Acute Stroke Treatment

Question 1

Admission to the hyper acute stroke unit

Answer 1

• just over half of patients in the uk are able to access HASU
• 8 units accross london
• prior patients go to a&e and assessed by on call stroke team
• head scan and diagnoses withing 30 mins of arrival
• if stroke diagnosed sent to HASU for critical care treatment and typically stay less than 72 hours

Question 2

Diagnosis of stroke

Answer 2

• CT or MRI
• blood tests
• chest x ray
• ECG
• carotid doppler ultrasound
• echocardiogram

Question 3

Ischaemic and haemorrhagic stroke

Answer 3

If diagnosed care pathway determined

• close monitoring
• checks on bp, temp, hr, resp rate
• nurses monitor blood sugar levels and spo2
• mobility assessment
• communication and cognitive assessments
• pressure risk assessment = pressure sores
• continence assessment
• swallowing screening

Question 4

Ischaemic stroke treatment

Answer 4

• 87% of all strokes
• either thrombotic (blood clot in vessels in brain)
• or embolic (blood clot or debris develops elswhere in the body and travels to brain)
• medication used to treat and reduce the risk of it happening again
• some taken immediately and short term others later and long term

Question 5

Thrombolysis

Answer 5

• alteplase - dissolves blood clots and restores blood flow to the brain
• most effective when started asap after the stroke
• not reccomended if more than 4.5 hours have pass d
• brain scan must be carried out before hand to confirm diagnosis of ischaemic stroke
• can make haemorrhagic strokes worse
• if thromolysed better chance of being dissability free after 3 months

Question 6

Thrombectomy

Answer 6

• emergency procedure to remove blood clots
• restores blood flow to the brain
• insert catheter into an artery (often upper right thigh)
• stent retriever pushed to clot site and traps clot in cage
• then removes both the stent and the clot restoring blood flow

Question 7

Decompressive hemicraniectomy

Answer 7

• proportion of skull removed to relief intercranial pressure
• prevents neuronal damage in other regions of yourbbrsin
• bone stored and replaced when appropriate
• helmet and temp implant to protect brain and prevent further damage

Question 8

Carotid Endartectomy

Answer 8

• surgery to unblock carotid artery
• incision in neck to open carotid and remove fatty deposits
• close with stitches or patch

Question 9

Antiplatelets

Answer 9

• medication to soften a clot and reduce risk of further stroke
• most people offered aspirin - 300mg
• other antiplatelt such as clopidogrel and dipyridamole

Question 10

Anticoagulants

Answer 10

• medication to reduce further risk of stroke
• change the chemical composition of blood in a way that orevents blood clots occuring
• warfarin, apixaban, dabugatran, edoxaban, rivaroxaban

Question 11

Statins

Answer 11

• medication to lower cholesterol levels

- block a chemical in the liver that produces cholesterol

Question 12

Haeomorrhagic stroke - treatment

Answer 12

Divided into two main categories

• intracerebral haemorrhage (10%) bleeding fron blood vessels in the brain
• subarachnoid haemorrhage (3%)

Question 13

Intracerebral haemorrhage

Answer 13

ICH - diseased blood vessel in the brain bursts

• high blood pressure is the most common cause
• in younger people, abnormally formed blood vessels are another common cause (arterio-venous malformation)
• if ammount of blood increases rapidly the sudden increase in pressure can lead to unconsciousness or death
• if blood pressure too high 200mmhg systolic (hypertensive emergency) medicine given to lower it
• can lead to hydrocephalus, shunt can be placed to allow fluid to drain properly

Question 14

Subarachnoid haemorrhage

Answer 14

• bleeding in the subarachnoid space
• emergency surgery to remove blood from the brain
• craniotomy under general anaesthetic
• if scan shows SAH was caused by a brain aneurysm procedure to repair blood vessle and prevent aneurysm from bleeding is reccomended

Question 15

Neurosurgical clipping

Answer 15

• craniotomy
• when the aneurysm was located it would have been seales shut using a metal clip that stays permanently clamped on the aneurysm
• bone flap replaced and scalp stitched
• over time blood vessel lining heals along where the clip is placed sealing the aneurysm

Question 16

Endovascular coiling

Answer 16

• catheter inserted in leg or groin
• tiny platinum coils passed through the tube and into the aneurysm
• once aneurysm full of coils blood cant enter it
• also means sealed of from main artery preventing it growing or rupturing again

Question 17

Multi disciplinary team

Answer 17

• stroke consultant = physician responsible for care whilst in hospital
• clinical/ stroke nurse = provide day to day care in hospital
• physiotherapist = aim to re-educate your movement, sensation and balance
• occupational therapist = assess abilities to participate in ADL’s
• Speech and language therapists = assess all aspects of communication
• stroke liaison sisters = provide support and advice to you and your family members
• dieticians = explain how food can help post-stroke
• cognitive therapists = assess problems thinking
• care managers = can advise on service to provide with personal care, domestic help etc.
• pharmacists = makes sure medication is correct and a safe form for you to take
• opthamologist, orthotists, rehab assisstants, continence advisors, dieticiens, audiologists, podiatrists, social workers