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Semester 3 > Case 5 - stroke pathophysiology and clinical management > Flashcards

Case 5 - stroke pathophysiology and clinical management Flashcards

1
Q

how many stroke are there in the UK a year

A

100,000

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2
Q

how many people who are eligible for thrombolysis receive it

A

8 in 10 but 1 in 10 in Scotland

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3
Q

how many children have a stroke in the UK

A

400 per year

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4
Q

what happens within 48 hours of your stroke symptoms appearing

A

transferred to the acute stroke unit

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5
Q

what do paramedics use

A

the FAST test

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6
Q

what does the F stand for

A

face

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7
Q

what does the A stand for

A

arms - hold them up and keep them there

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8
Q

what does the S stand for

A

speech - slurred

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9
Q

what does T stand for

A

time to call an abylence

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10
Q

what is the WHO definition of a stroke

A

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

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11
Q

what are the main subtypes

A

ischaemic stroke - 85%
haemorrhage storke - 15% (intracerebral and subarachnoid)
transient ischaemmic attack - less than 24 hours lasting

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12
Q

what is the typical brain imaging appearances in an ischaemic stroke

A

wedged shaped hypo density with complete loss of grey-white matter differentiation
localised swelling with sulcal effacement
in a recognised arterial territory

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13
Q

what test is the only one that shows the penumbra

A

an angiogram

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14
Q

what is used in intravenous thombolysis

A

tissue plasminogen activator

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15
Q

characteristics of tPA

A

1mg/kg over 1 hour
only beneficial administered less than 4.5 hours after stroke
12% of stroke patients are eligible

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16
Q

what is a risk in tPA

A

patients can develop an allergic reaction called angioedma and there is a 1 in 14 chance of it happening

17
Q

what is angioedma

A

swelling of the lips and tongue and if severe it can interact with the airway and block it

18
Q

what is a mechanical thrombectomy

A

stent retriever
10-15% elegible
limited access

19
Q

when can a mechanical thrombectomy be used

A

less than 6 hours from onset

20
Q

what does secondary prevention include

A

identify the cause:
- athero-thrombo-ebolism: 50%
- cardioembolic: 20%
- small vessel disease: 25%
- miscellaneous rare causes: 5%

21
Q

what treatment is given

A

aspirin then clopidogrel

22
Q

what is an intracerebral haemorrhage different to stroke in the acute phase

A

because an ICH is a space occupying lesion

23
Q

what is secondary brain damage driven by

A

thrombin

24
Q

what now accounts for major of anti coagulant associated intracerebral haemorrhages

A

DOAC-ICH

25
Q

what are the options for ‘reversal’

A

prothrombin complex concentrate (VKA antagonists, favour Xa agents)
idarucisumab (for dabigatran)
andexanet alfa - for factor Xa agents

26
Q

table of anti coagulant reversal

A
27
Q

what is the target for hyper acute BP management in practice after a stroke

A

130-14mmgHg over first 24 hours

28
Q

what is the neuro surgery for infratentorial ICH

A

risk of brainstem compression, nervation syndromes and hyrocephalus

procedures: EVD / posterior fossa decompression / haematoma evacuation

29
Q

what is the neuro surgery for a supratentorial ICH

A

early haematoma evacuation in the stable patient
haematoma evacuation in the deteriorating patient
EVD for hydrocephalus

30
Q

what are minimally invasive surgeries for ICH

A
  • MISTE procedure
  • NICO brain path
  • penumbra Artemis
31
Q

what is the ABC hyper acute care bundle

A

A: anti coagulant reversal agent <90 minute from arrival

B: blood pressure lowering: deliver intense blood pressure lowering with needle to target time <60 minutes

C: care pathway: refer patients with good pre-morbid function and any of the following to neuro surgery:
- GCS >9
- posterior fossa ICH
- obstructed 3/4th ventricle
- haematoma volume >30mls

32
Q

what is the structural aetiology of ICH

A

hypertensiev microangiopathy
Cerebral amyloid angiopathy
Neoplasm (primary/metastasis)
Haemorrhagic transformation of cerebral infarction
Inter cranial vascular malformation
Intracranial arterial aneurysm
Intracranial venous thrombosis
Dural arteriovenous fistula
Septic arteritis/vasculitis

33
Q

what is the haemostatic/haemodynamic aetiology of ICH

A

Hypertension
Anticoagulation
Thrombolytic treatment
Antiplatelets
Clotting factor deficiency
Thrombocytopenia

Semester 3 (94 decks)

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