Neuro 2 Flashcards
Alteplase MOA?
tissue plasminogen activator
breaks down clots
when can you do thrombectomy?
occlusion of
proximal anterior circulation
proximal posterior circulation
when can you anticoagulate as a secondary prevention if Afib?
2 weeks of aspirin
what is carotid endartectomy?
Plaque removal from carotid arteries which supply the brain
surgical
angioplasty
small ballon catheter to open up narrowed area
catheter inserted through groin or arm
guided to affected carotid
balloon inflated to widen narrowed artery and improve blood flow
> after this sometimes a stent can be placed inside the artery
MDT for stroke patients?
stroke physians
nurses
Speech and language therapists
phsyio
OT
psychology
2^ prevention of stroke
clopidogrel 75mg (aspirin nd dipyridamole)
atorvastatin 20-80mg delayed start 48 hours
BP /DM control
what GCS score needs airway support?
8 /15
risk of airway obstruction
aspiration
= hypoxia
brain injury
E?
out of 4
4) open
3) noise
2)pain
1) not open
Verbal response
5
5) orientated
4)confused
3) inappropriate words
sounds
2) incomprehensible
1) none
motor response
6) obey command
5) localised to pain
4) normal flex
3) abnormal flex
2) extention
1) none
stroke CT
with contrast or non contrast?
NON CONTRAST
> highly sensitive
> hyperdense - BRIGHT on a CT scan
> FAST
Extradural bleeds are concave?
false
biconvex
Extradural bleeds
bi convex
lucid > LOC
trauma / young pt
subdural haemorrhage
duar matar and arachnoid mater
rupture of bridging veins in the outermost meningeal layer
crescent shaped and not limited by the cranial sutures
intracerebral haemorrhage
into brain tissue
hyperdense : blood is BRIGHT
subarachnoid haemorrhage
bleed into subarchnoid space
CSF
rupture aneruysm
what are the mx principles for haemorrhagic strokes?
admit to a specialist stroke centre
consider surgical mx
intubation / ventilation / Intensive care is reducced GCS
HTN correct
clotting abnormality correct
surgical options
craniotomy
open surgery remove section of skull
surgical option for extradural / subdural bleed?
burr holes: small holes drilled into skull to drain blood
RF for subarchanoid haemorrhage?
45-70
women
black ethnic origin
HTN
smoking
alcohol
what does hyper attenuation on a CT mean?
acute bleed
BRIGHTER / WHITER
- increase xray absorption
- blood clots are denser
CT angiography in a subarachnoid bleed?
identifies cause of bleed
CT with iodinated contrast
IV line with contrast injection
hydrocephalus?
increased CSF
= expansion of ventricles
tx?
LP
external ventricular drain
ventriculoperitoneal shunt
