stroke Flashcards
features
motor weakness speech problems - dysphasia swallowing problems - dysphagia homonoymous hemianopia balance problems
features of cerebral hemisphere infarcts
contralateral hemiplegia
contralaterol sensory loss
homonymous hemianopia
dysphagia
features of brainstem infarction
quadriplegia
locked in syndrome
lacunar infarcs
small infarcts around basal ganglia, internal capsule, thalamus and pons
lacunar infarct features
pure motor, pure sensoyr, mixed motor + sensory or ataxia
total anterior circulation infarct - what vessel
involves middle and anterior cerebral arteries
total anterior circulation infarct - criteria
3/3 of
- unilateral hemiparesis and/or hemisensory loss
- homonymous hemianopia
- higher cognitive dysfunctio ne.g. dysphasia
partial anterior circulation infarct - which vessels
involves smaller arteries of anterior circulation
e.g. upper or lower divisions middle cerebral artery
partial anterior circulation infarct - criteria
2/3 of
- unilateral hemiparesis and/or hemisensory loss
- homonymous hemianopia
- higher cogntive funciton decline e.g. dysphasia
Lacunar Infarcts - which vessels
perforating arteries around internal capsule, thalamus and basal ganglia
lacunar infarcts - criteria
1 of
- unilateral weakness (and/or sensory deficit)
- pure sensory stroke
- ataxic hemiparesis
posterior circulation infarcts - which vessel
involves vertebrobasilar arteries
posterior circulation infarcts - criteria
1 of
- cerebellar or brainstem syndromes
- loss consciousness
- isolated homonymous hemianopia
haemorrhagic stroke - more likely to have
decrease level of consciousness
headache
N&V
seizure
Ix
need emergency neuroimaging
CT
MRI
Mx ischamic strokes
thrombolysis
aspirin 300mg
Mx TIA
aspirin 300mg unless contraindicated
what is given as thombolysus
alteplase
thrombolysis should only be given if
- administered within 4.5hrs of onset stroke symptoms
- haemorrhage definitevly excluded i.e imaging
absolute contraindication to thrombolysis
- prev intracranial haemorrhage
- seizure at stroke onset
- intracranial neoplasm
- suspected SAH
- stroke/traumatic brain injury last 3mo
- LP in last 7 days
- GI bleed last 3wks
- active bleeding
- pregnant
- uncontrolled htn 200/120
relative contraindications to thrombolysis
- concurrent anticoagulation INR >1.7
- haemorrhagic diathesis
- active diabetic haemorrhagic retinopathy
- suspectedintracardiac thrombus
- major surgery/trauma last 2wks
when to offer thombectomy within 6hrs + IV thrombolysis
acute ischaemic stroke
confirmed occlusion of proximal anterior circulation by CTA or MRA
offer thrombectomy ASAP to people …
last known to be well between 6-24hrs ago
confirmded occlusoin proximal anterior circulation
potential to salvage brain tisssue
2ry prevention
clopedigrol
