Stroke Flashcards
What are symptoms of a stroke in the carotid territory?
- Weakness of face, arm, leg
- Impaired language
What are symptoms of a stroke affecting the posterior circulation?
- Dysarthria
- Dysphagia
- Diplopia
- Ataxia
- Dizziness
- Diplegia
What are the 3 common types of stroke?
- Ischaemic
- Primary intracerebral haemorrhage
- Transient ischaemic attack
According to the Bamford stroke classification what is the criteria for a total anterior circulation stroke?
3/3 of…
- Unilateral weakness of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
What is lacunar infarction?
Occlusion of deep penetrating arteries of the brain
According to the Bamford stroke classification what is the criteria for a partial anterior circulation stroke?
2/3 of…
- Unilateral weakness of the face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
According to the Bamford stroke classification what is the criteria for a lacunar syndrome?
1 of…
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
According to the Bamford stroke classification what is the criteria for posterior circulation syndrome?
1 of…
- Cranial nerve palsy and contralateral motor/sensory deficit
- Bilateral motor/sensory deficit
- Conjugate eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia/cortical blindness
What is the initial management when someone presents with stroke?
- ABCDE + bloods + BM
- Breif Hx + Ex
- BP
- NIHSS
What is NIHSS?
National institutes of health stroke scale. For grading and tracking the severity of a stroke and monitoring response to acute treatment
What is the first line Ix for stroke?
CT head
What is the acute management of ischaemic stroke including time-windows?
- Thrombolysis - within 4.5 hrs of symptom onset
- +/- Thrombolectomy - within 6 hrs of symptom onset for anterior circulation stroke
- Or … Aspirin 300mg
What is used for thrombolysis in ischaemic stroke?
IV tissue Plasminogen Activator e.g. alteplase 0.9mg/kg
What is the purpose of investigations following acute treatment of stroke? Give examples?
To confirm Dx, identify the aetiology and prevent complications
- Bloods - WWC (intracranial infection), platelet count, clotting screen, glucose (hyper/hypoglycaemia can mimic stroke), lipid profile (look for rf)
- ECG - MI, AF, atrial flutter
- Carotid Doppler USS - carotid stenosis
- Echo - endocarditis/thrombosis
- MRI - confirm Dx, look for mini strokes
What colour is fresh blood on a CT? What happens over time?
White as is more dense than brain matter, over time darkens as is broken down and becomes less dense
What is the management of a primary intracerebral haemorrhage (haemorrhagic stroke)?
- ABCDE
- Blood pressure lowering therapy if systolic 150-220 and <6hrs OR if >220 and >6hrs
- Manage bleeding tendency - reverse meds/treat low platelets
- Mange underlying malformation - tumour aneurysm, amyloid angiopathy, cavernoma
How does amyloid angiopathy cause primary intracerebral haemorrhage?
Amyloid (type of protein) builds up in the walls of cerebral vessels causing them to become friable and rupture
How do you reveres warfarin?
Beriplex and vit K
How do you reverse LMWH?
Partially reversed with protamine
How do you reverse DOACs?
Beriplex may be effective
