503. Stroke and head bleeds

Question 1

What are some causes of stroke?

Answer 1

Thrombosis

Heamorrhage

Sudden BP drop >40mmHg

Carotid artery dissection

Vasculitits

SAH

Venous sinus thrombosis, antiphospholipid syndrome, thrombophilia

Question 2

What are some differential sfor stroke?

Answer 2

Head injury

Hypo/hyperglyceamia

Subdural heamatoma

Intracranial tumour

Hemiplegic migraine

Post ictal

Encephalopathy

Drug overdose

Question 3

What are some of the initial management aspects when a stroke is suspected?

Answer 3

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

Question 4

What secondary prevention i sone after a stroke?

Answer 4

Aspirin 300mg for 2 weeks then longterm clopidogrel

Optimise blood pressure management

Optimise statin management

Question 5

What secondary investigations can be ordered for stroke?

Answer 5

Blood pressur emanagement

ECG and 24hr ECG

CArotid artery stenosis

Blood sugars

Vasculitits screening

Question 6

What are the various antiplatelets methods of action?

Answer 6

Aspirin- suppressed prostagladin and thrombxane synthesis

Clopidogrel- Inihibts platelet agrigation

Dipyridamole- inhibits cyclic AMP and inhibits thromboxane

Question 7

What post-stroke management is important to remember

Answer 7

Swallow assessment

Minimise falls

Ensure good bowel and bladder care- frequent toileting

Physio, position ot minimise spasticity

Monitor mood

Monitor progress

Question 8

What occurs when the retinal artery is occluded?

Answer 8

A,aurosis fugax- loss of vision that is described as “like a curtain falling”

Question 9

How do you investigate a TIA?

Answer 9

Secondar ycare referral

FBC, ESR, U&E’s, Glucose, Lipids,

CXR, ECG,

Carotid doppler, angiography

CT/ diffusion weightde MRI

Echo

Question 10

How do you treat a TIA?

Answer 10

Control cardio risk factors

Antiplatelet drugs (aspirin 2 week sthen clopidigrel 300mg)

Anticoagulation indications acted upon

Carotid endarterectomy if >70% stenosis

Question 11

What are the signs of a subarachnoid heamorrhage

Answer 11

Sudden onset occipital headache

Neck stiffness (6 hours post insult)

Focal neurology

Vomiting, collapse and seizures

Question 12

What are some causes/risk factors for a subarachnoid heamorrhage?

Answer 12

Berry aneursyms

Atriovenous malformations

Tumour

PCOS

coarctation of the aorta

Ehlers danlos syndrome

Question 13

What are the differentials for a subarachnoid heamorrhage

Answer 13

Meningitis

Migraine

Intracerebral bleed

Cortical vein thrombosis

Dissection of carotid or vertebral artery

Question 14

How do you manage a subarachnoid heamorrhage?

Answer 14

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

Question 15

What complications may occur in a subarachnoid heamorrhage?

Answer 15

Rebleeding

Cerebral ischameia

Hydrocephalus

Hyponatreamia- seek expert help

Question 16

What are the symptoms of an intrcranial venous thrombosis?

Answer 16

Seizures

Headache

vomiting

visual changes

papilloedema

Cerebellar signs

Question 17

What are the causes of an intracranial heamorrhage?

Answer 17

Pregnancy

Combined oral contraceptive pill

Head injury

Dehydration

tumpours

Infection (Meningitis, abcess, TB)

Drugs (androgens)

Question 18

How is an intracranial venous thrombosis treated?

Answer 18

Anticoagulation with heparin or Low molecular weight heparin

Warfarin

Endovascular thrombolysis or mechanical thrombectomy may be beneficial

Decompresive craniotomy

Question 19

Describe the course of a subdural heamatoma?

Who typicaaly gets a subdural?

Answer 19

Bleeding from bridging veins that occurs slowly usually after trauma.

Can take months to present.

Typically happens ot elderly as bridging veins are vulnerable

Question 20

What ar the signs and aymptoms of a subdural?

Answer 20

Fluctuatin levels of conciousness

Inisidious physical or intellectual slowing

Sleepiness, headaches, unsteadniess

Raised ICP, seizures,

Question 21

What is seen on imaging in a subdural heamatoma?

Answer 21

hook shaped gathering of blood nedxt to brain

Pushing of sulci over the midline

Question 22

What is a woryrign sign that indicates epidural heamatoma?

Answer 22

No loss of conciousness/some drowsiness

Feels fine

Deteriorates neurologically

Question 23

What are the signs and symtpoms of an extradural heamatoma?

Answer 23

Increasingly severe headache

Vomiting

Confusion

Seizure

Hemiparesis

Question 24

What is seen on imaging during an extradural heamatoma?

Answer 24

Egg shaped pattern of bleeding over the petrsoal bone indicating a middle menignealrupture