Stroke Flashcards
Storke definiton
brain ischemia, focal onset resulting in neurological deficit
types of stroke
ischmia - occlusion due to emboli or thrombus
hemorrhagic - bleeding in brain or other CNS regiosn
what is TIA
ischemic stroke present along a spectrum with TIA being the least sevre
TIA is an episode of neuronal deficit that lasts from minutea to hours. usually only lasts an hour
types of hemorhagic storke
intracranial hemorrhage
sudural hemorhage
subarachnoid hemmorahe
whats more common hemorrhagic or ischemic stroke?
hemorrhiga - 15 %
Ischmic - 85%
what are non modifiable risk factors for stroke?
age (above 55)
sex (M)
ethnicity
family histoyr
what are some modifiable risk factors for stroke
HTN
Dyslipidemia
A Fib
DM
Smoking
Cardiac disease
Lifestyle
Hormone replacement therapy
how do we distinguish between thrombotic and embolic stroke?
- usualy can’t
- TIa preceded thrombotic 10% of time
- emboli present with max deficits
what does loss of cerebral blood flow cause?
hypoperfusion- tissue hypoxia- cell death
what do we know above hemohagic stokre?
- not much
- compression is main outcome
risk factors for hemorhagic stroke?
- illicit drug use
- htn
- smoking
- ruptured aneurysm
- systmic bleeding (hemophilia, anticogaulants)
why would we get ahemorrhig stroke after an ischmic one?? risk factors
due to tissue reperfusion
risk factors:
- HTN
- two or more antiplatentles
- signs on CT of edema or mass effect
symtoms distinguish between ischmis or hemmorhagica
hemorrhagic
- the worst headache of life
- N, V
- LOC
- COMA
- Seizures
how should we diagnose stroke?
- s and s are not enough for a dignosis
- neede CT or MRI
- A fib is sig risk factor
- patients with TIA or storke should get a 12 lead EKG in first 24 hours
what is the clinical presentation of stroke
F
A
S
T
what is the acute management of ischemic stroke?
- reperfusion therapy using thrombolytics and endovascular thrombectomy (EVT)
- antiplatelet therapy single or dual
what kind of support is needed for ischmic strokes
- time is brian
- respiratoyr, cardiac
- neurological deficit/ imagining
-Asses BP - ECG to rule out cardiac causes
- swallowing assement
reperfusion therpay - thrombolytic
- recommended for all that are not CI
- done with 4.5 hours of symptom onset
- door to needle time is less than 60 mins and a median of 30 minutes
- works by dissolving the clot
- agents: tPA and TNK
exclusion for thromboltic
Absolute:
- active bleed
- BP above 180/105
Relative:
- hisotyr
- Symptoms of SAH, stroke,
- DOACS
- LAB abnormalities - hypo/hyperglycemia, elevated aPTT, INR, low platent count
Adminstrtaion, adverse effects moniotring of thrombolytic
Admin
- 4.5h of symptoms
- door to needle <60 min
- can’t give another anticoagulant or antiplatelet for 24 hours
Dose
- TNK weight-dependent
Adverse effect
- hypo
- bleeding
Monitor:
- BP
- neurologic
- if severe headache, acute HTN, N and V, D/C drug!!!! and get CT
Endovascualr thrombectomy
- with or without thormblytic
- 12-24 hours window
- mechanical revascularization
Single antiplatelet therapy
- ASA / clopidogrel
- all patients should receive the only rule is if you have a thrombolytic don’t use an ASA till 24 hours after
- continued indefiitly
- rule out hemorrhage
- can use safely with LMWH/UH for DVT prophylaxis
Dual antiplatelet therapy
-used only for high risk TIA, minor stroke (not mod/ severe stroke or those who get reperfusion therapy)
ASA plus clopdirgorl for 21 days
ASA plus ticagrelor for 30 days
LMWH/UH storke?
- no benift may increase bleeding risk hemmorhage
- use an lowest dose possible for VTE prophylaxis
