Acute Stroke Diagnosis and Management Flashcards
What are the clinical features of L MCA syndrome?
R hemiparesis, aphasia, R sensory/visual inattention, R hemianopia
What are the clinical features of R MCA syndrome?
L hemiparesis, dysarthria, L sensory/visual inattention, L hemianopia
What does isolated face/arm/leg weakness with dysarthria usually indicate?
stroke in deep perforating vessels
What are the clinical features of a posterior circulation stroke?
diplopia, vertigo, dysarthria, dysphagia, ataxia, hemiparesis, ipsilateral face/contralateral body numb/weak
What are differential diagnoses for stroke?
migraine
seizure with todd’s paresis
functional
metabolic/sepsis
What does an ICH along the floor of the anterior cranial fossa usually indicate?
anterior communicating artery aneurysm
What does blood around the sylvian fissue usually indicate?
MCA aneurysm
What are the CT findings in acute stroke?
hyperdense artery
subtle loss of grey white matter differentiation
What does TTP on CT perfusion indicate?
time to peak
areas where blood flow takes longer to arrive are in yellow/red -> indicates the tissue at risk/penumbra
What does CBV on CT perfusion indicate?
Cerebral blood volume -> if low then likely the area is irreversibly damaged
What is the most sensitive imaging for ischaemic stroke?
diffusion MRI
What is the risk of stroke in the first week after TIA (untreated)?
10%
In which patients should a bubble study be performed?
age < 60 and no other cause identified
What did the EXTEND trial show?
That CT perfusion or MRI selected patients benefit for alteplase 4.5-9hours after onset or within 9 hours of midpoint of sleep
What SBP is required to treat with thrombolysis?
< 185
What percentage of patients get the complication of orolingual angioedema post thrombolysis?
2% overall
5% if taking ACE
What did the DAWN/DEFUSE trial show?
Benefit for thrombectomy up to 24 hours after stroke with select patients (imaging findings)
Which patient’s are eligible for delayed thrombectomy?
6-24 hours with ICA/M1 occlusion and < 70mL core on perfusion imaging
Is there an age/severity limit for thrombectomy?
no
In which vessels can you do thrombectomy?
ICA, M1, basilar, ?M2
Are platelet transfusions indicated in ICH?
no -> associated with worse outcome
In what time period can thrombectomy be done?
0-6 hours broad criteria
6-24 hours with imaging criteria
In what time period can thrombolysis be done?
0-4.5 hours broad criteria
4.5 - 9 hours with imaging criteria
