Stroke Flashcards
What is a stroke?
Acute and sudden onset of symptoms.
Focal neurological deficit not global.
Pattern of symptoms and signs attributable to one part of the brain and a particular vascular system.
What is a TIA?
Explain
Transient Ischaemic Attack (TIA)
It is a brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia:
symptoms typically less than an hour, without evidence of infarction.
How does a TIA differ from a stroke?
It differs only in duration.
How long does a TIA last?
Typically less than an hour.
Many patients with TIA’s lasting more than 2 hrs will have infarction on MRI scan.
Requires urgent assessment as many high risk for full CVE (full cardiovascular events).
What are transient focal neurological events?
Focal fit/partial seizure, transient global amnesia, demyelination, hypoglycaemia, peripheral nerve compressions migraine.
When should TIA patients be assessed?
Within 1 week,
24 hrs if high risk.
23% strokes preceded by TIA, 17% same day, 9% day before, 40% in 7 days prior to stroke.
What is the most severe form of stroke?
TACS > PACS > LACS
TACS >50% dead at 90 days.
What is TACS?
which artery?
Total anterior circulating syndrome
Extensive middle cerebral artery infarct
What are the signs of TACS?
All of:
- Unilateral weakness (+/or sensory deficit) or face, arm and leg.
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder).
What is PACS?
Partial anterior circulating syndrome
Branch of middle cerebral area infarct
What are the signs and symptoms of TACS?
Any 2 of the 3 components of TACS:
- Unilateral weakness (+/or sensory deficit) of face, arm and leg.
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
DYSPHASIA ALONE
What is LACS?
Lacunar syndrome
Tiny deep infarcts usually silent (80%)
What are the signs and symptoms of LACs?
One of:
a. unilateral weakness of face and arm, arm and leg or all three
b. pure sensory stroke
c. ataxic hemiparesis
What is POCS?
Posterior circulating syndrome
What are the signs and symptoms of POCS?
One of:
- Cerebellar or brainstem syndromes.
- Loss of consciousness.
- Isolated homonymous hemianopia.
What is ABCD^2 score?
Age, BP, Clinical symptoms, Duration, Diabetes
It predicts stroke at 2 days
Age >60 yrs SBP >1400 mmHg or DBP >90mmHg speech impairment unilateral weakness duration 10-59 mins duration > 60 mins diabetes
What are the risk factors of stroke?
- hypertension
- diabetes
- smoking
- hyperlipidaemia
- carotid stenosis
- atrial fibrillation
What is the single most important modifiable risk for stroke?
Hypertension. risk of stroke 2-4x risk. risk doubles every 7.5mmHg Small reduction in BP results in large reductions in recurrence of stroke. aim 140/85. diabetic 130/80
How do you treat a stoke?
Thrombolysis:
IV tPA within 4.5hrs of ischaemic stroke.
IV tPA = Intravenous tissue plasminogen activator.
Requires CT to exclude haemorrhage.
Acute treatment:
General medical care of STROKE UNIT.
if infarct aspirin 300mg OD.
pressure sore prevention/TED stockings. Hydration and nutrition. Antipyretic. Active glucose monitor.
What is a stroke unit?
Hydration, nutrition, handling, pressure, continence, early mobilisation, fever (<38) glucose (<10mmols/L), oxygen, TED stockings, vigilant observations for complication.
> prevents complications e.g. pneumonia, infections and early recurrence (aspirin)
> control blood glucose and body temp
> avoid aggressive BP lowering
What is secondary prevention of a stroke?
Thromboprophylaxis Hypertension Cholesterol management, Glucose management Rhythm Carotid stenosis
Antiplatelet therapy:
- clopidogrel
- aspirin combined with dipyridamole.
warfarin and NOACs - secondary prevention if AF or PAF
What are the oral manifestations related to stroke?
Related to antihypertensive drugs
- xerostomia
- gingival hyperplasia
- lichenoid reaction
- cough and/or loss/alteration of taste (aguesia/dysgeusia)
most antihypertensive drugs have drug interactions with LA and analgesics,
What is the most important modifiable risk factor for stroke?
Hypertension
What scoring system is used to predict stroke risk?
ABCD^2
Regarding Bamford classification of strokes, which type of stoke would result from an extensive middle cerebral artery infarction?
TACS
Using Bamford classification of strokes, which is the most common type of stroke?
PACS
PACS>LACS>POCS>TACS
Using Bamford classification of strokes, which type of stoke would be associated with nystagmus, unsteady gaits and acute visual loss?
POCS
Regarding Bamford Classification, which stroke has the highest mortality rate at 90 days?
TACS
