Neuro conditions > Stroke > Flashcards

Stroke Flashcards

(48 cards)

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1
Q

What is a stroke

A

An acute neurological condition resulting from a disruption in cerebral perfusion, lasting more than 24hrs

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2
Q

What are the 2 types and which is more common

A

Ischaemic stroke (85%)
Haemorrhagic stroke (15%)

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3
Q

What is ischaemic stroke

A

Cerebral infarction due to insufficient blood flow due to a thrombus or embolus

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4
Q

What is haemorrhagic stroke

A

Cerebral infarction due to haemorrhage (rupture of blood vessel causing leakage of blood into the brain)

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5
Q

Risk factors of stroke

A

Age >65
Hypertension
Diabetes
AF
Obesity
Smoking
High cholesterol

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6
Q

What classification can you do?

A

Bamford stroke classification

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7
Q

What are the criterias of total anterior circulation stroke

A

Need three of the following
. Unilateral weakness (and/or sensory deficit) of the face, arm and leg
. Homonymous hemianopia
. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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8
Q

What is partial anterior circulation stroke

A

Need two of the following:
. Unilateral weakness (and/or sensory deficit) of the face, arm and leg
. Homonymous hemianopia
. Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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9
Q

What is lacunar syndrome

A

One of the following
. Pure sensory stroke
. Pure motor stroke
. Sensory-motor stroke
. Ataxic hemiparesis

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10
Q

What is posterior circulation syndrome (POCS)

A

One of the following
. Cranial nerve palsy and a contralateral motor/ sensory deficit
. Bilateral motor/ sensory deficit
. Conjugate eye movement disorder (e.g. gaze palsy)
. Cerebellar dysfunction (e.g. ataxia, nystagmus, vertigo)
. Isolated Homonymous hemianopia or cortical blindness

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11
Q

What is the main feature regardless of where the stroke is

A

Acute onset

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12
Q

What features would you see in a middle cerebral artery stroke

A

. Contralateral weakness and sensory loss in upper limb and lower half of face
, contralateral Homonymous hemianopia
. Aphasia

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13
Q

What would damage to brocades area (left frontal lobe) cause

A

Expressive aphasia- it’s responsible for speech production

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14
Q

What would damage to wernicke’s area (left temporal lobe) cause

A

Receptive aphasia- it’s responsible for speech comprehension

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15
Q

What features would you see in an anterior cerebral artery stroke

A

Contralateral weakness and sensory loss in lower limbs
Abulia (behavioural changes)
Urinary incontinence

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16
Q

What features would you see in a posterior cerebral artery stroke

A

. Contralateral Homonymous hemianopia with macular sparing
. Visual agnosia (difficulty recognising familiar objects/ faces)
. Contralateral sensory loss
. Memory deficits
. Vertigo
. Nausea

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17
Q

What do you see on stroke of midbrain branches of posterior cerebral artery

A

Ipsilateral oculomotor palsy (down and out eye) and contralateral weakness of the upper and lower extremities

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18
Q

What features would you see in a posterior circulation stroke

A

Damage to the brain stem
Ipsilateral symptoms
DANISH (cerebellar signs)

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19
Q

What is danish (cerebellar signs)

A

Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

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20
Q

What would you see in a posterior inferior cerebellar artery (PICA) stroke

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A

Lateral medullary syndrome:
. Cerebellar signs
. Nystagmus
. Vertigo and vomiting
. Ipsilateral facial pain and temp loss
. Contralateral upper and lower limb pain and temp loss
. Ipsilateral Horner’s

21
Q

What would you see in an anterior inferior cerebellar artery stroke

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A

Sudden onset vertigo and vomiting
Ipsilateral facial paralysis
Deafness

22
Q

What is Weber’s syndrome and its features

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A

A form of midbrain stroke characterised by:
. Ipsilateral CN 111 palsy
. Contralateral hemiparesis

23
Q

What features would you see in pontine haemorrhage?

