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stroke week > assessment and management of acute stroke > Flashcards

assessment and management of acute stroke Flashcards

1
Q

what is advertised in the fast campaign?

A

if there is a facial droop, a weakness in raising arms or slurred speech, need to ring 999 as soon as possible

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2
Q

describe the events that occur when a suspected stroke patient is reported from home to A&E

A
  • paramedics called via a priority 1 call
  • paramedics assess patient and if they believe the patient is having a stroke, they will alert the hospital via the batphone
  • hospital will prealert the stroke team
  • stroke team will meet patient in A&E and try adn determine stroke probability
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3
Q

what occurs when an acute stroke patient enters A&E?

A

met by the stroke team
focused history and examination ( including NIHSS)
initial investigations ( bloods and Iv access / ECG)
CT scan

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4
Q

what is a stroke?

A

a clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of ceebral function lasting greater than 24 hours ( or leading to death) with no apparent cause other than that of vascular origin

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5
Q

when are the different types of stroke?

A

ischaemic stroke
intracerebral haemorrhage
TIA

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6
Q

what is the different classifications of stroke in the oxford classification of stroke?

A

TACS
PACS
LACS
POCS

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7
Q

what is the aetiology of TACS

A 
Proximal 0cclusion (ICA
or proximal MCA)
Large volume infarct
Superficial + deep
territories
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8
Q

what is the presentation of TACS?

A 
Higher cerebral
dysfunction AND
homonymous
hemianopia AND
ipsilateral motor +/-
sensory deficit
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9
Q

what is the aetiology of PACS?

A

Occlusion of MCA
branch
Restricted infarct

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10
Q

what is the presentation of PACS?

A

2 out of 3 TACS deficits
OR higher cerebral
dysfunction alone OR
monoparesis

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11
Q

what is the aetiology of LACS?

A

Single perforating artery

Basal ganglia/pons

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12
Q

what is the presentation of LACS

A

Pure motor or pure
sensory, or ataxic
hemiparesis

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13
Q

what is the presentation of POCS

A

Cranial nerve palsy/
crossed signs/
cerebellar signs

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14
Q

what is the aetiology of POCS?

A

Posterior vessel
occlusion
(PCA or branches of
basilar/ vertebral)

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15
Q

What is the NIHSS score?

A

a way to objectively quantify the impairment caused by a stroke. Scored from 0 to 42. higher the score the more severe the stroke.

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16
Q

what are the limitations of a NIHSS score?

A

not a diagnostic tool

doesnt pick up many cranial nerve or cerebellar signs so can underestimate or miss a POCS

17
Q

what are the advantages of NIHSS?

A

useful for showing the benefits of treatment/ progression of the stroke

18
Q

why are CT scans useful in stroke patients?

A

to rule out haemorrhagic strokes - bright white (high attenuation) if blood present
Ischaemic stroke CT scans often appear normal

19
Q

what is meant by reperfusion?

A

opening up the blocked vessel in ischaemic stroke to reperfuse the ischaemic brain

20
Q

what is used to do thrombolysis in stroke?

A

alteplase given IV. Given as bolus and then rest over next hour

21
Q

when is thrombolysis used to treat stroke?

A

clinical diagnosis of acute ischaemic stroke
CT imaging appears consistent with ischaemic stroke
symptom onset within 4.5 hours
no contraindications of high bleeding risk

22
Q

what are the benefits of quick admission onto the hyper acute stroke unit?

A

Dysphagia screening (nursing staff)
Monitoring of neurological status and GCS
Cardiac monitoring
Early assessment by OT/Physio
Early mobilisation and discharge planning
SLT for detailed swallowing assessment and where
communication is impaired
Continence assessment
Nurses: insert NG tubes and monitor
Dietitian: monitor intake, prescribe NG regimes
Emotional and psychological support and education (Stroke
Association/ Neuro-psychology)

23
Q

what is used as early secondary prevention after a stroke or TIA?

A

aspirin or clopidogrel if not in AF
initiate a statin
control BP
anticoagulate if in AF - DOACs now first line
carotid surgery - do carotid doppler ultrasound

24
Q

how do we treat intracerebral haemorrhage?

A 
Reversal of coagulopathy
 BP lowering (<150mmHg) if hypertensive
 Surgery only if:
- haemorrhage with hydrocephalus
- lobar haemorrhage with Glasgow Coma Score
 between 9 and 12
- cerebellar haemorrhage
25
Q

what are common complications after stroke?

A 
pneumonia
seizures
pressure sores 
dehydration and malnutrition 
constipation
incontinence and retention
depression
spasticity 
deep venous thromboembolism
26
Q

how do we prevent DVTs in stroke?

A

intermittent pneumatic compression stockings

stroke week (2 decks)

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