Limb Weakness 2 Flashcards
Why might the weakness be greater in arm and face than the leg? Which arteries supply these?
- ACA: supplies leg and foot primary motor cortex
- MCA: supplies rest of primary motor cortex
- so MCA affected in stroke
What else does the MCA supply?
right posterior paritetal cortex, where damage can cause a contralateral hemineglect
If the signs resolve in less than 24hr what is it?
TIA not stroke
What are the first line investigations for suspected right sided MCA stroke?
- Non contrast CT head
- FBC
- Blood glucose
- Blood clotting
- ECG
Why would you do a non-contrast CT head?
- determine if stroke is ischaemic or haemorrhagic
2. Help rule out other diagnosis
Why do you do a FBC?
can show cause for arterial occlusion (e.g. polycythaemia, thrombocytosis) or heamorrhage (thrombocytopenia)
Why do you measure blood glucose?
rule out hypoglycaemia
Why do you measure blood clotting?
esp if patient on warfarin - also to exclude haemophilia or coagulopathy
Why do you do an ECG?
looking for AF as cause of emboli
Which type of stroke is more common?
ischaemic (80%)
Why is it important to know if ischaemic or haemorrhagic stroke?
ischaemic potentially treatable with thrombolysis e.g. tPA
What is an ischaemic stroke caused by?
embolism or in situ thrombosis occluding a cerebral artery
How would you manage a haemorrhagic stroke?
suppportive therapy to aid rehabilitation and RF reduction
What is the acute management of MCA ischaemic stroke outside of the 4.5hr window for thrombolysis?
- antiplatelet drugs
- stroke unit/specialist ward
- VTE prophylaxis
Which antiplatelet drug do you prescribe?
aspirin - as soon as confirmed ischaemic stroke but delayed 24hr is thrombolysis given