Acute Ischaemic Stroke Flashcards
What is the current approach to management of ischemic stroke
Primary prevention: reducing risk factors etc.
Acute phase: reperfusion, neuroprotection
Recovery: functional and cognitive, neuroreperation
True or false: treatment is time dependant
True
What treatment is associated with improved long term survival and functional status after ischemic stroke
Thrombolysis with intravenous alteplase
Why is thrombolysis an effective treatment
Stroke is caused by a clot in the artery so thrombolysis breaks down the clot
Name another, quite expensive, treatment
Endovascular thrombectomy, some case studies have shown earlier treatment with ET and medical therapy compared to medical therapy alone, was associated with lower degrees of disability at 3 months.
True or false: there’s an age limit of endovascular thrombectomy
False. Every patient has their own course of infarct evolution so prior state matters more
Why are reperfusion therapies still used for AI stroke if only 10-20% of patients benefit
Because they open a new field for neurorepair therapies
What outperforms alteplase for stroke thrombolysis
Tenecteplase
Why does tenecteplase outperform alteplase
It’s cheaper, provides more ignition reperfusion at initial analogram, improved functional outcomes, convenience of single bolus and no safety concerns
Intravenous treatment can be done up to 4 hours after stroke, how long can a thrombectomy be done after?
7.3 hours
What is a Code Stroke in the hospital
- All conditions of pt. established in emergency box
- Nurses and doctors attend to stabilise
- Move pt. to CT scan
- Differentiate type of stroke e.g. ischemic or haemorrhagic
How long can brain tissue stay alive for after losing sufficient blood flow
2-3h
What is the penumbra
The region around the infarctocore with more blood flow
What is oligaemia
The reduction of blood flow to a tissue, oligaemia is the step down from penumbra, surrounds the areas of penumbra but with more blood flow
What is one of the mechanisms for auto regulation/compensation after occlusion
Capillary vasodilation - cerebral blood volume stabilises or increases, blood cerebral flow decreases
Why are autoregulatory compensation mechanisms not always enough
They’re insufficient and stop eventually, CBF decreases too much causing protein synthesis to stop, electrical activity and eventually, irreversible damage
What is the baseline CT scan useful for in AIS
Ruling out haemorrhage
Rule out other minor strokes eg tumour
Assess early signs of stroke
What is the CT perfusion helpful for
Quantify the extent of
- infarcted ischemic tissue
- tissue at risk of penumbra potentially recoverable
- better selection of candidate for advanced treatments
What is CT-angiography useful for in AIS analysis
Intra and extracranial circulation
Shows is Thrombectomy necessary
Why does sever Alzheimer’s result in physically in the brain
Severe atrophy
What is biological marker (not a guarantee) for future onset of Alzheimer’s disease
Deposits of beta amyloid in the brain
