STROKE 2 Flashcards
Stroke is also referred to as cerebrovascular accident (CVA).
Cerebrovascular accidents are either 2 things …what?
- Ischaemia or infarction of brain tissue secondary to inadequate blood supply
- Intracranial haemorrhage
what is a TIA?
crescendo TIA?
transient neurological dysfunction secondary to ischaemia without infarction that resolves within 24 hrs?
is where there are 2 or more TIAs within a week. This carries a high risk of developing in to a stroke.
if theres a sudden onset of neurological symptoms what should u suspect as a cause?
vascular cause
what are typical Stoke symptoms?
typically asymmetrical
- Sudden weakness of limbs
- Sudden facial weakness
- Sudden onset dysphasia (speech disturbance)
- Sudden onset visual or sensory loss
what symptoms do ptx who’ve suffered haemorrhagic stroke are more likely to have vs ischemic?
- decrease in the level of consciousness: seen in up to 50% of patients with a haemorrhagic stroke
- headache is also much more common in haemorrhagic stroke
- N & V is also common
- seizures
stroke mimics
BE HIM
Oxford Stroke Classification
(also known as the Bamford Classification)
what 3 criteria should be assessed?
classifies strokes based on the initial symptoms
The following criteria should be assessed:
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg (weakness)
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Risk Factors
- Cardiovascular disease such as angina, myocardial infarction and peripheral vascular disease
- Previous stroke or TIA
- Atrial fibrillation
- Carotid artery disease
- Hypertension
- Diabetes
- Smoking
- Vasculitis
- Thrombophilia
- Combined contraceptive pill
post-stroke complications:
PRISM R
- Pain and fatigue Post-stroke
- Recurrent stroke and extension of stroke
- Infections > chest infection bc aspiration) UTI (bc incomplete bladder empty from constipation or bed bound
- Spasticity, contractures & secondary epilepsy
- Mood & cognitive dysfunction
- Raised ICP
What determines the recovery of the stroke?
due to loss of the ischaemic penumbra resulting from suboptimal physiology.
Name 2 different types of tools used for stroke and what theyre used for?
FAST Tool for Identifying a Stroke in the Community
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)
ROSIER Tool for Recognition Of Stroke In Emergency Room
ROSIER is a clinical scoring tool based on clinical features and duration. Stroke is likely if the patient scores anything above 0.
what is the ABCD2 Score?
The ABCD2 score is used for assessing patients with a suspected TIA to estimate their risk of having a stoke.
The ABCD2 score is based on:
A – Age (> 60 = 1)
B – Blood pressure (> 140/90 = 1)
C – Clinical features (unilateral weakness = 2, dysphasia without weakness = 1)
D – Duration (> 60 = 2, 10 – 60 = 1, < 10 = 0)
D – Diabetes = 1
what is the NIHSS
National Institutes of Health Stroke Scale
CALCULATES THE SEVERITY OF ISCHEMIC STROKE
It is a systematic neurological assessment for stroke which measures “neurological deficit”
• Score from 0 - 42
NICE: a score of more than 5 consider thrombectomy
1st line investigation for stroke?
A non-contrast CT head scan–> exclude primary intracerebral haemorrhage
Investigations of TIA
Carotid doppler uss
ECHO
CT OR MR ANGIOGRAPHY By specialist
Secondary Prevention of Stroke
when do u do endarterectomy?
SAC
anticoagulation is usualyy given cuz they have an AF
- after 2 weeks–> Clopidogrel 75mg once daily
- Atorvastatin 80mg should be started but not immediately
- Stenting or carotid endarterectomy in ptx w/ carotid artery disease
Treat modifiable risk factors such as hypertension and diabetes
⇒ if Stenosis is >70%
what is the standard target time to offer thrombectomy
6 hrs!
ECEPTION CAN BE EXTENDED TO 6- 24hrs–> For PROXIMAL ANTERIOR CIRCULATION
if there is a potential to save brain tissue shown by CT perfusion or diffusion-weighted MRI showing not limited infarct core volume
(only “proximal” cuz its easier acces to put stent)
