Stroke Flashcards
What is a cerebrovascular accident?
Stroke
2 types - ischaemic stroke, haemorrhagic stroke
Ischaemia or infarction of the brain tissue secondary to a disrupted blood supply (ischaemic stroke)
Intracranial haemorrhage, with bleeding in or around the brain (haemorrhagic stroke)
Causes of ischaemic stroke
Thrombus/embolus
Atherosclerosis
Shock - causes hypofusion
Vasculitis
Stroke presentation
Asymmetrical symptoms (unilateral) - limb weakness, facial weakness, sensory loss
Dysphagia - speech
Visual field defects (amaurosis fugax, diplopia, homonymous hemianopia)
Altered consciousness / confusion
Ataxia - loss of muscle co-odination
Vertigo
Syncope
Headache - esp in haemorrhagic
Medical and behavioural risk factors of stroke
Hypertension
AF
Valscular disease
Carotid stenosis
Diabetes
Chronic heart failure - left ventricular hypertrophy
Previous stroke/TIA
History of pre-eclampsia
Hypercholesterolaemia
Vasculitis
COCP - in those with migraines
Sickle cell disease
SMOKING and alcohol
Drugs - cocaine, meth
Physical inactivity / obesity
What is a TIA !!!
Transient ischaemic stroke
- temporary neurological dysfunction (SUDDEN ONSET LASTING LESS THAN 24 HOURS) caused by ischaemia but WITHOUT INFARCTION
DDx of speech difficulty, arm/leg weakness or sensory changes
TIA
Stroke
Seizures
Head injury - haemorrhage
Migraines
TIA management
Symptoms resolve within 24 hrs of onset
Goal - stroke prevention due to high risk
Aspirin 300mg - started immediately - clopidogrel is aspirin allergy
Refer within 24 hrs
Lifestyle management - smoking, exercise, diet
Risk factor management - HTN, DM, dyslipidaemia
At referal:
Diffusion weighted MRI scan
Carotid USS
Blood tests - lipid profile, clotting factors
Stroke investigation
FAST - face , arm, speech, time
ROSIER tool (recognition of stroke in the emergency room) - score scale
Signs of stroke in anterior circulation
ACA - anterior cerebral artery stroke
- lower limb weakness
- minimal sensory changes
MCA (V. COMMON) - middle cerebral artery stroke
- upper limb weakness
- visual field effects
- speech distrubance
Signs of stroke in posterior circulation
Vertebrobasilar artery stroke
- facial expression
- weakness in arm/legs
- fatal
PCA - posterior cerebral artery stroke
- behavioural symptoms
- vertigo/dizziness
- decreased sensation on one side (pin prick/light touch)
- vision defects
Stroke investigations
Initial Ix - NON CONTRAST HEAD CT SCAN - exclude haemorrhagic stroke
Diagnosis - CT angio
Check glucose - EXCLUDE HYPOGLYCAEMIA
IV access
Blood tests
ECG - AF / arrythmias
Ischaemic Stroke management
Aspirin
Aggressively manage cholesterol
Glucose control in DM
Thrombolysis - tPA (tissue plasminogen activator) e.g. altepase - BUT check for bleeding and other contraindications first (other anticoagulant history, other internal bleeding, recent major trauma, ACTIVE HYPERTENSION - DON’T LOWER BP, history of haemorrhagic stroke)
Thrombectomy within 24 hrs if blockage in proximal circulation
Refer for physio, occupational, speech therpay
Types of haemorrhagic stroke
Extradural haematoma (between dura and skull)
Subdural haemoatoma (between dura and arachnoid)
Subarachnoid haemorrhage (lines within brain)
Intraparenchymal haemorrhage (inside brain)
Intraventricular - inside ventricles
PAD layers - dura, arachnoid, pia
Causes of intracerebral haemorrhage (haemorhagic stroke) and risk factors
Hypertension - weakens small arterioles in brain parenchyma causing bleeding
RF - HTN, smoking history, alocohol abuse, amyloidosis, warfarin use
Ix for haemorrhagic stroke
CT head with contrast - fresh blood (hyperintense/bright white) area in vascular distribution
