503. Stroke and head bleeds Flashcards
What are some causes of stroke?
Thrombosis
Heamorrhage
Sudden BP drop >40mmHg
Carotid artery dissection
Vasculitits
SAH
Venous sinus thrombosis, antiphospholipid syndrome, thrombophilia
What are some differential sfor stroke?
Head injury
Hypo/hyperglyceamia
Subdural heamatoma
Intracranial tumour
Hemiplegic migraine
Post ictal
Encephalopathy
Drug overdose
What are some of the initial management aspects when a stroke is suspected?
Protect the airway
Keep glucose between 4-11 and BP below 185/110
Nil by mouth until swallow assessment
CT head
Antiplatelet agents/throbolysis/thrombectomy
What secondary prevention i sone after a stroke?
Aspirin 300mg for 2 weeks then longterm clopidogrel
Optimise blood pressure management
Optimise statin management
What secondary investigations can be ordered for stroke?
Blood pressur emanagement
ECG and 24hr ECG
CArotid artery stenosis
Blood sugars
Vasculitits screening
What are the various antiplatelets methods of action?
Aspirin- suppressed prostagladin and thrombxane synthesis
Clopidogrel- Inihibts platelet agrigation
Dipyridamole- inhibits cyclic AMP and inhibits thromboxane
What post-stroke management is important to remember
Swallow assessment
Minimise falls
Ensure good bowel and bladder care- frequent toileting
Physio, position ot minimise spasticity
Monitor mood
Monitor progress
What occurs when the retinal artery is occluded?
A,aurosis fugax- loss of vision that is described as “like a curtain falling”
How do you investigate a TIA?
Secondar ycare referral
FBC, ESR, U&E’s, Glucose, Lipids,
CXR, ECG,
Carotid doppler, angiography
CT/ diffusion weightde MRI
Echo
How do you treat a TIA?
Control cardio risk factors
Antiplatelet drugs (aspirin 2 week sthen clopidigrel 300mg)
Anticoagulation indications acted upon
Carotid endarterectomy if >70% stenosis
What are the signs of a subarachnoid heamorrhage
Sudden onset occipital headache
Neck stiffness (6 hours post insult)
Focal neurology
Vomiting, collapse and seizures
What are some causes/risk factors for a subarachnoid heamorrhage?
Berry aneursyms
Atriovenous malformations
Tumour
PCOS
coarctation of the aorta
Ehlers danlos syndrome
What are the differentials for a subarachnoid heamorrhage
Meningitis
Migraine
Intracerebral bleed
Cortical vein thrombosis
Dissection of carotid or vertebral artery
How do you manage a subarachnoid heamorrhage?
Refer to neurosurgery
Re-examine- GCS monitoring, repeat CT head if deterioration
Maintain cereral perfusion- keep SBP<160
Nimodipine- reduces vasospams
Surgery- coiling vs clipping
What complications may occur in a subarachnoid heamorrhage?
Rebleeding
Cerebral ischameia
Hydrocephalus
Hyponatreamia- seek expert help
What are the symptoms of an intrcranial venous thrombosis?
Seizures
Headache
vomiting
visual changes
papilloedema
Cerebellar signs
What are the causes of an intracranial heamorrhage?
Pregnancy
Combined oral contraceptive pill
Head injury
Dehydration
tumpours
Infection (Meningitis, abcess, TB)
Drugs (androgens)
How is an intracranial venous thrombosis treated?
Anticoagulation with heparin or Low molecular weight heparin
Warfarin
Endovascular thrombolysis or mechanical thrombectomy may be beneficial
Decompresive craniotomy
Describe the course of a subdural heamatoma?
Who typicaaly gets a subdural?
Bleeding from bridging veins that occurs slowly usually after trauma.
Can take months to present.
Typically happens ot elderly as bridging veins are vulnerable
What ar the signs and aymptoms of a subdural?
Fluctuatin levels of conciousness
Inisidious physical or intellectual slowing
Sleepiness, headaches, unsteadniess
Raised ICP, seizures,
What is seen on imaging in a subdural heamatoma?
hook shaped gathering of blood nedxt to brain
Pushing of sulci over the midline
What is a woryrign sign that indicates epidural heamatoma?
No loss of conciousness/some drowsiness
Feels fine
Deteriorates neurologically
What are the signs and symtpoms of an extradural heamatoma?
Increasingly severe headache
Vomiting
Confusion
Seizure
Hemiparesis
What is seen on imaging during an extradural heamatoma?
Egg shaped pattern of bleeding over the petrsoal bone indicating a middle menignealrupture
