Stroke Flashcards
Stroke symptoms
- limb and facial weakness/numbness
- speech disturbance
- visual loss
- disturbance of balance
- swallowing problem
- neglect
Definition of stroke WHO
Sudden onset of acute focal neurological deficit probably due to pathological process in blood vessels
Epidemiology of stroke
Common - 110,000 per year in UK
At 30 days 17% will have died
50% died or disabled at 6 months
A quarter of stroke victims are under 65 yo
Cost NHS £7 billion per year
Ischameic stroke
85% of all strokes
Brain artery blocked by blood clot
- embolic: clot formed outside the brain and lodges in part of the brain (atherosclerosis)
- thrombotic: formation of blood clot in BRAIN artery
Haemorrhagic stroke
15% of strokes
Brain artery bursts causing bleeding
- intracerebral: blood enters into substance of brain
- subarachnoid: blood enters various spaces surrounding brain
CT scan densities and colours
White: high density (bone, clotted blood)
Grey: normal brain tissue
Black: low density (water or CSF)
CT scan in ischaemic stroke
Oedema develops in area of tissue with the reduced blood flow.
Therefore will have area of relatively low density (blacky grey)
CT scan in haemorrhagic stroke
High arterial pressure blood ruptures into brain substance (brain paranchyma)
Area of clotted blood will show up white on CT
Risk factors for ischaemic stroke
- high blood pressure
- hi cholesterol
- left ventricular hypertrophy
- peripheral pulses
- carotid bruit
SMOKER, OBESITY, STRESS
Transient ischaemic attack TIA
Mini stroke
ROSIER form
Recognition Of Stroke In Emergency Room
Clinical assessment form that nurses can do quickly to ring dr up with results
Admit if result between 1 and 6
Acute management of stroke - BRAINATTACK
Blood pressure Respiration: keep O2 sat above 95% Airway management Iv saline Normoglycaemia Aspirin: if haemorrhage excluded Temperature: keep <37 degrees TEDS compression stockings (avoid DVT) Assess water swallow test CT as soon as possible Keep 30 degree head tilt
Thrombolysis
Unblocking of arteries using a tissue plasminogen activator like ateplase.
Fibrinalysis
Who is eligible for thrombolysis
Acute onset stroke with haemorrhage excluded on scan
Within 6 hours, preferably 3
In unit with properly trained staff
Access to imaging
Complications of thrombolysis
2 in 3 will not be OK. Breaking clot thins blood, increasing risk of intracranial (4 in 100) and extracranial (GU, GI) bleeding
Angio oedema: immune mediated swelling of tongue leading to resp failure
Or simply no clinical improvement