Cerebrovascular Accident (CVA) Flashcards
What is the definition of stroke?
- Ischaemia or infarction of brain tissue secondary to inadequate blood supply
- Intracranial haemorrhage
What is the blood supply to the brain?
What is the pathophysiology of haemorrhagic stroke?
- Sustained HTN leads to haemorrhage deep within the brain as blood vessels can’t cope with the pressure
What is the pathophysiology of ischaemic stroke?
- Embolism (various origins), thrombus, atherosclerosis, shock and vasculitis
- After strojke excitotoxicity occurs (release of glutamate vesicles from synapse increases Ca2+ and Na moves through glutamate receptors, as Na moves so does water and cells can burst)
- Ca2+ also causes release of enzymes and can get a cytotoxic and free radical storm contributing to the damage
What are the criteria of the NIHSS?
- 0 = No stroke symptoms
- 1-4 = Minor stroke
- 5-15 = Moderate stroke
- 16-20 = Moderate to severe stroke
- 21-42 = Severe stroke
What are the features of a Total Anterior Circulation Syndrome (TACS) on the Oxford Community Stroke Project Classification and which arteries are likely to be occluded?
- Hemiparesis + higher cortical dysfunction + hemianopia
- Usually proximal MCA or ICA occlusion
What are the features of a Partial Anterior Circulation Syndrome (PACS) on the Oxford Community Stroke Project Classification and which arteries are likely to be occluded?
- Isolated higher cortical dysfunction OR any 2 of hemiparesis, higher cortical dysfunction, hemianopia
- Usually branch MCA occlusion
What are the features of a Posterior Circulation Syndrome (POCS) on the Oxford Community Stroke Project Classification and which arteries are likely to be occluded?
- Isolated hemianopia or brainstem syndrome
- Can include perforating arteries, PCA or cerebellar arteries
What are the features of a Lacunar Syndrome (LACS) on the Oxford Community Stroke Project Classification and which arteries are likely to be occluded?
- Pure motor stroke OR pure sensory stroke OR pure sensorimotor stroke OR ataxic hemiparesis OR clumsy hand-dysarthria
- Perforating artery/small vessel disease
Management of stroke
- Admit to specialist stroke centre
- Exclude hypoglycaemia
- Immediate CT brain to exclude primary intracerebral haemorrhage
- Aspirin 300mg stat after CT for 2 weeks
- Thrombolysis with Alteplase (tissue plasminogen activator) within 4.5hrs of onset - monitor for haemorrhage post-administration
- Prevention:
- Aspirin (or other antiplatelet)
- antihypertensive
- cholesterol lowering
- warfarin and DOACs (in AF)
- carotid endartectomy (for carotid artery stenosis)
Blood supply to the brain
Risk factors for stroke
- CV disease
- Previous TIA or stroke
- AF
- CAD
- HTN
- DM
- Smoking
- Vasculitis
- Thrombophilia
- COCP
FAST tool for identifying stoke in the community
- Face
- Arm
- Speech
- Time (act fast and call 999)
ROSIER tool for recognition of stroke in the ED
- Anything above a 0 indicated stroke likely
- Scored on:
- LOC
- Seizure activity
- Asymmetric facial weakness
- Asymmetric arm weakness
- Asymmetric leg weakness
- Speech disturbance
- Visual field defect
Stroke rehabilitation
- Nurses
- SALT
- Nutrition and dietetics
- PT
- OT
- Social services
- Optometry and ophthalmology
- Psychology
- Orthotics