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A

Reduced GCS
Paralysis
Bilateral pin point pupils

24
Q

What feature would you see in basilar artery stroke

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A

Locked in syndrome- decreased GCS and motor syndrome

25
What is GCS
Glasgow coma scale Score of 13-15 indicate a mild injury Score of 8 or below- severe brain injury
26
What feature would you see in a retinal/ ophthalmic artery stroke?
Amaurosis fugax- temporary vision loss Caused by insufficient blood flow to retina and optic nerve
27
What features would you see in a posterior communicating artery aneurysm
3rd nerve palsy (down and out eye, dilated pupil) Eye pain
28
Wernicke’s aka receptive aphasia symptoms
Speech fluent Comprehension abnormal Repetition impaired
29
Brocades aka expressive aphasia symptoms
Speech no -fluent, laboured and halting Comprehension normal Repetition impaired
30
Conduction aphasia symptoms
Speech fluent Comprehension normal Repetition impaired. Aware of the errors they are making
31
Global aphasia symptoms
Speech non-fluent Comprehension impaired Repetition impaired
32
What score can we use to tell the difference between strokes and stroke mimics
ROSIER (recognition of stroke in the emergency room
33
How does ROSIER work
Exclude hypoglycaemia first then assess the following, stroke is likely if score >0 . Loss of consciousness or syncope- -1 point . Seizure activity- -1point . New acute onset asymmetric facial weakness- +1 point . New acute onset asymmetric arm weakness- +1 point New acute onset asymmetric leg weakness- +1 point New acute onset speech disturbance- +1 point New acute onset visual field defect- +1 point
34
What scans can we do first?
Non-contrast CT head to exclude haemorrhage and confirm ischaemic stroke (normal CT doesn’t rule out ischaemic stroke) CT angiogram to look for which vessel is occluded
35
How do we investigate after the patient has been treated and HOw?
Look for cause of stroke . Echocardiogram . Ambulatory ECG . Carotid Doppler (carotid atherosclerosis)
36
What do we do if >70% occlusion in carotid Doppler?
Carotid endarterectomy- surgery to remove plaque from carotid
37
What score can we use to measure disability of someone after a stroke
Barthel index: standardised assessment tool used in heathcare esp in rehabilitation, stroke and elderly care to measure a person's level of independence in activities ofdaily livings (ADLs)
38
What is the first step of management
CT head before thrombolysis to rule out haemorrhage esp if on warfarin/ DOAC/ has bleeding disorder
39
What do we do after the first step if the stroke has been less than 4.5hrs from onset?
Thrombolysis (IV alteplase) . clot busting treatment used in emergencies to dissolve a blood clot
40
What do we do for anterior circulation strokes (ACA or MCA) within 6 hours
THrombectomy- medical procedure to physically remove a blood clot (thrombus) from a blocked blood vessel Thrombolysis
41
When is thrombolysis contraindicated?
Absolute contraindicated: . Previous intracranial haemorrhage . Seizure at onset of stroke . Intracranial neoplasm . suspected subarachnoid haemorrhage . active bleeding . pregnancy Relatively contraindicated: . Concurrent anticoagulant active diabetic haemorrhagic retinopathy . Major surgery in the preceding 2 weeks
42
What to do if it has been more than 4.5hrs from onset? after 2 weeks?
conservative management (aspirin, 300mg oral), swallow assessment b) after 2 weeks, stop aspirin and start clopidogrel 75mg daily for life
43
what are aspirin and clopidogrel?
antiplatelet drugs- prevent platelets from sticking together which reduces risk of forming blood clots in the arteries
44
what do we give if clopidogrel is not tolerated?
aspirin and modified release dipyridamole
45
What do we give patients with a stroke due to AF?
Anticoagulant (DOAC) initiated 2 weeks after stroke
46
When do you do surgery and which one do we do? What nerve is at risk of being damaged
if ipsilateral carotid artery stenosis >70% then we do carotid endarterectomy b) hypoglossal
47
How do we manage haemorrhagic stroke patients?
Stop anticoagulants (if warfarin consider vitamin K and prothrombin concentrate) and control BP if acute
48
When do we start anticoagulation following a stroke vs TIA due to AF?
. After 2 weeks for ischaemic stroke (give antiplatelet in the meantime) . Immediately for TIA once haemorrhage ruled out
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