Stroke Flashcards
Def of stroke
An acute onset neurological deficit which can be motor sensory or cognitive by focal cerebral, spinal or retinal infarction or hemorrhage.
Def of TIA
Brief episode of neurological deficit due to temporary focal cerebral, spinal or retinal ischemia without infarction.
The specific artery blockages and their symptoms?
iPad notes
Causes of stroke (ischemic, hemorrhage and rare)
Ischemic- Atherosclerosis Vasculitis,carotid A stenosis Thrombophilia Cardioembolism 8 Hypoperfusion
Hemorrhagic- Av malformation Aneurysm Hypertension Anticoagulant
Rare- Thrombocythemia, polycythemia, hyper viscosity, thrombophilia (protein c def, factor V Leiden) APLS Low dose estrogen containing OCP migraine Vasculitis Amyloidosis Hyper homocysteinaemia HIV,neurosyphilis, mito disease, fabry’s disease Sympathomimetic drugs like cocaine CADASIL
ABCD2 score in TIA assessment
If score <4 low risk
>6 high risk for a stroke within 7 days of TIA
Clinical evidence of source of embolus?
Carotid artery bruit AF and other dysarhythmia Valvular heart disease/IE Recent MI UNDERLYING CONDITIONS LIKE; Atheroma HTN postural hypotension Brady or low CO DM Rarely arteritis, polycythemia, neurosyphilis, HIV APLS
Ix for stroke?
Immediate-
Brain imaging (NCCT) Ideally within 1 hour but atleast within 24 hrs
Blood count and glucose
Within 24h-
Routine blood-count, ESR, glucose, clotting studies, lipids
ECG and 24h ECG
carotid Doppler studies
Other Ix in some selected patients DwI MRI ( MRI diffusion weighted sequences) more sensitive for early changes of infarction
Acute stroke features?
FAST
Stroke Mx?
A B C
brain imaging and see if thrombolysis appropriate
If ischemic, rTPA (alteplase), aspirin 300mg and atorva 40 mg after 24 hrs of thrombolysis or if thrombolysis is contraindicated.
If hemorrhage, sx might be needed
Admit to multidisciplinary stroke unit
Rehabilitation
Indications for thrombolysis
Age > 18 Clinical diagnosis of acute ischemic stroke Onset clear and within 4.5 hrs Assessment by experienced team Persistent neurological deficit Imaging exclude hemorrhage
Contraindications for thrombolysis?
Historical-
1 stroke or head trauma prior to 3 months
2 any prior hx of ICH
3 major sx within 14 days
4 GI or GU bleeding within previous 21 days
5 arterial puncture at a non compressible site in last 7 days
6 lumbar puncture within 7 days
Clinical -
1 rapidly improving stroke syndrome
2 minor or isolated neurological signs
3 seizure at the onset of stroke if the residual impairments are due to postictal phenomena
4 symptoms suggest of SAH even if the CT is normal
5 persistent SBP > 185 DBP > 110 Or requiring aggressive therapy to control bp
6 pregnancy
7 active bleeding or acute trauma
Lab- 1 platelets <100000/mm3 2 serum glucose <2.8 mmol/L or > 26.2 3 INR > 1.7 if on warfarin 4 elevated thromboplastin time if on heparin
General tx of acute stroke? What to do to salvage ischemic penumbra?
Prevention hypotension (tx if > 220/120) , hyperglycemia, pyrexia
Mx of dehydration and swallowing
Early mobilization
Types of intracranial hemorrhage?
Intracerebral and cerebellar hemorrhage
SAH
subdural and extradural hemorrhage/ hematoma
Causes of intracerebral hemorrhage?
- HTN (rupture of microaneurysms like charcot-Bouchard A)
- Cerebral amyloid angiopathy
- secondary causes ( av malformation, cavernomas, aneurysm, dural venous thrombosis, coagulopathies, anticoagulant, thrombolysis, hemorrhagic transformation of a large ischemic infarction coccaine, alcohol)
Tx of intracerebral hemorrhage?
Medical and surgical
Medical-
Frequent monitoring of GCS and neurological signs
Anti platelets are contraindicated
Anticoagulant rapidly reversed by IV vit K and clotting factor concentrate
Mx HTN in ICU if > 180
Reduce ICP by mechanical ventilation and manitol
Recombinant activated factor 7
