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Exam 1- GI and CVD > Cerebrovascular accident (STROKE) > Flashcards

Cerebrovascular accident (STROKE) Flashcards

1
Q

What are the main types of stroke?

A
  • Ischaemic
  • Haemorrhagic- splits into intracerebral haemorrhagic and subarachnoid haemorrhagic
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2
Q

What percentages of occurrence of each type of stroke?

A
  • Ischeamic- 85%
  • intracerebral haemorrhagic- 10%
  • Subarachnoid haemorrhagic- 5%
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3
Q

What is a transient ischaemic attack (TIA)?

A

An acute loss of focal cerebral or ocular function with symptoms that last LESS than 24 hours (symptoms usually resolve within minutes to a few hours)>

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4
Q

What is the difference between the two types of haemorrhage stroke?

A
  • Intracerebral hemorrhage- is when blood vessels bleeds into the deep cerebral tissue of the brain
  • Subarachnoid haemorrhage- when a blood vessel on the surface of the brain bleeds into the subarachnoid space
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5
Q

What is the difference in incidence of strokes between black and white people?

A

Black people are almost 2x more likely to have a stroke

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6
Q

What are the risk factors for ischaemic stroke?

A

smoking
alcohol use
inactivity
poor diet
hypertension
cardiac disease e.g. atrial fibrillation, heart failure
dyslipidaemia
diabetes
migraines
increasing age
Male
family history of TIA or stroke
Previous stroke/TIA

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7
Q

What are the risk factors for haemorrhagic stroke?

A

Hypertension
male
smoking/drugs
diabetes
anticoagulant use
head injury

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8
Q

What are some of the causes of an ischaemic stroke?

A
  • Atherosclerosis
  • Carotid embolism
  • Arterial stenosis
  • Hypercoagulable stress
  • Arterial dissection
  • Vasoconstriction associated with substance misuse
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9
Q

What are some of the causes of a intracerebral haemorrhagic stroke?

A
  • Hypertension
  • Vessel abnormalities
  • Bleeding disorders
  • Vasculitis
  • amyloid angiopathy
  • Arteriovenus malformations
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10
Q

What are some of the causes of a subarachnoid haemorrhagic stroke?

A
  • Aneurism- congenital or due to high blood pressure
  • Arteriovenous malformations
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11
Q

What is atrial fibrillation?

A

AF is a cardiac arrhythmia in which the atria contract rapidly but not all pulses are passes from the atria to the ventricles by the AV node. This leads to irregular and incomplete contraction.
This causes turbulent blood flow and blood stasis in the heart which increases the risk of an embolus formation

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12
Q

What is a haemorrhagic transformation?

A

A haemorrhagic transformation can occur in up to 6% of ischaemic stroke patients and is when patients will suffer an ischaemic stroke and then also a brain haemorrhage

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13
Q

What are the factors that increase risk of a haemorrhagic transformation?

A
  • If the ischaemic stroke was cardioembolic
  • The larger the infarct size
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14
Q

What is the difference between arterial thrombosis and an arterial embolism?

A
  • Arterial thrombosis- when a thrombus forms in an artery that supplies the brain with blood and oxygen. this is commonly caused by atherosclerotic plaques that rupture, leading to the formation of clots
  • Arterial embolus- Thrombus/debris accumulates at a site away from the brain. Then a part or all of this is dislodged and travels to the brain and forms a blockage.
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15
Q

What is an arterial thrombosis?

A
  • Arterial thrombosis- when a thrombus forms in an artery that supplies the brain with blood and oxygen. this is commonly caused by atherosclerotic plaques that rupture, leading to the formation of clots
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16
Q

What is an arterial embolism?

A
  • Arterial embolus- Thrombus/debris accumulates at a site away from the brain. Then a part or all of this is dislodged and travels to the brain and forms a blockage.
17
Q

What is a TIA?

A

Transient ischaemic attack
- Is like a mini stroke
- Similar symptoms but they resolve quickly

18
Q

Symptoms of an ischaemic stroke

A
  • Weakness- can affect half of the body, or all (more rare- paresis)
  • Loss of sensation in one side of body
  • Facial droop
  • Blindess
  • Dysarthria- difficulty articulating words
  • Ataxia- failure of muscle coordination
  • dysphagia
  • confusion
  • headache
19
Q

What does FAST stand for?

A

FACE weakness, can they smile?, is it droopy
ARM- can they raise both arma
SPEECH- can they speak clearly, do they understand
TIME- call 999

20
Q

What is important regarding medication/nutrients in a suspected stroke patient?

A

All suspected stroke patients should be made ‘NIL by mouth’ until they have had a SALT assessment (should be within 4 hours of admission)

21
Q

Why is brain imaging important in determining a stroke?

