Stroke Flashcards
Define stroke
Reduced blood flow to a part of the brain, depriving it from oxygen and nutrients
85% of stroke are due too…
Cerebral infraction
Non modifiable risk factors
• age
• gender
• ethnicity
Modifiable risk factors
• obesity
• HTN
• diabetes
• AF
• cholesterol
• smocking
• alcohol
• reduced physical activity
• stress
Symptoms of stroke?
• quick onset
• slurred speach
• difficulty understanding
• unilateral weakness
• visual disturbance
• hearing loss
• thunder clap headache - In haemorrhage stroke
Circle of wills is…
The brains blood supply
Middle cerebral artery delivers blood to..
The most outer part of the brain
Anterior cerebral artery supplies blood to..
Frontal inner portion
Posterior cerebral artery delivers blood to….
Back inner potion
Basilar artery delivers blood to….
Brain stem
What are the types of strokes?
• TIA
• ischemic stroke
• haemorrhage stroke
How long does a TIA attack last for and is it temp or permanent ?
<20mins & temp interruption to blood flow
How long do symptoms resolve in?
24hours
List examples of Focal neurological deficits
~TIA
• dysphasia
• vertigo & ataxia (unsteadiness)
• unilateral weakness
• loss of vision in one eye
• loss of vision in the same half of both eyes
Ischemic stroke occurs due to
Thrombus
Ischemic stroke occurs as a result of atherosclerosis or clot formation, which occurs in….
• heart
• ventricles
• AF
What is a haemorrhage stroke
Blood vessel ruptures, resulting in bleeding around the brain
What does FAST stand for
Face
Arms
Speech (slurred)
Time (call 999)
What tool is used the diagnosis of stroke to differentiate between stroke and other symptoms that are similar to stroke
ROSIER
Recognition of stroke in emergency room
List examples of stroke mimics
• syncope
• severe migraines
• sepsis
• HYPOglycemia
• space occupying lesions on imaging
Which diagnostic methods are used to diagnose stroke
• CT (exclude haemorrhage or IS)
• MRI (preferred in confirmed TIA)
• ECG
• ECHO
• catotid ultrasound
• cerebral angiography
• blood test
Initial management of TIA
•STAT - aspirin 300mg
• refer to TIA specialist within 24 hours of symptom onset
• imaging not required
Once TIA diagnosis is confirmed, what is the secondary prevention
Anti platelets:
• 1st line: clopidogrel 75mg OD
• 2nd line: Aspirin 75mg with dipyridamole MR 200mg BD
+
• atorvastatin 20-80mg
Thrombolysis management of ischemic stroke
If onset of symptoms within <4.5h
• give IV Alteplase
* exclude intercrainial haemorrhag before giving*
If onset >4.5 (with 6-24 hours)
• preform thrombectomy
Initial drug management of Ischemic stroke?
• aspirin 300mg OD, 14 days
• PPI
• Atorvastatin 40mg
• oxygen supplement
• control blood glucose
• control HTN
Acute drug management of haemorrhage stroke?
• stop antiplatlets
• start surgical intervention (craniotomy or hemicranietctomy)
• stop bleeding - vit K or tranexemic acid
• reduce BP (systolic <140)
• ventricular drainage
• statin
• nomidopine 60mg every 4 hours (for subarachnoid haemorrhage)
Treatment for intracerebral haemorrhage?
Decompressive hemicraniectomy
^needs robbed done within 48h of symptoms onset
What complications occur after (all types) strokes
• dysphasia
• cognitive dysfunction
• co-ordination difficulties
• depression
• anxiety
• speech disorders (dysarthria)
Dysphasia is difficult of swallowing, what does dysphasia increase the risk of
• pneumonia
• aspiration
• malnutrition
tubes are inserted to assist nutrition and medication requirements
How is nasogastric tube inserted,
Inserted into the stomach via nose
How is nasojejunal inserted
Into the jejunum via nose
How is percutaneous endoscopic gastrostamy inserted?
Into the stomach via abdominal wall
How is percutaneous endoscopic jejunostomy inserted?
Into the jejunum via abdominal wall
How is percutaneous endoscopic gastro-jejunostomy inserted?
Into jejunum via abdominal wall and stomach
When should tube positing be checked?
• after inserting
• before feeds
• before administration of meds
• once daily during continuous feed
• evidence of displacement
• after coughing, vomiting or retching
How can tube position be check
• imaging - but too much radiation
• pH
At which pH is it okay to start feeding?
5.5 or below
if over do not use and wait for gastric acids to rise
Some patient may be on gastroprotection drugs, thus pH is over 6 - use imaging instead of pH testing
How does external feeding tubes affect drug absorption?
The drug will be in the stomach for a small amount of time, affecting the absorption, especially if it requires acidic environments for dissolution
What type of water is required for enternal feeding tube and why?
Sterile - because it reduces risk of infection and contamination
How much ml of water is required to flush enternal tubes?
10-30ml
What is the maximum time water can be left for?
24 hours
What can occur if drugs are mixed together via enternal tube
• blockages
• interactions
Are injections with high polyethylene gycol content suitable for enternal feedings and give example?
No
Example: vancomycin
