Stroke Flashcards
How many neurones die every minute until blood flow is restored in an acute stroke?
1.9 million
What is the NIHSS?
The National Institute of Health Stroke Scale
What is first line imaging in acute stroke?
CT head non-contrast
What hyperacute changes can be visualised on CT head in a stroke?
- Visualisation of a clot (as early as immediate)
2. Early parenchymal changes (early as 60 minutes post stroke)
What imaging allows us to definitively find the causative clot in acute stroke?
CT Angiography
What happens between the white and grey matter following an acute stroke?
There is loss of differentiation between the tissues which becomes obvious on CT head
When is the cut off for thrombolysis according to the most up to date evidence/guidance?
Thrombolyse within 4.5 hours of stroke onset
What are the 2 warning complications of thrombolysis in acute stroke?
- 6% risk of haemorrhage
2. 7% risk of angioedema
What medication do we give to thrombolyse?
Alteplase
What is the dose of alteplase?
0.9mg/kg IV infusion within 1 hour
What needs to be done before someone receives thrombolysis?
- Blood tests
- CT head
- Specialist review
What are the 2 strongest predictors of outcome in an acute stroke?
Age and stroke severity
What percentage of acute strokes are ischaemic?
85%
What percentage of acute strokes are haemorrhagic?
15%
How quickly must a patient recover from a “funny turn” to be classed as a Transient Ischaemic Attack?
Within 24 hours
What is a crescendo TIA?
2< episodes of TIA within 1 week -this needs urgent evaluation by a specialist
When a TIA is suspected by a GP, where should they refer the patient?
To a specialist TIA clinic to be seen in 24 hours
What should a patient with a suspected TIA be prescribed?
Aspirin 300mg
What investigations should be carried out in a TIA clinic?
- Blood glucose
- ECG
- Height, weight BMI
- Bloods: FBC, U&Es, LFT, lipids
- Carotid artery US doppler
What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; right posterior cerebral artery?
Affects; upper midbrain, occipital cortex, thalamus, medial temporal lobes
Causes; visual field defects, motor or sensory loss
What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; left posterior cerebral artery?
Affects; upper midbrain, occipital cortex, thalamus, medial temporal lobes
Causes; visual field defects, motor or sensory loss
What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; Right middle cerebral artery?
Affects; right left fronto-parietal cortex and subcortical structures
Causes; neglect, left motor and sensory deficits
What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; left middle cerebral artery?
Affects; left fronto-parietal cortex and subcortical structures
Causes; dysphasia, right visual field defect, right motor and sensory deficits
Weakness most likely in the face then the arm then the leg
What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; right anterior cerebral artery?
Affects; right frontal and parasagittal areas
Causes; behavioural changes, weakness (legs>arms)
What symptoms would you see in a right handed patient with an occlusion in the following artery, and which parts of the brain would it affect; left anterior cerebral artery?
Affects; left frontal and parasagittal areas
Causes; speech disturbance, behavioural changes, weakness (legs>arms)
