Stroke Flashcards
Stroke assesment tools
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FAST
On non-contrast CT, acute ischaemic strokes will show
Hyperdense artery sign
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
What artery(ies) is involved
Bamford classification
MCA and ACA
TACI
2 of 3 are present
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
What artery
Bamford
ACA
PACI
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
What artery
Bamford
involves perforating arteries around the internal capsule, thalamus and basal ganglia
Lacunar infarcts (LACI)
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
What artery
Bamford
involves vertebrobasilar arteries
POCI
Stroke by anatomy
Contralateral hemiparesis and sensory loss, lower extremity > upper
Anterior cerebral artery
Stroke by anatomy
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia
MCA
Stroke by anatomy
Contralateral homonymous hemianopia with macular sparing
Visual agnosia
PCA
Stroke by anatomy
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
Weber’s syndrome
branches of the posterior cerebral artery that supply the midbrain
Stroke by anatomy
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Posterior inferior cerebellar artery
Wallenberg, lateral medullary syndrome
Stroke by anatomy
Ipsilateral: facial paralysis and deafness
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Anterior inferior cerebellar artery (lateral pontine syndrome)
Stroke by anatomy
Amaurosis fugax
Retinal/ophthalmic artery
Stroke by anatomy
‘Locked-in’ syndrome
Basilar artery
Stroke by anatomy
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule
Lacunar strokes
Once hemorrhagic stroke excluded, what to give
aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded
Thrombolysis within
4.5 hours
Haemorrhage excluded
Thrombectomy
Within 6 hours
INCLUDING thrombolysis (within 4.5 hours)
Indication of thrombectomy
Confirmed PCA stroke on angiography
Offer thrombectomy as soon as possible to people who were last known to be well between 6 hours and 24 hours previously (including wake-up strokes) if
Confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA
AND
if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
Consider thrombectomy together with intravenous thrombolysis (if within 4.5 hours) as soon as possible for people last known to be well up to 24 hours previously (including wake-up strokes):
who have acute ischaemic stroke and confirmed occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA
AND
if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume
Secondary prevention (ischaemic stroke)
Clopidogrel
2nd line aspirin plus MR dipyridamole
Carotid endarterectomy
recommend if patient has suffered stroke or TIA in the carotid territory and are not severely disabled
should only be considered if carotid stenosis > 70% according ECST** criteria or > 50% according to NASCET*** criteria
AF management post-stroke
warfarin or a direct thrombin or factor Xa inhibitor
anticoagulation for AF should start immediately following a
TIA
anticoagulation therapy should be commenced after 2 weeks in a
acute stroke
(Aspirin in the meantime)
