Stroke Flashcards
Describe the impact of stroke to the UK
110,000 new strokes a year
30,000 people have further strokes
Commonest cause of adult onset disability
Cost NHS £7bn a year
Describe the global burden of stroke
3rd most common cause of death in developed countries (after IHD & cancer)
15 million /year suffer
5 million deaths
5 million permanently disabled
Increasing due to ageing population
What are the major modifiable risk factors for stroke?
Hypertension Smoking Diabetes High cholesterol AF IHD PVD Previous Tia Obesity Unhealthy diet
Name three social risk factors for stroke
Excess alcohol use
Psychosocial stress
Low socioeconomic status
What are the non-modifiable risk factors for stroke
Age ( risk doubles each decade > 55)
Family history
Race
What races are most susceptible to strokes and why?
African and Caribbean
Twice as likely than age and sex counterparts
Higher prevalence of high bloody pressure (ICH & ischemic) & higher risk of diabetes
Possible linked to diet
Describe the link between blood pressure and stroke
>140/90 30% of adults in most countries Most important modifiable risk factor 4/10 deaths preventable by < BP BP linked to BMI, physical activity and dietary salt intake BP tends to increase with age
Describe the effect of blood pressure on stroke risk
Risk of stroke increases w/ mean BP
Interactions bw blood pressure and other risk factors
Decision to treat BP depends on cardiovascular risk
Describe the link between smoking and stroke
Doubles risk of stroke in men and women
Damages endothelial lining, promotes atheroma, enhances clotting, raises LDL cholesterol, lowers HDL cl, raised BP
Stopping smoking reduces cardiovascular risk to close to that of non-smoker
Describe the link between diabetes and stroke
Doubles risk of stroke
Higher risk of dying from the stroke
Increase in prevalence of type 2 due to physical inactivity, obesity & excessive calorie intake
High LDL and low HDL are important risk factors for what?
Ischaemic heart disease (IHD)
Evidence from trials that lowering cholesterol in those with history of IHD, PVD or prior stroke on preventing further events
What is the link between social deprivation and stroke
Those living in deprived areas 3 times more likely to die from stroke
Higher rates of smoking?
Poor diet?
Obesity?
Lack of exercise?
How much does AF Increase risk of stroke by
6 times
What is the risk of stroke in first month after TIA/ minor stroke?
10-12%
Early identification & treatment reduces risk of stroke significantly (lancet 2007)
describe a population based approach to stroke
Education to
Increased exercise Lower salt intake Better diet Reduced cholesterol intake Reduced alcohol intake Stop smoking
How can primary prevention help reduce risk in at risk groups
Identify high risk populations Regular BP checks 'Well man' clinics Diabetes/high chol/AF assess overall CV risk prior to treatment
Secondary prevention for stroke
Rapid assessment of patients with TIA
Aim for BP < 140/90 in diabetics
Statins for people with CL> 3.5
Warfarin/NOACs for patients in AF
carotid endarterectomy for tight symptomatic stenosis
Give the WHO definition of Stroke
A clinical syndrome consisting of a ‘rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin
What is the definition of TIA
Focal cerebral ischaemic event producing clinical symptoms lasting less than 24 hours
what type of migraine is a common stroke mimic
Hemiplegic migraines
Unilateral hemipenes is can outlast headache (rarely>24 hrs)
What symptoms of hypoglycaemia can cause it to present as a stoke mimic
Hemiplegia
Aphasia
Name two alcohol related conditions that can mimic TIA
Wernickes
Korsakovs
What other acute conditions can mimic strokes/TIA
Hepatic encephalopathy Drugs -AEDs -carbamazepine Infections UTIs Electrolyte imbalance Functional conditions
What acute stroke mimics show an abnormal CT
Encephalitis Abscess Subdural heamotomas Tumour AVM
