Stroke Flashcards
What is TIA
mini stroke
brief blockage of blood flow = temporary stroke like symptoms
dose NOT damage brain cells = no permanent damage or disability
how long does TIA last
few mins to few hours
fully resolved <24h
what is ischaemic stroke
blockage cuts off blood supply to brain
kills brain cells = permanent damage
symptoms usually very sudden
how long does ischaemic stroke last
few mins - hours - days
>24h
FAST
facial drooping or unilateral weakness
arm weakness/numbness
speech impairment
time to call 999
headache in intracranial haemorrhage
- sentinel headaches can occur in preceding weeks
- bleed in brain (not blockage)
- sudden severe headache, usually gradually increasing intensity
- THUNDERCLAP headache
headache in subarachnoid haemorrhage
- bleed between brain and membrane that covers it
- thunderclap headache - very severe and sudden
- neck stiffness
Patient comes in with very bad headache and neck stiffness. What is this
subarachnoid haemorrhage, call 999
Why should you not give aspirin in suspected stroke
First need to rule out haemorrhage, giving aspirin would make it worse
management of TIA and minor ischaemic stroke
- 300mg daily until diagnosis established
- if presenting within <24 hours and low risk of bleeding, consider DAT: C+A followed by C monotherapy, or, T + A followed by T or C monotherapy
- if not appropriate for DAT, give C monotherapy
- consider PPI as necessary
- secondary prevention following diagnosis
dose of aspirin for suspected TIA
300mg daily until diagnosis established
dose of aspirin for TIA or minor ischaemic stroke, in combination with clopidogrel in pt with low risk bleeding
300mg aspirin initially for one dose to be started within 24h of symptom onset
then 75mg OD for 21 days
dose of aspirin for disabling acute ischaemic stroke
PO or rectally
300mg OD for 14 days
start 24h after thrombolysis or within 24h symptom onset in people not receiving thrombolysis
management of ischaemic stroke
- thrombolysis with alteplase or tenecteplase if it can be given within 4.5 hours of symptom onset and haemorrhage excluded by imaging techniques
- if you have had thrombolysis, start on antiplatelet after 24h unless CI (PO or rectal 300mg OD for 14 days)
- some patients may be eligible for surgery
who can administer thrombolytis e.g. alteplase
only experienced medical staff within specialist stroke centre
treatment of HTN in acute phase of ischaemic stroke
can result in reduced cerebral perfusion
avoid treating in acute phase unless there is a HTN emergency or in people considered for thrombolysis
you must avoid this AC in the acute phase of ischaemic stroke
warfarin
secondary prevention following stroke
long term clopidogrel therapy. alternative = aspirin.
high intensity statin as soon as pt can swallow.
what to do in pt who is receiving AC for prosthetic heart valve who experiences disabling ischaemic stroke and is at significant risk of haemorrhagic transformation
stop AC
replace with aspirin for 7 days
management of intracerebral haemorrhage
- may need surgery to remove haemotoma and relieve intracranial pressure
- consider rapid BP lowering therapy if they present within 6 hours symptom onset and have systolic BP 150-220 (and do not fit in exclusion criteria)
- aim for systolic BO 130-139
- if pt taking AC, stop and reverse (but may only be used if symptomatic PE or DVT)
Patient is immobile after acute stroke. Should you give any thromboprophylaxis
Do not routinely give LMWH or graduated compression stockings for prevention of DVT
Long term management for intracerebral haemorrhage
- manage BP and take care to avoid hypoperfusion
- avoid statins (but may be used in caution if risk of vascular event > risk of further haemorrhage)
If somebody has had intraceberal haemorrhage, they must not ever be given these drugs
statins
all of alteplase and tenecteplase interactions are to do with
increased risk of bleeding
alteplase monitoring when used for acute ischaemic stroke
Monitor for intracranial haemorrhage.
Monitor blood pressure; ensure blood pressure reduced to below 185/110 mmHg before treatment.
when used for acute ischaemic stroke, when is alteplase CI
Convulsion accompanying stroke; history of stroke in patients with diabetes; hyperglycaemia; hypoglycaemia; stroke in last 3 months
What is the Glasgow Coma scale
Assess the depth and duration of impaired consciousness and coma.
People are scored on three different aspects of behavioural response: eye opening, verbal, and motor responses
