Stroke Flashcards
What is a stroke?
A syndrome of sudden onset local or global neurological symptoms caused cerebral tissue infarction
2 main causes of stroke?
- Ischaemic
2. haemorrhage (intracerebral or SAH)
Most common type of stroke?
Ischaemic (85% of cases)
What is an ischaemic stroke? What are the 3 main causes?
Occlusion of a cerebral blood vessel due to:
- thrombosis (atherosclerosis)
- embolic (from AF or carotid artery disease)
- dissection (intramural haematoma causes compromises cerebral blood flow)
Causes of haemorhagic strokes? (3)
- Hypertension (most common)
- Trauma
- brain tumour
Risk factors for stroke?
- Essentially these are CV risk factors:
1. Hypertension
2. Smoking
3. Obesity
4. Diabetes
5. Hypercholesterolaemia
6. Carotid artery disease
7. Sickle Cell
8. Thrombophillic disorders
What are the main blood vessels that supplies the brain?
- Anterior Cerebral
- Middle Cerebral
- Posterior Cerebral
What part of the brain is supplied by the ACA?
Part of the frontal lobe and parietal lobe
What part of the brain is supplied by the MCA?
Large portion of the lateral hemispheres, internal capsule, basal ganglia
What part of the brain is supplied by the PCA?
Occipital and inferior temporal
Classification system for ischaemic strokes?
Bramford and Oxford classification
How are strokes classified according to Bramford and Oxford classification? (4)
- TACS
- PACS
- LACS
- POCS
Typical clinical features of anterior circulation strokes? (4)
- facial weakness and sensory deficit
- limb weakness and sensory deficit
- higher cerebral dysfunction (dysphagia, visuospatial dysfunction)
- homonymous hemianopia (same side vision loss)
Typical clinical features of posterior circulation strokes?
- ataxia, dizziness
- visual field defects
- diplopia
- brainstem syndromes
- dysphagia, dysarthria
Types of brainstem syndromes? (2)
- Wallenburg syndrome (lateral medullary syndrome)
2. ‘Locked in syndrome’
Investigations for strokes?
- bedside - glucose, ECG (AF)
- bloods - FBC, U&Es, LFTs, bone profile, clotting, lipids, Hba1c
- CT head - differential between strokes
Management of ischaemic strokes?
- referral to hyperacute stroke unit
- determine type (CT head)
- thrombolysis (4.5 hours and NIHSS score between 5 and 26) or aspirin 300mg
- thrombectomy
Management of haemorrhagic strokes?
- Refer to neurosurgery
2. decompressive craniotomy
Medical management in the secondary prevention of strokes?
- Aspirin 300mg (24-48 hours after thrombolysis) for 2 weeks followed by Clopidogrel 75mg or Warfarin/DOAC in AF
- Statins (started 48 hours after stroke)
Management of patients who are not eligible for thrombolysis?
Aspirin 300mg for 3 weeks
Secondary management of strokes?
- medical management - Aspirin 300mg and Statins
- Rehabilitation - SALT, PT/OT, dieticians,
- Driving - stop for 1 month and inform DVLA (more if symptoms not resolved)
- Carotid artery assessment (doppler and endarterectomy or stenting)
What is a TIA?
Transient neurological symptoms due to ischaemia without infarction. Lasts <24 hours.
Management of a TIA?
- Referral to stroke specialist within 24 hours
2. start aspirin 300mg and other secondary prevention measures
