stroke Flashcards
symptoms of an ACA stroke
disinhibition // contralat limb weakness + sensory // legs > arms
symptoms MCA stroke
contralateral weakness + paralysis upper limbs // aphasia // contralateral heminopia
PCA stroke symptoms
contralteral heminopia // visual symptoms
weber’s syndrome stroke vessels
branching arteries of PCA – > midbrain
webers syndrome stroke syndrome
ipsilateran CNIII palsy // contralteral limb weakness
cerebellar stroke symptoms
vertigo, ataxia, contralteral torse pain + temp loss // posterior = ipsilat face pain + temp loss // anterior = ipsilat face paralysis + deafness
when does lateral medullary syndrome occur + symptoms
posterior cerebellar stroke –> ataxia, nystagmus, ipsilateral facial weakness + dysphagia (horners), contralateral sensory loss
opthalamic artery stroke symptoms
Amarousis faugux
vertebral artery stroke symptoms
locked in syndrome
what causes lacunar stroke
hypertension + atherosclerosis of smaller vessels
area affected by lacunar stroke
basal ganglia, thalamus, internal capsule
symptoms lacunar infarcts (LACI)
(usually affect one limb) one of: ataxic hemiparesis // sensory loss // unilateral weakness
oxford stroke classification criteria
unilateral hemiparesis +/- sensory loss // heminopia // cognitive dysfunction eg dysphagia
TACI vessels
ACA + MCA
TACI symptoms
all 3 criteria (hemiparesis, heminopia, dysphagia)
PACI vessels
lower branches of ACA
PACI symptoms
2/3 criteria (hemiparesis, heminopia, dysphagia)
POCI vessels
vertebral
POCI symptoms
one of: cerebellar, LOC, heminopia
most common types of stroke
ischaemic 85% vs haemorrhage 15%
symptoms more common in haemorrhagic stroke patients
headache, deacreased LOC, N+V, seizure
RF stroke
atheromas, hypertension, hyperlipidaemia, obesity, age, T2DM, drugs, smoking
what should be excluded 1st in a stroke
hypoglycaemia
what assessment is used for stroke + what result indicates stroke is likelu
rosier - score >0
imaging + findings stroke
urgent non-contract CT: ischaemia = hypodense affected area + hyperdense artery // haemorrhage = hyperdense blood
what drug should be given as soon as haemorrhagic stroke is excluded
300mg aspirin rectallu
1st line mx ischaemic stroke
IV thrombolysis with alteplase (tPa)
when can stroke thrombolysis be given
within 4.5 hours of symptoms + haemorrhagic excluded
contraindications thrombolysis
previous haemorrhage // seizure at same time // recent TBI, LP or GI bleed // pregnant // hypertension >200 // oeseophageal varisces
in what 2 scenarios is thrombectomy offered in stroke
within 6 hours of onset, anterior circulation stroke (ACA or MCA), give with thrombolysis // OR give between 6-24 hours if patient well + can salvage brain tissue
what scenario is thrombectomy considered in stroke
with IV thrombolytsis in people who have been well for 24 hours + posterior circulation (basilar or PCA)
what scenario is thrombectomy considered in stroke
with IV thrombolytsis in people who have been well for 24 hours + posterior circulation (basilar or PCA)
what prophylaxis mx is 1st + 2nd line post stroke
1 = lifelong clopidogrel // 2 = aspirin + dipyridamole of clopidogrel contraindicated // give a statin if lipids >3.7
when is BP management allowed after an ischaemic stroke
hypertensive encephalopathy, nephropathy, CF // aortic dissection // pre-eclampsia
what must be assessed post-stroke
swallow function
post-stroke prophylaxis in AF
warfarin or Xa inhibitor
in afib when should anticoag be started post-TIA
immediately
in afib when should anticoag be started post-stroke
after 2 weeks - give antiplatelets in interim
what is a TIA
transient neuro dysfunction, vascular ischaemia of brain, spinal cord or retina // no acute infarction
symptoms TIA
last <1 hour // unilateral weakness, aphasia, vertigo, ataxia, sudden vission loss
immediate mx TIA
aspirin 300mg
mx for TIA patient with bleeding disorder/ taking anti-coag
urgent admission to exclude haemorrhage
invx TIA
MRI // CT only if suspected alternative diagnosis // carotid imaging with USS
when is carotid artery endartectomy considered (2)
if carotid TIA or stroke but not disabled // if carotid stenosis >70%
DVLA driving after stroke/ TIA
1 month
DVLA dricing after multiple TIAs
3 months
disability survery post stroke
barthel
