STROKE Flashcards
What is stroke
Sudden global or focal neurological
deficit resulting from spontaneous hemorrhage or infarction of the
central nervous system, with objective evidence of an infarction or hemorrhage, irrespective of the duration of clinical symptoms
……….. or …………….. is required to make the diagnosis and exclude other intracranial lesions that could present similarly
CT or
MRI scan
What is TIA
is a transient
episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia.
There is no objective evidence of acute infarction in the affected region of brain or retina in TIA . T/F
T
Causes of cerebral infarction
Thrombosis
Embolism
Important risk factors of stroke in children
sickle cell disease
cyanotic heart disease
Risk factors of stroke
hypertension
diabetes
dyslipidemia
atrial fibrillation
smoking
Causes of stroke
Cerebral infarction
Intracerebral hemorrhage
Subarachnoid hemorrhage
Symptoms of stroke
Weakness of one side of the body including the face
Inability to rise up from a sitting or lying position
Sudden fall/collapse
Loss of speech
Loss of vision
Unconsciousness in some patients
Seizures
Severe headache and/or neck pain is seen in ……………..
subarachnoid hemorrhage
What is hemianopia
loss of one-half of visual field
Neck stiffness is seen in …………..
Subarachnoid hemorrhage
Signs of stroke
Paralysis of a limb
Facial paralysis
Initial flaccidity of limbs, but later spasticity and exaggerated reflexes
Hemianopia
Hemi-anaesthesia
Extensor plantar response
Dysarthria/dysphasia
Neck stiffness (in subarachnoid haemorrhage
What is Hemi-anaesthesia
loss of sensation of one-half of body
Treatment objectives in stroke
To limit the area of brain damage
To protect patients from the dangers of unconsciousness and immobility
To prevent aspiration
To treat the underlying cause if possible
To identify and manage modifiable risk factors
To institute measures to improve functional recovery To support and rehabilitate patients who survive with residual disability
To minimize adverse effects of drug therapy
Investigations in stroke
FBC, ESR
Blood glucose
Serum lipid profile
BUE/Cr
Uric acid
ECG
CT scan/MRI of the head
Chest X-ray
Non-pharmacological management of stroke
- Monitoring
- Establish adequate airway in unconscious patients
- Swallowing test in an upright position
- Insert nasogastric tube
5.Nurse in the lateral position with suctioning where necessary - Elevate head of bed
- Prevent pressure sores by regular turning (every 2 hours) in bed
- Maintain adequate hydration
- Keep patient clean and dry by frequent use of bedpan/urine pot, diapers, condom catheter as required. Urethral catheter should be used only if absolutely necessary
- Start physiotherapy as soon as practicable
How often should a stroke patient’s vital signs and neurological signs be monitores
Every 4 hours
Volume of water used for the swallow test
10 to 15ml
Purpose of nasogastric tube
Feeding and Nutrition
Which patients will require a nasogastric tube and why
unconscious patients or those with swallowing difficulties to prevent aspiration
At what angle should the stroke patients head be elevated to and why
30 degrees to reduce intracranial pressure
Pharmacological treatment of infarctive stroke and TIA
Aspirin
and
Atorvastatin or Rosuvastatin
Dose of rosuvastatin increased
Adults
20-40 mg daily
Children
Not recommended
Should oral metformin be given in acute stroke
No
RBS target in stroke
4 to 10 mmol/l
Dose of aspirin
Aspirin, oral,
Adults
300 mg stat.
Then
75 mg daily
Children
> 16 years; same as adult dose
< 16 years; not recommended
Dose of atorvastatin
Adults
40-80 mg daily
Children
Not recommended
Blood pressure management in stroke
If > 180/110 mmHg aim for gradual reduction
of no more than 20% over 24 hours.
Dose of hemorrhagic
Mannitol, IV,
Adults
0.5-1 g/kg 6 hourly (up to 2 g/kg per dose)
Children
1 month-18 years; 0.5-1.5 g/kg
Or 2.5-7.5 ml/kg of 20% solution
Should SL nifedipine be used in BP management in stroke patients
No
Which fluids should be avoided in stroke
Dextrose 5% or 10% unless patient is hypoglycaemic
Which fluids should be used for hydration in stroke
Normal saline
Dextrose saline
Therapies to reduce ICP in stroke
Nurse at 30 degrees head up
IV mannitol
Dexamethasone
Treatment for aspiration pneumonia in stroke
IV Amoxiclav and IV metronidazole for first 48 hours then review
Algorithm for stroke management
History and
examination
Investigations
Hydration
Stress ulcer prophylaxis
Glucose control
Pyrexia
BP management
Treatment of infarcts
Atrial fibrillation
Mobilisation of patients
Aspiration pneumonia
DVT and PE prophylaxis
Seizures
Change in consciousness level
Increased ICP
High cholesterol
Factors that can cause change in consciousness level in stroke
cerebral oedema
hypoglycaemia
metabolic
drugs
Treatment of infarcts in stroke
aspirin 300 mg stat as soon as infarct identified via (oral/
NG) if no contraindications. Reduce dose to 75 mg daily after 1
week, and consider further anti-platelet medication
