L 43 Flashcards
3 types of ischaemic stroke (normal 2 + another)?
Thrombotic, embolic
+ Transient
2 types of haemorrhagic strokes
Intracerbral (ICH) and subarachnoid (SAH)
What do these stand for: “A stroke = CVA = CVAE”
A stroke = cerbrovascular accident = cerebrovascular adverse event
ACS and angina are types of … which are … … rich clots
ACS and angina are types of IHD which are white platelet rich clots
DVT and PE are types of… which are … … rich clots
DVT and PE are types of VTE which are red fibrin rich clots
Along with heart disease, stroke is the … cause of death and disability in NZ
Along with heart disease, stroke is the leading cause of death and disability in NZ.
Around 25% of ischaemic strokes are …
Around 25% of ischaemic strokes are embolic
Biggest modifiable risk factors for stroke (without history)
Cigarette smoking and hypertension
Sudden stroke signs and symptoms x5
- Weakness/numbness of face/arm/leg on one side
- Blurred or loss of vision in one or both eyes
- Dysarthria or aphasia
- Sudden dizziness, loss of balance, difficulty controlling movements
- Headaches (more common in haemorrhagic stroke)
Stroke complications x4
- Mortality
- Permanent loss of function
- Long term: impaired vision/speech, hemiparesis, limb hemiplagia, dysphagia, memory loss, depression.
Hemiparesis
Severe weakness on one side of body
Hemiplegia
Paralysis of one side of the body
Stroke diagnostics x6
- Clinical assessment
- Blood glucose
- Platelets and coagulation screen
- Head CT to rule out haemorrhagic stroke
- Head MRI to show area and extent of ischaemia
- ECG (especially if at risk of AF)
Principles of stroke treatment x4
Prevention of stroke
Quick recognition, treatment, and propagation prevention
Brain recovery and rehabilitation
Secondary prevention (HTN, AF etc)
NP treatments for stroke (similar to IHD) x6
- Nutritional advice
- Regular physical activity and weight loss
- Moderation of alcohol consumption
- SMOKING CESSATION!
- Surgery (reperfuse brain or repair damaged vessel)
- Brain recovery and rehab (physio, speech, occupational therapy)
Short term treatment strategy for ischaemic stroke (4.5h-24h)
- Revascularisation (thrombectomy or fibrinolytics) !!!!
- IV DHP CCB only if BP >220/120 mgHg (don’t do if diastolic <80 as will be too low).
- Antiplatelets (e.g aspirin +/- clopidogrel), 24 hours after alteplase therapy.
What does TIME IS BRAIN mean
Every minute that the stroke is not treated, more of the brain is getting damaged.
Long term treatment strategy for ischaemic stroke
Reduce risk factors AND…
If cardioembolic warfarin (or dabigatran or rivaroxaban)
If non-cardioembolic aspirin (+ dipyridamole) or clopidogel
+ moderate/high intensity statin
+ ACEI +/- thiazide, ARB or CCB if BP >140/90mmHg
Cardioembolic
Stroke due to blood clot in the heart traveling to the brain.
Why are the treatments different for cardioembolic or non-cardioembolic strokes?
Because with a cardioembolic stroke, the blood will be stagnating and causing red clots, therefore you need anticoagulants not antiplatelets.
Anticoagulants are used to treat:
Red clots, fibrin rich. They reduce fibrin formation to prevent clots from forming and growing.
Antiplatelets are used to treat:
White clots, platelet rich. They prevent platelets from clumping together and therefore prevent white clots from forming.
Following an ischaemic stroke, you want to get the patient’s LDL to be below …
2mmol/L
Which type of stroke is more common and largely preventable?
Ischaemic stroke
What is primary prevention of ischaemic stroke?
Management of HTN, smoking and AF.
Treatment summary for ischaemic stroke:
PROMPT TREATMENT!
- Reperfursion through alteplase or mechanical reperfusion
- Antiplatelet therapy lifelong + high dose statin + BP management
- Brain recovery and rehabilitation
