Lacune stroke often due to what condition

A

hypertension

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8
Q

What are risk factors fro strokes

A

taking eostrogen pills
smoking
being a couch potato (high bmi)
High lipid diet
cocaine
high blood pressure
diabetes
af

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9
Q

Where are particularly at risk of developing stokes in the brain and why?

A

around the basal ganglia, brainstem and subcortical areas (just inside the white matteron outside of brain)

Because they are all small vessles straight off from the big vessles witha highpressure in them and so they are more likely to rupture

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10
Q

Hypertenstion , cigarette smoke and diabetes all contribute to what being deposited in the arterial walls?

A

LDL-C

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11
Q

WHat can we give someone with AF to reduce the affect of ischaemic stroke?

A

Can give them DOACs ge edoxaban/apixaban(best), warfrin (not as good)

note: aspirin has no effect on reducing the risk of a stroke

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12
Q

How many cerebellar arteries and what do they come off from?

A

3 - all off from the basilar artery:

-superior
-anterior inferior
-posterior inferior

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13
Q

Frontal lobe functions

A

personality

executive functions (concentration, reasoning and abstraction)

motor cortex (in.c speech)

Urinary continance

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14
Q

Parietal lobe functions

A

sensory cortex, 2 point discrimination (sensation)

spatial orientation and visospatial information (nonn dominant hemisphere)

Ability to performed learned motor tasks (dominant)

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15
Q

Temporal lobe functions

A

Hearing, comprehension of speech, perception of visual, auditory and olfactory

learning, memory and emotional

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16
Q

Middle cerebral artery stroke vs anterior cerebral aretery stroke effects (due to the homonculus)

A

middle = extermnal lateral sides of brain, so the face, hands, arm

Amterior = internal medial sides of brain, so the legs, toes, genitals

17
Q

What are the effects of a brianstem stroke?

A

same side cranial nerve dysfunction and contralateral hemiparesis

18
Q

Occipital lobe functions

A

Vision, and visual perception

19
Q

What can lead to the chiasm being cut off?

A

tumours presing on, can be from below (pituiotary) or above (can other tumour)

20
Q

What is homonomous hemianopia?

A

When you can only see one visual field (issue beyond the optic chiasm)

21
Q

WHat can causse Hemianopia due to astroke?

A

A massive MCA stroke or pca stroke. If MCA will have other symptoms for sure too like motor issues

22
Q

migrain evs stroke

A

migraines have plus symptoms whereas stroke are minus symptoms, so loss of functions for stroke but add of visual stimuli or simelar is suggestive of migraine

23
Q

What are the 4 classifications of stroke?

A

TACS - Total anterior Circulation Stroke
PACS - PArtial anterior circulation stroke
POCS - Posterior circulation stroke
LACS - Lacunar Stroke

24
Q

What do you need to test ot distinguish between lacs, pacs, pocs and and tacs?

A

Anterior strokes distinguished by: Hemianopia , dysphasia (LHS) , neglect (RHS).

TACS = 2 (inc. hemianopia)
PACS = 1

Brainstem = brainstem/cerebellar signs

25
Q

What are the symtpms of neglet(agnosias) (adn the subtypes)

A

just being unaware,

eg. of one whole side,

can be visual, sensory, anosagnosia (denial of hemiplagia) or prosopagnosia (inability to recognise faces)

26
Q

Signs of a basilar artery occlusion

A

ischaemia in pons, motor/oculomotor signs/symptoms

Hyperdense nasilar artery indicating a blockage

27
Q

Sub type with highest mortality

A

TACS

28
Q

7 mimics if strokes

A

Seizures, syncope, sugar (hypo/hyper), Sepsis, Severe migraine, Space occuping lesions, SI CHological

AND
vestibular disorders, demylenation, transient global amnesia, mononeuropathy

29
Q

What ios hoovers sign

A

functional vs actual paralysis

In actual paralysis, you will feel the non paralysed leg trying to push down whilst they are trying to lift the other leg up.

If the leg has functional paralysis, you won’t get the other leg pushing down.

30
Q

What investigations for stroke?

A

CT/MRI

blood tests (check fr infection, hypo/hyper glycemia, lipids)

ECG/Holter - AF/LVH

CArotid US (Stenosis)

31
Q

Best treatment for strokes

A

Thrombectomy and thrombolysis

Followed purely by thrombolysis on a stroke unit

Aspirin has little effect.

32
Q

WHen wouldn’t you give thrombolysis?

A

Brain bleed(!)
Recent surgery
Oesophageal varices/recent bleeding
Coag issues

High blood pressure (>185 systolic/110 diastolic)

Very abnormal glucose (under 2.8/over 22mmol/L)

33
Q

What has the best outcome for the patient?

A

Thromboectomy and thrombolysis, medical treatment and stroke ward

34
Q

What has tbe most benefit to most peoplr?

A

Stroke wards!

35
Q

What is the best treatment of a TIA

A

Antiplatelets, antihypertensive, statins and endartectomy

36
Q

When do you perform a carotid endarterectomy?

A

Ideally pretty immediately after a TIA with at least 50% stenosis

37
Q

WHat other secondary prevention of strokes can you give following a TIA

A

antihypertensive, antiplatelets, lipid lowering agents, warfarin for AF, carotid endarterectomy

Neuro 3 (10 decks)

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