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OPIC > Stroke > Flashcards

Stroke Flashcards

1
Q

What is an ischaemic stroke

A

A clot blocks blood flow to an area of the brain

Ischaemia is reversible, infarction is not

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2
Q

What are the stages of infarction in stroke

A

Hyperacute (0 - 6 hours)

Acute (up to 7 days)

Subacute (up to 4 months)

Chronic (beyond 4 months)

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3
Q

How are hyperacute infarctions managed

A

IV thrombolysis (alteplase)

Do not give thrombolysis until haemorrhagic stroke has been excluded

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4
Q

Why is it important to get an uninhanced CT for suspected strokes

A

Highly sensitive for haemorrhage

See signs of stroke mimics

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5
Q

What are the early signs of infarction in CT

A

Hypoattenuation

Sulcal effacement

Obscuration and loss of grey matter

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6
Q

What is meant by potentially salvageable brain

A

Infract core area minus ischaemic penumbra

Thrombolysis only benefits ischaemic penumbra (no penumbra = no benefit)

Thrombolysis in large cores increases risk of secondary haemorrhage

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7
Q

What is catheter-guided intervention in strokes

A

Used to physically remove clots

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8
Q

What is haemorrhagic stroke

A

Bleeding inside or around brain tissue

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9
Q

What are the primary causes of haemorrhagic stroke

A

Hypertension

Cerebral amyloid angiopathy

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10
Q

What are the secondary causes of haemorrhagic stroke

A

Haemorrhagic transformation infarct

Tumours

Aneurysms

Vasculitis

Coagulopathies

Warfarin, aspirin

Cocaine, alcohol

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11
Q

What causes neurological deficits up to 72 hours after a haemorrhagic stroke

A

Continued bleeding

Oedema, brain swelling, mass effect

Raised intracranial pressure

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12
Q

What are the predictors of poor outcome for haemorrhagic stroke

A

Radiological signs (> 30 mls, intraventricular component, deep location, brainstem)

Clinical factors (>80, GCS < 9)

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13
Q

What is the management for haemorrhagic stroke

A

Neurosurgery

Clot reduction, decompression craniotomy

Intraventricular shunting for hydrocephalus

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14
Q

What are the causes of anticoagulant haemorrhagic strokes

A

Heparin

Warfarin

Thrombolysis

Antiplatelets

Alcohol abuse

Chemotherapy

Coagulopathies

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15
Q

Give an overview of extradural haemorrhages

A

Young men

Acute presentation

90% have skull fracture

Biconcave, hyperdense

Limited by sutures

Blood between bone and meningeal dura

Bleeding from meningeal vessels or dural sinus

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16
Q

Give an overview of subarachnoid haemorrhages

A

Bleeding into subdural space

Bloods spreads around brain

Convex

Bleeding from torn bridging veins or lacerations

At extremes of age (elderly have atrophy, children have interhemispheric fissure)

Crescent shape

Not hyper-dense

17
Q

What are the elements of post-stroke secondary prevention

A

Lifestyle modification (smoking cessation, healthy weight, decrease alcohol, aerobic exercise)

Antithrombotic therapy (clopidogrel, aspirin, anticoagulate AF (warfarin, DOACs))

Risk factor modification

Address specific causes

18
Q

What are the 5 Rs of rehabilitation

A

Realisation of potential

Reablement

Resettlement

Role fulfilment

Readjustment

19
Q

What is early supported discharge

A

Hospital level of therapy at home

Reduces average stay by 8 days

20
Q

What is the rehab transfer criteria

A

Medically stable

Need no more than 24% oxygen

NG established with no risk of refeeding

Consultant review twice per week

21
Q

What are the positive prognostic factors in stroke rehabilitation

A

Absence of coma

Early motor recovery

Continence

22
Q

What are the poor prognostic factors in stroke rehabilitation

A

Severe communication deficit

Old age

Incontinence

Neglect

No leg movements at 2 weeks

Severe upper limb weakness at 4 weeks

23
Q

What are the main problems during rehab

A

Aphasia and dysarthria

Impaired swallowing

Malnutrition

Impaired balance and walking

Fatigue

Incontinence

Spasticity and contractures

Altered sensation

Mouth care

Cognitive impairment

Anxiety and depression

Neuropathic pain

24
Q

What are the non-pharmacological management strategies for incontinence

A

Timed toileting

Review caffeine intake

Medications review

Bladder retraining

Pelvic floor exercises

Minimise constipating drugs

Oral laxatives

25
Q

What are the indications for alteplase

A

Must be given within 4.5 hours

Disabling impairment

No contraindications

26
Q

What are the absolute contraindications for alteplase

A

Blood pressure > 185/110

Surgery or trauma within last 14 days

Stroke within last 14 days

Active intracranial bleeding

Severe haematological abnormalities

INR > 1.7

On DOACs

On high dose LMWH

Platelets < 50

Symptoms of subarachnoid haemorrhage

Labour within last 4 weeks

Acute pancreatitis

Severe liver disease

27
Q

What are the complications of thrombolysis

A

Evolution of stroke causing raised ICP

Seizures

Infection

Metabolic disturbance

Extracerebral haemorrhage

Intracerebral haemorrhage

28
Q

Name some stroke assessment tools

A

National institute of health stroke scale (NIHSS)

Alberta stroke programme early CT score (ASPECTS)

Oxford community score project (OCSP) classification

TOAST classification

ABCD2

29
Q

How is a lacunar infarct (LACI) classified

A

Pure motor stroke

Pure sensory stroke

Sensori-motor stroke

Ataxic hemiparesis

30
Q

How is a total anterior circulation infarct (TACI) classifies

A

Higher cerebral dysfunction

Homonymous visual field defect

Ipsilateral motor and/or sensory deficit

Affecting 2 of face, arms, legs

31
Q

How is a partial anterior circulation infarct (PACI) classified

A

2 components of TACI

Higher cerebral dysfunction alone

Motor/sensory deficit more restricted than in LACI

32
Q

How is a posterior circulation infarct (POCI) classified

A

Ipsilateral cranial nerve palsy with contralateral motor/sensory deficit

Bilateral motor/sensory deficit

Disorder of conjugate eye movement

Cerebellar dysfunction

Isolated homonymous visual field defect

33
Q

What are the categories of the TOAST classification

A

Large artery atherosclerosis

Cardio-embolic

Small vessel disease

Other determined

Undetermined

34
Q

What is the ABCD2

A

Shows risk of stroke after a TIA

Age, blood pressure, clinical features of TIA, duration, diabetes

OPIC (4 decks)

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