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#Phase 2.2: Elderly & Chronic Care > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the 2 different types of Stroke?

A
  1. Ischaemic stroke (87%)
  2. Haemorrhagic stroke (13%)
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2
Q

How do Ischaemic strokes occur? (2 steps)

A
  1. Blood supply to area of brain tissue reduced
  2. Tissue hypoperfusion
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3
Q

What are the mechanisms that can cause an Ischaemic Stroke? (4 things)

A
  1. Embolism
  2. Thrombosis
  3. Systemic hypoperfusion
  4. Cerebral venous sinus thrombosis
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4
Q

How does an Embolism result in an Ischaemic stroke? (3 steps)

A
  1. Embolus originates somewhere (e.g heart)
  2. Causes obstruction to Cerebral vessel
  3. Hypoperfusion to part of brain
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5
Q

How does Thrombosis result in an Ischaemic stroke?

A

Blood clots forms WITHIN cerebral vessel

(bc atherosclerotic plaque rupture)

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6
Q

How does Systemic Hypoperfusion result in an Ischaemic stroke? (2 points)

A
  1. Blood supply to ENTIRE brain reduced
  2. Secondary to systemic hypotension (e.g cardiac arrest)
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7
Q

How does Cerebral venous sinus thrombosis result in an Ischaemic stroke? (3 steps)

A
  1. Blood clot forms in veins that drain brain
  2. Venous congestion
  3. Tissue hypoxia
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8
Q

How do Haemorrhagic strokes happen?

A

Secondary to rupture of a blood vessel in brain

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9
Q

What are the 2 subtypes of Haemorrhagic strokes?

A
  1. Intracerebral haemorrhage
  2. Subarachnoid haemorrhage
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10
Q

What doe Intracerebral haemorrhages involve?

A

Bleeding WITHIN brain

(secondary to ruptured vessel)

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11
Q

What are the 2 subtypes of Intracerebral haemorrhages?

A
  1. Intraparenchymal (within brain tissue)
  2. Intraventricular (within ventricles)
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12
Q

What do Subarachnoid haemorrhages involve?

A

Bleeding OUTSIDE brain

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13
Q

Where does the bleeding in Subarachnoid haemorrhages happen?

A

Between Pia mater + Arachnoid mater

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14
Q

What does TIA stand for?

A

Transient Ischaemic Attack

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15
Q

What was the original definition of TIAs?

A

Stroke symptoms that resolve within 24 hours

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16
Q

What is the new definition of TIAs?

A

Transient neurological dysfunction secondary to ischaemia WITHOIT infarction

17
Q

What do TIAs often precede?

A

Full stroke

18
Q

What do you call it when someone has 2+ TIAs within 1 week?

A

Crescendo TIA

19
Q

What is the ONSET of Stroke CF?

A

Sudden

20
Q

Are Stroke CF symmetrical or asymmetrical?

A

Asymmetrical

21
Q

What are the CF of Stroke? (4 things)

A
  1. Facial weakness
  2. Visual / sensory loss
  3. Dysphasia (speech disturbance)
  4. Limb weakness
22
Q

What are the RF for Stroke? (9 things)

A
  1. CVS disease (e.g angina / MI / PVD)
  2. Stroke / TIA Hx
  3. AF
  4. Carotid artery disease
  5. HTN
  6. DM
  7. Smoking
  8. Thrombophilia
  9. COCP
23
Q

What are the NICE guidelines MAIN points of Mx of Stroke? (4 things)

A
  1. Admit pt to specialist stroke centre
  2. Exclude hypoglycaemia
  3. CT brain (immediately to exclude Primary Intracerebral Haemorrhage)
  4. Aspirin 300mg stat
24
Q

How long should Stroke pt continue Aspirin for?

A

2 weeks

25
Q

Once the CT brain has excluded Primary Intracerebral Haemorrhage, what medication can you use?

A

Altepase (for thrombolysis)

26
Q

What is Alteplase?

A

Tissue plasminogen activator

27
Q

How does Alteplase work? (2 things)

A
  1. Breaks down clots
  2. Reverses stroke effects (if given in time)
28
Q

What is the time window Alteplase must be given within?

A

4.5 hours

29
Q

What complications should you monitor for after Thrombolysis with Alteplase?

A

Intracranial / systemic haemorrhage

30
Q

How should you monitor for these Post-thrombolysis complications?

A

CT brain

31
Q

If CT scan confirms an occlusion, what should be offered?

A

Thrombectomy (mechanical removal of clot)

32
Q

What is the time window Thrombectomy must be done within?

A

24 hours since onset of symptoms

33
Q

What are the Mx options for TIA? (3 things)

A
  1. Aspirin 300mg daily
  2. Secondary prevention measures for CVS diseases
  3. Refer to Stroke specialist within 24 hours
34
Q

What are the Secondary Prevention measures of CVS diseases for TIA / Stroke? (4 things)

A
  1. Clopidogrel 75mg OD
  2. Atorvastatin 80mg (but not immediately)
  3. Carotid endarterectomy / stenting (in pt w CAD)
  4. Treat modifiable RF (e.g HTN / DM)

#Phase 2.2: Elderly & Chronic Care (8 decks)

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