Neuro - stroke, MMA, VST + brain haemorrhages Flashcards
Def stroke
Acute focal neurological deficit
CV in origin
Persisting >24hrs
Def TIA
Acute focal neuro deficit persisting <1hr
No longlasting signs on MRI
Def amaurosis fugax
Sudden transient LOV in 1 eye
RF stroke - irreversible (4)
age
PMHx/FHx
Hyper-coagulable states
AF
RF stroke - reversible (8)
HTN Hypercholesterol DM Smoking Alcohol Poor diet/exercise Obese COCP
What are the 2 broad categories of stroke + prevelance
Ischaemic - 85%
Haemorrhagic - 15%
What is an ischaemic stroke due to
Arterial embolus from distal site
Or aa thrombosis from carotid/vertebral/basilar aa
What are the 2 types of haemorrhagic stroke
SAH - 5%
Intra-cerebral - 10%
Where has stroke happened in TACS
Proximal MCA occclusion
TACS
all 3 of:
High dysfunction
Homonous hemianopia
Hemiplegia + sensory loss
Where has stroke happened PACS
Distal MCA/or ACA occlusion
PACS
2/3 of:
High dysfunction, homonymous hemianopia, hemiplegia/sensory loss
Higher dysfunction alone
Where has stroke happened - LACS
Lacunar branch of MCA
LACS
2/3 of: face, arm, legs Pure motor Pure sensory Pure sensorimotor Ataxic hemiparesis
where has stroke happened - POCS
PCA occlusion
POCS
CN palsy + contralat deficit Bilat motor or sensory deficit Eye movement problems Cerebellar dysfunction Isolated homonous hemianopia
% who die from TACS in a year
60%
% dead from PACS in a year
15%
% dead from LACS in a year
10%
What is NHISS
15 item neuro exam assessing stroke on various levels
Ix stroke
Bloods - FBC, U+E, gluc, lpipids, coag, ESR
Imaging - MRI (gold standard)/ CT
ECG
Acute Mx stroke
A-E
Withold antiplatelets until CT headh
Arrange thrombolysis if <4.5hrs
Thrombolysis
Check C/I
Alteplase 0.9mg/kg 10% bolus 1 min
Remainder over 60 mins
What Mx stroke if thrombolysis C/I
300mg aspirin daily
2’ prevention stroke
lifestyle mods antiHTN therapy Aspirin 300mg od 2w Clopidogrel 75mg life statin LMWH stated day 3 post stroke
Non-pharma Mx stroke
SALT (assess within 2w)
physio
OT
Nursing + SSKIN
Driving + stroke
No driving 4 w
complications stroke
Malignant MCA syndrome DVT/PE Aspiration pneumonia P sores Depression Incontinence
What is malignant MCA syndrome?
Rapid neuro deterioration due to effects cerebral oedema
PS Malignant MCA syndrome
Incr aggression/restlessness
Decr GCS
Haemodynamic instability/thermal instability
Incr ICP
Mx malignant MCA syndrome
Decompressive hemicraniotomy
High risk features TIA (3)
Rec TIA
AF/TIA whilst anti-coag’d
ABCD score 4 or more