9: Stroke Flashcards
What is a stroke?
Rapidly developing loss of brain function due to a vascular event
Loss of brain function due to a stroke can be ___ or ___.
focal
global
What score is used to diagnose a stroke in A&E?
ROSIER score
What are the two main types of stroke?
Infarction
Haemorrhage
What does a CT head of an
a) infarction stroke
b) haemorrhagic stroke
look like?
a) Affected area is darker, smudged
b) Blood is lucent i.e bright white
What is a TIA?
Transient ischaemic attack
i.e mini stroke
What is the difference between a TIA and a stroke?
Time frame
TIA < 24hrs ongoing symptoms, stroke > 24hrs
What does TIA increase your risk of?
Stroke
___ intervention is key to reducing the risk of stroke following a TIA.
Early
How is suspected stroke investigated?
Imaging (CT or MRI scan)
Cardio investigations - blood pressure, ECG, carotid scans, angiograms…
Lifestyle - blood glucose, cholesterol, take a smoking history
What must be assessed before offering a stroke patient food or water?
Swallowing
To ensure patient doesn’t aspirate
What is an emergency intervention which can be given to a patient acutely suffering a stroke?
Thrombolysis
Which classes of drug are given to patients to reduce the likelihood of another stroke?
Statins
Antiplatelets e.g aspirin, clopidogrel, ticagrelor
Anticoagulants e.g warfarin, apixaban, LMWH
Which imaging modes are better for picking up
a) haemorrhages
b) infarcts?
a) CT
b) MRI
Which antiplatelet drug is given for infarcts?
Aspirin
What cardio disease does immobility increase your risk of?
DVT
> MI, stroke…
Why isn’t LMWH given for DVT prophylaxis in stroke patients?
Increases bleeding risk
What is used as DVT prophylaxis in stroke patients?
Pneumatic compression stockings
Intermittently expand and contract to push blood along
Why can patients aspirate following a stroke?
Impaired swallow
How can patients be assisted with feeding if they have an impaired swallow following a stroke?
NG feeding
Thicker, textured food
Parenteral nutrition
How are stroke patients assessed for malnutrition?
MUST score
What is a red thrombus?
Where are they formed?
Which drugs are effective for breaking them up?
Clot formed mainly of red blood cells and fibrin
Found in areas of low pressure and blood status e.g heart
AntiCOAGULANTS - warfarin, apixaban
What is a white thrombus?
Where are they formed?
Which drugs are effective for breaking them up?
Clot formed mainly of platelets
High pressure circulation e.g the arteries
AntiPLATELETS - aspirin, clopidogrel, ticagrelor
Patients who have had MIs, strokes etc. often have hypertension in the days following their event.
What drugs are given to control this and when?
Antihypertensives i.e ACE inhibitor, amlodipine at around 10 days post-event
What
a) lifestyle advice
b) medication
is given to stroke patients for secondary prevention?
a) Stop smoking, exercise, diet…
b) Statin, antiplatelet, anticoagulant
Which arrythmia increases your risk of MI and stroke?
Atrial fibrillation
What scoring system is used to estimate a patient’s risk of stroke?
CHA2D vasc score
revise from 1st year
What scoring system is used to estimate a patient’s risk of bleeding while on anticoagulation?
HASBLED
What type of diet is thought to be cardioprotective?
Mediterranean diet
high in starchy food, fruit and veg; low in meat
