Stroke Flashcards
What is a CVA?
Cerebrovascular accident
Sudden interruption to the blood supply of the brain
What are the broad types of stroke?
Ischaemic
Haemorrhagic
What is a TIA?
Transient ischaemic attack
Symptoms of a stroke that resolve within 24 hours
What are risk factors for a stroke?
HTN DM Hyperlipidaemia AF Previous stroke/TIA Anticoagulation therapy
What tools can be used for stroke assessment?
FAST
ROSIER (recognition of stroke in emergency room)
NIHSS
What classification system is used for stroke?
Oxford
What are the different types of stroke under the Oxford classification system?
TACs
PACs
LACs
POCs
What are the features of a TACs?
Total anterior circulation
Sensory or motor loss
Homonymous hemianopia
Higher cognitive dysfunction
What are the features of a PACs?
Partial anterior circulation
2 of
- Sensory or motor loss
- Homonymous hemianopia
- Higher cognitive dysfunction
What are the features of a LACs?
Lacunar (internal capsule, thalamus, basal ganglia)
1 of
- pure motor
- pure sensory
- pure sensorimotor
- ataxic hemiparesis
What are features of a POCs?
Posterior circulation
1 of
- ipsilateral CN palsy + contralateral motor/sensory deficit
- bilateral sensory/motor deficit
- cerebellar signs
- brainstem syndrome
- isolated homonymous hemianopia
How should suspected strokes be investigated?
BM - rule out hypoglycaemia
CT - rule out haemorrhage
ECG - AF
Carotid USS
When shoudl carotid disease be managed?
Blockage >50% + symptomatic
How is carotid disease managed?
Carotid endarterectomy
How can ischaemic strokes be managed?
Thrombolysis
Thrombectomy
Anti-platelets
What thrombolysis agent is used?
Alteplase
IV by weight
When can thrombolysis be given?
Within 4.5 hours of onset of stroke
What are contraindications for thrombolysis?
Previous ICH Seizure with onset of stroke Intracranial neoplasm Stroke/TBI in previous 3 months LP in previous 7 days GI haemorrhage in previous 3 weeks Active bleeding Pregnancy BP >200/120
What are the indications for thrombectomy?
Within 6 hours of stroke onset
Large vessel occlusion seen on MRA/CTA
NIHSS >6
What anti-platelet agents are used in ischaemic stroke?
300mg aspirin OD for 2 weeks
Then clopidogrel 75 mg PO OD
How are haemorrhagic strokes managed?
BP control
+/- neurosurgery
What stroke secondary prevention is used?
BP control
Statins
DM control
Who is involved in stroke rehab?
PT
OT
SALT
Dieticians
