STROKE Flashcards
What are the diff strokes?
- ischaemic
- thrombotic
- embolic
What is stroke?
cerebrovascular event caused by disruption of blood supply to the brain, characterised by rapidly developing neurological signs, lasting for more than 24 hours (or leading to death)
Ischameic stroke?
(most common type of stroke-85%)
Occlusion of blood vessel
Can be caused by the formation of a thrombus or an embolus
What are thrombotic stroke
Blood clot forming in blood vessel that supplies the brain with blood
Thrombus can occur due to: atherosclerotic plaque rupture or narrowing of arteries (stenosis
what is embolic stroke
Blood clot that has formed elsewhere in the body
Cardiac e.g. atrial fibrillation
What are the sign of stroke
If there’s no blood flow, no oxygen delivery to tissues & clearance of a waste products such as carbon dioxide–> cells become injured–> eventually leads to cell death & necrosis
What is haemorrhage
Intracerebral: bleeding in the brain
Subarachnoid: Bleeding between the brain and the arachnoid mater
Haemorrhages occur when there is a break in a blood vessel
This can occur due to hypertension
However, other causes such as vascular malformations e.g. abnormal connection between the artery & the vein–> the connections are very fragile & are prone to breaking, & causing bleeds
What are the risk factors of ischarmic stroke
-Older age
-Atrial fibrillation
-Hypertension (damage to vessel wall)
-Hyperlipidaemia (forms atherosclerosis plaque)
-Diabetes (high blood sugar is directly toxic to vessel wall)
-Obesity (linked to high cholesterol)
-Smoking (directly toxic to vessel wall)
-Alcohol (directly toxic to vessel wall)
What do anterior cerebral arteries do?
supplies front/inside of the brain i.e. frontal region, parietal portion of the brain & hippocampus
What is haemorrhagic stroke risk factors
- Age 45-70
-Cerebral aneurysm
-Family history
-Hypertension
-Smoking
-Alcohol excess/illicit drug use
-Antiplatelet/anticoagulation (increase risk of bleeding)
What do middle cerebral arteries do
supplies front/outside of the brain i.e. temporal region
What do posterior cerebral arteries do
supplies back of the brain i.e. occipital lobe
What is anterior circulation stroke
-Middle &/or anterior cerebral arteries
-If damage to the right side of the brain, clinical features on the left side of the body EXCEPT for the face; facial symptoms will be on the same side as the damaged part of the brain (vice versa)
What are the signs and symptoms
One sided weakness
Loss of sensation
Speech disturbance (if dominant)
Problems with eye movements
What are the posterior circulation stroke signs nd symptoms
brain stem:
- complex ; facial weakness, eye movement signs, vertigo
cerebellum:
-Ataxia: describes poor muscle control, group of disorders that affect co-ordination, balance & speech
Nystagmus: rhythmical, repetitive & involuntary movement of the eyes
What are the S&S of subarachnoid haemorrhage
‘Thunderclap headache’- severe & sudden onset
Signs of ‘meningism’: stiff neck, photophobia, nausea & vomiting
What are the S&S of TIA
Stroke-like symptoms resolve within 24 hours
At higher risk of developing subsequent stroke- greatest risk within 30 days
Important to treat risk factors
What are the investigations?
- CT (first line) scan of head to distinguish between haemorhagic and ischameic
- blood tests; clotting, cholesterol,glucose,haemoglobin, infection markers
- further imaging ; MRI head, carotid doppler within 24 hrs
- cardiac; ECG, 24hr tape, echocardiogram
What are ways to manage ischaemic stroke
-CT scan shows no blood
-Break the clot using a thrombolysis
-Medication: alteplase
-Needs to be done within 4.5 hours of onset (thrombolysis window)
-Contraindications: bleeding, recent neurosurgery
-If not appropriate from thrombolysis–> 300mg aspirin for 2 weeks, followed by clopidogrel
-Thrombectomy:
Removing the clot under radiological imaging
Specific criteria & location specific
What are ways of management of haemorrhagic stroke
-CT shows a bleed
-Depends on extent of bleeding
-Ensure any precipitants of bleeding are stopped (e.g. blood thinners)
-Good blood pressure control
-Neurosurgery
What are non-pharmacological ways of management
- admission to a specialist stroke unit
- early rehabilitation
- goal driven care pathway
- swallow assessment
What are the secondary preventions?
- anti platelet therapy (prevent further ischameia)
- anticoagulation (atrial fibrillation)
- control BP (hypertensive)
- optimise blood sugar control(diabetes)
- lifestyle advice
start statis (high cholesterol) - smoking cessation (smoker)
- excersice/weight loss (obese)
- reduce alcohol
what are the impacts of stroke?
Physical disability
Cognitive impairment
Unemployment
Financial problems
Depression
Loss of independence
Loss of self esteem
1/3 require nursing home care