stroke Flashcards
subtypes of ischaemic strokes
thrombotic
embolic
- fat, air, clump of bacteria
- atrial fibrillation
risk factors for haemorrhagic strokes
arteriovenous malformation
age
hypertension
anticoag therapy
(15% of strokes, 85% ischaemic)
oxford stroke classification (also know as Bamford CLassification)
- unilateral hemiparesis and/or hemisensory loss of face, arm + leg
- homonymous hemianopia
- higher cognitive dysfunction - eg dysphagia
total anterior circulation infarcts
involves middle + anterior cerebral arteries
all 3 of criteria
- unilat hemiparesis
- homonymous hemianopia
- high cognitive dysfunction - dysphasia
partial anterior circulation infarcts
smaller arteries of anterior circulation eg upper or lower division of middle cerebral artery
2 of criteria present
arteries affected in Lacunar infarcts
involves perforating arteries around the internal capsule, thalamus and basal ganglia
lacunar infarct presentation
pure motor, pure sensory, mixed motor and sensory signs or ataxia
presents with 1 of following
- unilateral weakness of face and arm, arm and leg, or all 3
- pure sensory stroke
- ataxic hemiparesis
arteries affected in posterior circulation infarcts
involves vertebrobasilar arteries
posterior circulation infarct presentation
1 of the following
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
symptoms more likely to be seen in those who have had a haemorrhagic stroke
decreased level of consciousness
headache !!
N+V
seizures
FAST stroke campaign
Face - has their face fallen on one side? can they smile?
Arms - can you raise both arms and keep them there?
Speech - is there speech slurred?
Time - time to call 999 is you see any single one of these!
when is thrombolysis offered to stroke patients
imaging confirmed ischaemic
- presented with 4.5hrs of onset of sx
- no previous intracranial haemorrhage, uncontrolled hypertension etc
pharma in TIA
immediate antithrombotic therapy
- give aspirin 300mg
obvs unless contraindicated
- bleeding disorder/taking anticoag
–> immediate admission to exclude haemorrhage
mangement if the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis
admission / observation urgent with stroke specialist
Mx if the patient has had a suspected TIA in the last 7 days
arrange urgent assessment (within 24 hours) by a specialist stroke physician
mx If the patient has had a suspected TIA which occurred more than a week previously
refer for specialist assessment as soon as possible within 7 days
lateral medullary syndrome
posterior inferior cerebellar artery
- ipsilateral - ataxia, nystagmus, dysphagia, facial numbness
contralateral - limb sensory loss
Webers syndrome
ipsilateral III palsy
contralateral weakness
