Stroke Flashcards
Two types of stroke
Ischaemic (85%) or haemorrhagic (15%)
What is a stroke
Sudden onset of focal neurological signs and symptoms with a vascular aietiology lasting >24 hours
Two types of haemorrhagic stroke
Intracerebral or subarachnoid
What is a transient ischaemic attack
Sudden onset of focal neurological signs and symptoms with a vascular aietiology lasting <24 hours
Pathology of ischaemic strokes
Large vessel atherosclerosis (50%), intracranial small vessel atherosclerosis (25%), cardio-embolic (20%) and primary vascular and haematological causes
Risk factors for stroke
CVD, previous stroke or TIA, AF, carotid artery disease, HTN, diabetes, smoking, vasculitis, thrombophilia, combined oral contraceptive
Pathology of intracerebral haemorrhagic stroke
Hypertension causes microaneurysms to form on the lenticulostriate branches of MCA. These can rupture leading to haemorrhage
Outcomes of intracerebral haemorrhagic stroke
Sudden death from rapid accumulation of haematoma acting as SOP. Survivors have neurological deficit and 1 month mortality is 80%
Pathology of subarachnoid haemorrhage stroke
Rupture of saccular aneurysms of circle of willis or one of is main branches (berry aneurysms). Arise at points where arteries branch, weakness of arterial wall.
Common points for subarachnoid stroke
Anterior communicating artery
Anterior cerebral artery
Outcome of subarachnoid stroke
No symptoms until rupture. Often causes death or death within few hours from rebleeding. 1 month mortality of 45%
What is the main concern for survivors after subarachnoid stroke
Bleeding 7-10 days after event
Presentation of subarachnoid haemorrhage
Severe onset headache, followed by diminished consciousness
CT scan of haemorrhagic stroke
Hyperdense lesions straight away on CT
Management of stroke
Thrombolysis with alteplase, or thrombectomy
What does alteplase do
Tissue plasminogen activator that breaks down clots and reverses the effects of stroke if given in time.
When is alteplase given
After CT scan has excluded intracranial haemorrhage
Thrombolysis complications
Intracranial or systemic haemorrhage
What does thrombectomy do
Mechanical removal of the clot which can be offered if an occlusion is confirmed on imaging
When is thrombectomy not used
After 24 hours since onset of symptoms
Why should BP not be lowered in stroke
risks reducig perfusion to the brain
Management of TIA
Aspirin 300mg daily and start secondary prevention measures
Secondary prevention of stroke acronym
Hypertension
Anti-platelet
Lipid-lowering
Tobacco stop
Sugar control
Surgery
Seconary prevention of stroke medications
Clopidogrel 75mg
Atorvastatin 80mg
Carotid endarterectomy or stenting in patients with carotid artery disease
Presentation of stroke
Sudden weakness of limbs, facial weakess, dysphasia, visual or sensory loss
