Ischaemic stroke Flashcards
What is ischaemic stroke?
A sudden onset focal neurological deficit of vascular aetiology.
Sx last >24 hours (or with evidence of infarction on imaging).
Causes of ischaemic stroke?
- blood supply in a cerebral vascular territory is reduced secondary to stenosis or complete occlusion of a cerebral artery.
A thrombus or embolus
Atherosclerosis
Shock
Vasculitis
RFs of ischaemic stroke?
age, male sex, FHx of ischaemic stroke, HTN, smoking, DM, and AF
hypercholesterolaemia, obesity, poor diet, oestrogen-containing therapy, and migraine.
Vasculitis
Thrombophilia
Combined contraceptive pill
Presentation of ischaemic stroke?
Limb weakness
Facial weakness
Dysphasia (speech disturbance)
Visual field defects
Sensory loss
Ataxia and vertigo (posterior circulation infarction)
How is stroke categorised?
Ischaemic or haemorrhagic
Management of acute ischaemic stroke?
AA-E approach
CT must be done immediately (distinguish ischaemic or haemorrhagic stroke)
- if unclear, do diffusion weighted MRI.
Thrombolysis (IV bolus of Alteplase) -if presenting with 4.5hours of symptom onset.
Mechanical Thrombectomy -anterior circulatory stroke.
Aspirin 300 mg OD for 2wks
Management of post-acute ischaemic stroke?
In ischaemic stroke:
- carotid US
- CT/MR angiography (identify intracranial and extracranial stenosis)
- echocardiogram (cardio-emboli susepcted)
In haemorrhagic stroke:
- serum toxicology screen
Assess RFs:
- serum glucose and lipids
Long term management of ischaemic stroke?
Start anti-hypertensive meds 2wks after stroke.
Antiplatelet therapy:
- Clopidogrel 75 mg OD long term
- Warfarin (ischaemic stroke secondary to AF)
Atorvastatin 20-80 mg
Lifestyle modification
Surgery for ipsilateral carotid artery stenosis.
Rehabilitation and supportive management
- physiotherapy
- occupational therapy
- speech and language therapy
- neurorehabiliation.
