Stroke Flashcards
What are the 2 different types of Stroke?
- Ischaemic stroke (87%)
- Haemorrhagic stroke (13%)
How do Ischaemic strokes occur? (2 steps)
- Blood supply to area of brain tissue reduced
- Tissue hypoperfusion
What are the mechanisms that can cause an Ischaemic Stroke? (4 things)
- Embolism
- Thrombosis
- Systemic hypoperfusion
- Cerebral venous sinus thrombosis
How does an Embolism result in an Ischaemic stroke? (3 steps)
- Embolus originates somewhere (e.g heart)
- Causes obstruction to Cerebral vessel
- Hypoperfusion to part of brain
How does Thrombosis result in an Ischaemic stroke?
Blood clots forms WITHIN cerebral vessel
(bc atherosclerotic plaque rupture)
How does Systemic Hypoperfusion result in an Ischaemic stroke? (2 points)
- Blood supply to ENTIRE brain reduced
- Secondary to systemic hypotension (e.g cardiac arrest)
How does Cerebral venous sinus thrombosis result in an Ischaemic stroke? (3 steps)
- Blood clot forms in veins that drain brain
- Venous congestion
- Tissue hypoxia
How do Haemorrhagic strokes happen?
Secondary to rupture of a blood vessel in brain
What are the 2 subtypes of Haemorrhagic strokes?
- Intracerebral haemorrhage
- Subarachnoid haemorrhage
What doe Intracerebral haemorrhages involve?
Bleeding WITHIN brain
(secondary to ruptured vessel)
What are the 2 subtypes of Intracerebral haemorrhages?
- Intraparenchymal (within brain tissue)
- Intraventricular (within ventricles)
What do Subarachnoid haemorrhages involve?
Bleeding OUTSIDE brain
Where does the bleeding in Subarachnoid haemorrhages happen?
Between Pia mater + Arachnoid mater
What does TIA stand for?
Transient Ischaemic Attack
What was the original definition of TIAs?
Stroke symptoms that resolve within 24 hours
What is the new definition of TIAs?
Transient neurological dysfunction secondary to ischaemia WITHOIT infarction
What do TIAs often precede?
Full stroke
What do you call it when someone has 2+ TIAs within 1 week?
Crescendo TIA
What is the ONSET of Stroke CF?
Sudden
Are Stroke CF symmetrical or asymmetrical?
Asymmetrical
What are the CF of Stroke? (4 things)
- Facial weakness
- Visual / sensory loss
- Dysphasia (speech disturbance)
- Limb weakness
What are the RF for Stroke? (9 things)
- CVS disease (e.g angina / MI / PVD)
- Stroke / TIA Hx
- AF
- Carotid artery disease
- HTN
- DM
- Smoking
- Thrombophilia
- COCP
What are the NICE guidelines MAIN points of Mx of Stroke? (4 things)
- Admit pt to specialist stroke centre
- Exclude hypoglycaemia
- CT brain (immediately to exclude Primary Intracerebral Haemorrhage)
- Aspirin 300mg stat
How long should Stroke pt continue Aspirin for?
2 weeks
Once the CT brain has excluded Primary Intracerebral Haemorrhage, what medication can you use?
Altepase (for thrombolysis)
What is Alteplase?
Tissue plasminogen activator
How does Alteplase work? (2 things)
- Breaks down clots
- Reverses stroke effects (if given in time)
What is the time window Alteplase must be given within?
4.5 hours
What complications should you monitor for after Thrombolysis with Alteplase?
Intracranial / systemic haemorrhage
How should you monitor for these Post-thrombolysis complications?
CT brain
If CT scan confirms an occlusion, what should be offered?
Thrombectomy (mechanical removal of clot)
What is the time window Thrombectomy must be done within?
24 hours since onset of symptoms
What are the Mx options for TIA? (3 things)
- Aspirin 300mg daily
- Secondary prevention measures for CVS diseases
- Refer to Stroke specialist within 24 hours
What are the Secondary Prevention measures of CVS diseases for TIA / Stroke? (4 things)
- Clopidogrel 75mg OD
- Atorvastatin 80mg (but not immediately)
- Carotid endarterectomy / stenting (in pt w CAD)
- Treat modifiable RF (e.g HTN / DM)
