Assessment and management of stroke Flashcards
Define stroke
Acute focal or global impairment of the brain function lasting fro >24 hours and of vascular origin
What are the 2 main categories of stroke
Ischaemic - thromboembolic
Haemorhagic - subarachnoid or intercerebral bleeding
Define a TIA
Sudden focal loss of neurological function that resolves within 24 hours
Describe features of a TACS (total anterior circulation stroke)
= occlusion of a large cerebral artery (internal carotid or middle cerebral)
All 3 of
- contralateral hemiplegia and hemi sensory loss of FAL
- contralateral homonynmous hemianopia
- disturbances including aphasia and visual spatial problems e.g neglect
Describe the features of a LACs (lacunar stroke)
Occlusion of a single lenticulostriate artery supplying the basal ganglia
One of the following
- pure motor
- pure sensory
- sensory motor deficit
- ataxic hemiparaesis
What are the features of a PACs (partial anterior circulation stroke)
= middle cerebral artery occluded
2 of
- motor/sensory deficit
- homonymous hemianopia
- new higher cerebral dysfunction alone e.g aphasia or visuospatial disorder
Describe the features of a POCS (posterior circulation stroke)
= posterior vessel occluded leading to cerebellar, brain stem or occipital infarcts
one of:
- ipsilaterial cranial nerve palsy with contralateral motor or sensory deficit
- disorders of conjugate eye movement
- cerebellar dysfunction (DANISH)
- isolated homonymous hemianopia with macular sparing
- bilateral motor/sensory deficit
What is the immediate stroke management for a patient coming in
- priority 1 ambulance
- focused history and exam and carry out NIHSS and investigations (bloods, ECG)
- CT scan to check for bleeding (in haemoragic stroke)
- proceed with thrombolysis or thrombectomy if appropriate
What types of things does a focused stroke history include
- classifying what type of stroke it is
- check for medication which may contraindicated then from thrombolysis e.g if they take wafarin or other anticoagulants
- find out the time of onset to see if they’re within the window of thrombolysis
- check for bleeding tendency, recent surgery or trauma (may also contraindicate thrombolysis )
- assess the severity of the stroke using NIHSS (0-42 with 42 being the worsed)
Why do we need to do a CT immediately for a stroke patient
Rule out bleeding - this will show up as white on a CT scan
If its ischaemic this means can start reprofusion therapy
Also rules out alternative diagnoses
WHat is the time frame for reprofusion therapy
<4.5 hours for thrombolysis with alteplase
Mechanical thrombectomy can be used up to 24 hours but is best within 6 hours
What are the 2 treatments used in reprofusion therapy
- thrombolysis
Using alteplase to break up the clot, STILL a risk of haemorhage! - Mechanical thrombectomy
Intra arterial clot extraction used in conjunction with thrombolysis or as an alternative treatment in people contraindicated for thrombolysis
Which patients should be considered for mechanical thrombectomy
- stroke onset <6 hours
- NIHSS >4
- large vessel occlusion seen on CT angiogram
How to manage intercerebral haemorhage
- reverse any anticoagulants
- control BP
- consider neurosurgery in selected patients
What happens in a ischaemic stroke is not treated
Brain will infarct and die and appear black on the CT scan
