Stroke Flashcards
Stroke is also referred to as what?
cerebrovascular accident
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answer
Cerebrovascular accidents are either
1: ?
2: ?
1: Ischaemia or infarction of brain tissue secondary to inadequate blood supply
2: Intracranial haemorrhage
give 4 things which can disrupt the blood supply to areas of the brain
1: Thrombus formation or embolus, for example in patients with atrial fibrillation
2: Atherosclerosis
3: Shock
4: Vasculitis
what is a TIA?
Used to be ‘stroke symptoms which resolved within 24 hours
now: transient neurological dysfunction secondary to ischaemia without infarction.
what is a crescendo TIA?
two or more TIAs within a week. This carries a high risk of developing in to a stroke.
TIAs often precede what?
a full stroke
In neurology, suspect a ________ cause where there is a sudden onset of neurological symptoms.
In neurology, suspect a vascular cause where there is a sudden onset of neurological symptoms.
Stoke symptoms are typically ____________
Stoke symptoms are typically asymmetrical:
give some examples of asymmetrical stroke symptoms
Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss
give some risk factors for stroke (10)
Cardiovascular disease such as angina, myocardial infarction and peripheral vascular disease
Previous stroke or TIA
Atrial fibrillation
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
Combined contraceptive pill
what is the FAST tool?
used for identifying stroke in the community:
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)
what is the ROSIER tool?
ROSIER is a clinical scoring tool based on clinical features and duration. Stroke is likely if the patient scores anything above 0.
describe the management of Stroke (4)
1: Admit patients to a specialist stroke centre
2: Exclude hypoglycaemia
3: Immediate CT brain to exclude primary intracerebral haemorrhage
4: Aspirin 300mg stat (after the CT) and continued for 2 weeks
why do we wait until after the CT before giving aspirin for stroke?
CT rules out a intracranial hemorrhagic stroke.
what must we exclude before we treat for stroke?
hypoglycaemia
describe thrombolysis following stroke?
Alteplase used after CT. needs senior guidance.
needs to be given in a defined window of opportunity
monitor for bleeding - repeat CT scans of brain/
describe thrombectomy?
Thrombectomy (mechanical removal of the clot) may be offered if an occlusion is confirmed on imaging, depending on the location and the time since the symptoms started. It is not used after 24 hours since the onset of symptoms.
thrombectomy is not used after how many hours of stroke onset?
24 hours.
how should we manage blood pressure during stroke
Generally, blood pressure should not be lowered during a stroke because this risks reducing the perfusion to the brain.
how do we manage a TIA
Start aspirin 300mg daily.
Start secondary prevention measures for cardiovascular disease.
They should be referred and seen within 24 hours by a stroke specialist.
what imaging should we use to aid our diagnosis of a stroke
aim to establish which vascular territory is affected.
Diffusion-weighted MRI is the gold standard imaging technique. CT is an alternative.
Diffusion-weighted MRI is the gold standard imaging technique. CT is an alternative.
Carotid ultrasound can be used to assess for carotid stenosis.
Endarterectomy to remove plaques or carotid stenting to widen the lumen should be considered if there is carotid stenosis.
describe the secondary prevention of stroke
Clopidogrel 75mg once daily (alternatively dipyridamole 200mg twice daily)
Atorvastatin 80mg should be started but not immediately
Carotid endarterectomy or stenting in patients with carotid artery disease
Treat modifiable risk factors such as hypertension and diabetes
describe stroke rehabilitation
Once patients have had a stroke they require a period of adjustment and rehabilitation. This is essential and central to stroke care. It involves a multidisciplinary team including:
lots of people
