More Stroke Flashcards
What does the CHADS-VASc score measure
Risk of embolic stroke with chronic AF
What does the HAS-BLED score measure
Risk of bleeding with long term anticoagulation in chronic AF
Score for CHADS-VASc
CCF (1) HTN (1) Age - 65-74 (1) Age - >74 (2) Diabetes (1) Previous stroke/TIA/thromboembolism (2) Vascular disease (1) Female (1)
Score for HAS-BLED
All 1: HTN Abnormal liver function Abnormal renal function Age >65 Previous stroke Previous major bleeding Labile INR Alcohol >8 drinks per week Drugs - anticoagulation, antiplatelets, NSAIDs
What CHADS-VASc score should prompt starting a DOAC
1 for male
2 for female
What HAS-BLED score should prompt alternatives to anticoagulation
3 or over
Contraindications for thrombolysis (10)
Haemorrhagic stroke >4.5 hours since onset Anticoagulation Bleeding in non compressible site Peptic ulcer disease Major surgery <1 month Ischaemic stroke <1 month Head injury <16 year old CPR <24 hours
What drug is used in thrombolysis and what route
Alteplase (tissue plasminogen activator)
10% IV injection
90% IV infusion
Definition of stroke
Acute onset of focal neurological deficit (negative symptoms) attributable to vascular cause
In a specific vascular territory
Risk factors for stroke (10)
Obesity Smoking Hypercholesterolaemia HRT/COCP Diabetes mellitus AF Anticoagulation Antiphospholipid syndrome PKD Carotid artery atherosclerosis
What are the categories of oxford stroke classification
Total anterior circulation stroke
Partial anterior circulation stroke
Posterior circulation stroke
Lacunar stroke
Criteria for TACS
All 3:
Unilateral muscle weakness or sensory loss in face, arm and leg
Contralateral homonymous hemianopia
Higher cerebral dysfunction (aphasia or neglect)
Criteria for PACS
2 out of 3:
Unilateral muscle weakness or sensory loss in face, arm and leg
Contralateral homonymous hemianopia
Higher cerebral dysfunction (aphasia or neglect)
Criteria for POCS
1 of: Contralateral homonymous hemianopia Cortical blindness CN palsy with contralateral muscle weakness or sensory loss Loss of consciousness Cerebellar symptoms
Criteria for LACS
1 of:
Isolated sensory loss
Isolated muscle weakness in 2/3 of face, arm or leg
What does the NIHSS score measure
Quantify impairment of stroke
What does the modified Rankin scale measure
Degree of dependence of a patient following a stroke
Investigations of stroke
History and examination Baseline observations Capillary blood glucose Bloods - FBC, U+E, LFTs, clotting, lipid profile ECG CT head
Drug management of ischaemic stroke
Thrombolysis if not CI
Aspirin 300mg OD started 48 hours after thrombolysis for 14 days
When stopped aspirin, start clopidogrel 75mg OD
Start statin
Management of ischaemic stroke
Drugs Manage risk factors ICA stenosis >70% need carotid endarterectomy within 2 weeks OT/PT SALT Screen for depression Monitor bowel and bladder
Management of haemorrhagic stroke
Lower BP
Reverse high INR (vitamin K, octaplex)
Stop anticoagulants
Surgery to clamp aneurysm
Scoring system for TIA
Age 60 or over (1) BP 140/90 (1) Clinical features: - unilateral muscle weakness (2) - speech disturbance (1) Diabetes mellitus (1) Duration: - >1 hour (2) - 10-59 minutes (1)
What TIA score needs CT head and referral to TIA clinic within 24 hours
4 or above
Definition of TIA
Ischaemic neurological event with symptoms lasting <24 hours
Risk factors for TIA
Carotid atherosclerosis AF Hyperviscosity e.g polycythaemia Coagulopathy Hypertension Obesity Diabetes Smoking
Management of TIA
Modify risk factors
14 days 300mg aspirin OD then lifelong 75mg clopidogrel OD
Start statin
No driving for 1 month
Notify DVLA if multiple TIAs (no driving for 3 months)
