Stroke Flashcards
Types of cerebrovascular accidents
Ischaemia/ infarction
Intracranial haemorrhage
Risk factors
CVD (angina, MI, PVD)
Previous stroke/ TIA
AF
Carotid artery disease
HTN
Diabetes
Smoking
Vasculitis
Thrombophilia
COCP
Scoring tool to recognise stroke
ROSIER
Management of stroke <4.5h
Exclude intracranial haemorrgage
Thrombolysis with alteplase
Need monitoring for post thrombolysis complications (haemorrhage)
Management of stroke >4.5h <6h
Thrombectomy if acute ischaemic stroke and confirmed occlusion of proximal anterior circulation on CTA or MRA
Treatment between 6-24h
Thrombectomy if confirmed occlusion of proximal anterior circulation on CTA/MRA and potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion weighted MRI sequences
Secondary prevention
Clopidogrel 75mg OD
Aspirin plus modified-release dipyramidole in people who have had ischaemic stroke only if clopidogrel contraindicated (no more than 2 years)
Atorvastatin 80mg (not immediately)
Carotid endarterectomy or stenting in patients with carotid artery disease
Contraindications to thrombolysis
Previous intracranial haemorrhage
Seizure at onset of stroke
Intracranial neoplasm
Suspected SAH
Stroke or traumatic brain injury in preceding 3 months
Lumbar puncture in proceeding 7 days
GI haemorrhage in previous 3 weeks
Active bleeding
Pregnancy
Initial management of stroke
Admit to specialist stroke centre
Exclude hypoglycaemia
Immediate CT brain to exclude primary intracerebral haemorrhage
Aspirin 300mg stat (oral or rectal) continued for 2 weeks
Total anterior circulation infarcts
Involves middle and anterior cerebral arteries
Uinlateral hemiparesis and/or hemisensory loss of face/arm/leg
Homonymous hemianopia
Higher cognitive dysfunction
Partial anterior circulation infarcts
Involves smaller anteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of the criteria present
Lacunar infarcts
Involves perforating arteries around the internal capsule, thalamus and basal ganglia
Presents with 1 of
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg, or all 3
- pure sensory stroke
- ataxic hemiparesis
Posterior circulation infarcts
Involves verterbobasilar arteries
Presents with 1 of
- cerebellar or brainstem syndromes
- LOC
- isolated homonymous hemianopia