Case 5 - stroke pathophysiology and clinical management Flashcards
how many stroke are there in the UK a year
100,000
how many people who are eligible for thrombolysis receive it
8 in 10 but 1 in 10 in Scotland
how many children have a stroke in the UK
400 per year
what happens within 48 hours of your stroke symptoms appearing
transferred to the acute stroke unit
what do paramedics use
the FAST test
what does the F stand for
face
what does the A stand for
arms - hold them up and keep them there
what does the S stand for
speech - slurred
what does T stand for
time to call an abylence
what is the WHO definition of a stroke
A clinical syndrome characterised by the rapid onset of focal or global cerebral deficit lasting more than 24 hours or leading to death with no other apparent cause than vascular ones
what are the main subtypes
ischaemic stroke - 85%
haemorrhage storke - 15% (intracerebral and subarachnoid)
transient ischaemmic attack - less than 24 hours lasting
what is the typical brain imaging appearances in an ischaemic stroke
wedged shaped hypo density with complete loss of grey-white matter differentiation
localised swelling with sulcal effacement
in a recognised arterial territory
what test is the only one that shows the penumbra
an angiogram
what is used in intravenous thombolysis
tissue plasminogen activator
characteristics of tPA
1mg/kg over 1 hour
only beneficial administered less than 4.5 hours after stroke
12% of stroke patients are eligible
what is a risk in tPA
patients can develop an allergic reaction called angioedma and there is a 1 in 14 chance of it happening
what is angioedma
swelling of the lips and tongue and if severe it can interact with the airway and block it
what is a mechanical thrombectomy
stent retriever
10-15% elegible
limited access
when can a mechanical thrombectomy be used
less than 6 hours from onset
what does secondary prevention include
identify the cause:
- athero-thrombo-ebolism: 50%
- cardioembolic: 20%
- small vessel disease: 25%
- miscellaneous rare causes: 5%
what treatment is given
aspirin then clopidogrel
what is an intracerebral haemorrhage different to stroke in the acute phase
because an ICH is a space occupying lesion
what is secondary brain damage driven by
thrombin
what now accounts for major of anti coagulant associated intracerebral haemorrhages
DOAC-ICH
