ISCHAEMIC STROKE Flashcards
What is Ischaemic stroke
When a clot occludes the brain leading to ischaemia and infarction presenting focal symptoms and reversible oedema
How would you distinguish ischaemic stroke vs haemorrhage stroke
Urgent CT/MRI
How long does a stroke last
longer than 24 hours
<24 = TIA
What is the ischaemic penumbra
The area around the ischaemic event that can be reversed with thrombolysis as there is no necrosis
What are the causes of IS
Artherothromboembolism -From carotid = carotid bruit Cardioembolism -AF -Post MI -Valve disease Hyperviscosity and Hypoperfusion
What are the risk factors for IS
Age HTN Hyperlipidemia Smoking Diabetes AF TIA history
What is the classification system used in Stroke
Bamford/Oxford classification
- TACI (Total Anterior)
- PACI (Partial Anterior)
- LACI (Lacunar)
- POCI (Posterior)
How would you define a TACI (Total anterior)
Anterior and middle cerebral arteries
Contralateral Hemiplegia/hemiparesis
Contralateral Homonymous Hemianopia
Aphasia
How would define a PACI (Partial anterior)
Anterior OR Middle cerebral arteries
Any two TACI or Aphasia alone
How would you define a LACI (Lacunar)
Small deep arteries of internal capsule/thalamus
Purely motor/sensory or sensorimotor or ataxia
NO Vision defect/Aphasia/Brainstem dysfunction
How would you define a POCI (Posterior)
Vertrobasilar arteries supplying cerebellum, brainstem and occipital lobe
Cerebellar syndrome OR eye movement disorder OR bilateral sensorimotor deficit OR ipsilateral CN palsy OR cortical blindness/hemianopia
What are the presentations of a cerebral infarct
Contralateral Sensory loss (Hemiparesis) Contralateral Hemiplegia (Floppy limb) UMN facial weakness Dysphagia Hemianopia Spatial deficit
What are the presentations of a brainstem infarct
Quadriplegia (4 Limb paralysis) Numb face Dysarthria/Aphasia Vertigo/n+v "Locked in" aware with no movement - Basilar Coma
What are the presentations of a lacunar infarct
Sensory loss
Weakness
Ataxic Hemiparesis
Dysarthria
What is the immediate management of a patient with IS
IV Alteplase (4.5 hours) Aspirin if after
How would you manage a patient with IS
IV Alteplase (<4.5 hours) Antiplatelet therapy -300mg Aspirin for two weeks and then Clopidogrel If AF = DOAC (Rivoroxaban/apixaban) Mechanical Thrombectomy
What is the most specific sign of stroke
Pronator drift
-Arms to ceiling sees pronating on affected side (Palm faces down)
-Affected arm pronates(palms face down) when asked to lift them
How would you investigate stroke
NCCT Head
Ischemic= Normal
Haemmorhagic = HYPERDENSE BLOOD
What does a lacunar stroke affect
Lenticulostriate arteries supplying BG, Internal capsule, Thalamus, PONS….
What are the presentations of a patient with a stroke
Focal neurology depending on what is affected
Raised ICP
State the 4 results of Increased ICP
Increase pressure on skull, brain and vessels -> NECROSIS
CSF obstructed -> HYDROCEPHALUS
Midline shift -> TENTORIAL HERNIATION
Coning -> BRAINSTEM COMPRESSION
If a patient is on DOAC, what is the course of action when presented with stroke
Treat as haemorrhage until proven different
How do you manage a patient with haemorrhagic stroke
Neuro referral w/ IV mannitol
Atorvastatin with Ramipril
What is given to a patient to decrease ICP
IV Mannitol
What causes and ischaemic stroke
Blood vessel blockage by atherothrombo-embolism
What causes a haemorrhagic stroke
Ruptured blood vessel leading to reuced blood flow due to trauma, HTN and berry aneurysms
What type of stroke is most common
IS = 85%
HS = 15%
What are the two types of haemorrhagic strokes
Intracerebrlal = Bleeding in brain
Subarachnoid = Bleeding on brain surface