A

CT scan can determine between an ischaemic and a haemorrhagic stroke
- In a haemorrhagic stroke- we wouldn’t want to give thrombolysis or aspirin

22
Q

What tests need to be done on the arrival of a stroke patient?

A

BP, oxygen sat, temp
Blood glucose- symptoms may be related to hypoglycaemia?
Clotting- APTT, INR- determine bleeding risk
ECG- determine any arrythmias
Fasting lipids-likeliness of atherosclerois
Blood culture- infection?
FBC- thrombocytosis? leukaemia?
urea and electrolytes

23
Q

How is the severity of the stroke determined?

A

Using NHS stroke scale (NHSSS)

SCORES:
0 = no stroke
1-4= minor
5-15 = moderate
16-20 = moderate-severe
21-42 = severe

24
Q

What is the immediate treatment for a patient with a TIA or minor stroke WITHOUT AF, within 24 hours of onset?

A

Dual anti-platelet therapy:
Clopidogrel 300mg STAT
Aspirin 300mg STAT
- Then 75mg of each OD for 14 days
Consider PPI
- Then, clopidogrel 75mg OD monotherapy (long-term antithrombotic)

For those that are not appropriate for dual antiplatelet, including those outside 24 hours of onset – clopidogrel 300mg STAT followed by 75mg OD

25
Q

When is thrombolysis used?

A

Once an ischaemic stroke has been confirmed
Thrombolyis with alteplase or tenecteplase to break up the clot may be used
- Patients should definitely be considered if treatment can be started within 4.5 hour of onset of symptoms
- if it has been between 4.5 and 9 hours and scan shows potential to salvage brain tissue = consider!!

  • Patients who are to have thrombolysis must have their blood pressure reduced to below 185/110 mmHg, before treatment.
26
Q

What must a patients blood pressure be before they can have thrombolysis?

A

Below 185/110 mm/Hg

27
Q

What must be given within 24 hours of having thrombolysis?

A

An anti-platelet

28
Q

What should all patients with a disabling acute stroke be given?

A

Aspirin 300mg OD for up to 2 weeks
At 2-week point, long term anti-thrombotics should be commenced:
- Anti-coagulation in form of a DOAC or warfarin and PPI (lansoprazole over omeprazole)

29
Q

Should statins be initiated immediately?

A

No- secondary prevention in the form of statins should be considered from 48 hours- any earlier has links to haemorrhagic transformation

30
Q

Does high blood pressure need to be reduced immediately in a stroke?

A

NO,
- Elevated BP is common following a stroke and usually resolves on its own after 4-10 days. Due to decreasing blood pressure = decreased blood flow to brain- but we want to preserve the penumbra as much ad possible- so held all anti-hypertensives until stable

Only necessary in the case of a hypertensive emergency (HT encephalitis, pre-eclampsia, HT cardiac failure) or to blow 185/110mmHg for thrombolysis
In this case, give CCB e.g. amlodipine or b-blocker e.g. labetalol

31
Q

What is a patients target BP if they’ve had a stroke?

A

<130/80 mmHg

32
Q

What Vte prophylaxis is recommended for a stroke patient?

A

Intermittent pneumatic compression on the legs within 3 days of admission

33
Q

Why are LMWH contra-indicated in stroke patients?

A

They propose a risk of intracerebral haemorrhage

34
Q

What lipid management therapy is offered to a patient following a stroke?

A

Lifestyle advice e.g. Diet, activity, weight loss, alcohol, smoking
- AND. a high-intensity statin e.g. Atorvastatin 80mg

35
Q

If patients have atherosclerosis, what is the aim for their fasting LDL levels?

A

Those with evidence of atherosclerosis, should aim to reduce fasting LDL- cholesterol to below 1.8 mmol/L.
▪ If this is not achieved by 4-6 weeks – discuss adherence/tolerability, optimise diet and lifestyle, optimise dose, consider adding ezetimibe 10mg OD.

36
Q

What is the recommendations for longterm anti-platelet use following a stroke?

A

1st line = clopidogrel 75mg OD
2nd line = (if clopidogrel contra-indicated) Aspirin 75,g OD

When to start:
- In minor stroke or TIA- after completion of dual anti-platelet therapy
- In severe/disabling stroke- after 2 weeks since onset of symptoms or at discharge (whichever is sooner)- follows on from aspirin 300mg

37
Q

What is recommended INR ratio for most patients?

A

2.5

38
Q

What does NICE recommend for secondary stroke prevention in terms of anti-coagulants?

A
  • First line = DOACs
  • Second = warfarin

Exam 1- GI and CVD (43 decks)

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