Stroke Flashcards
What are the two types of stroke?
Ischaemic
Haemorrhagic
Ischaemic stroke can be subdivided into what?
> 24 hrs (ischaemic)
<24 hrs (TIA)
Which type ischaemic or haemorrhagic is more common?
Ischaemic (85%)
Haemorrhagic (15%)
Features of a stroke? (5)
Motor weakness - contralateral Speech problems (dysphasia) Swallowing problems Visual field defects Balance problems Facial palsy - ipsilateral
Cerebral hemisphere infarct features? (4)
contralateral hemiplegia
contralateral sensory loss
homonymous hemianopia (visual field loss on the same side of both eyes)
dysphasia
Brainstem infarction features?
May result in more severe symptoms including quadriplegia and lock-in-syndrome
Lacunar infarct features? (small infarcts around the basal ganglia, internal capsule, thalamus and pons)
Pure motor, pure sensory, mixed motor and sensory signs or ataxia
No visual or speech disturbances
Stroke Types (Oxford Stroke Classification - also known as the Bamford Classification)
Total anterior circulation infarcts (15%)
Partial anterior circulation infarcts (25%)
Lacunar infarcts (25%)
Poster circulation infarcts (25%)
Total anterior circulation infarcts symptoms?
Involves which arteries?
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg (contralateral)
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
Involves middle and anterior cerebral arteries
Partial anterior circulation infarcts symptoms?
Involves which arteries?
2 of:
- unilateral hemiparesis and/or hemisensory loss of the face, arm & leg (contralateral)
- homonymous hemianopia
- higher cognitive dysfunction e.g. dysphasia
involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
Lacunar infarcts symptoms?
Involves which arteries?
1 of the following:
- C/L weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- ataxic hemiparesis
- Dysarthria/clumsy hand
- Pure sensory stroke
small infarcts around the basal ganglia, internal capsule, thalamus and pons
Poster circulation infarcts symptoms?
Involves which arteries?
1 of the following:
- cerebellar or brainstem syndromes
- loss of consciousness
- isolated homonymous hemianopia
involves vertebrobasilar arteries
Although symptoms only cannot differentiate between haemorrhagic and ischaemic stroke, symptoms of haemorrhagic stroke are more likely to be? (4)
decrease in the level of consciousness: seen in up to 50% of patients
headache
nausea and vomiting
seizures occur in up to 25% of patients
What is the FAST campaign?
Face - ‘Has their face fallen on one side? Can they smile?’
Arms - ‘Can they raise both arms and keep them there?’
Speech - ‘Is their speech slurred?’
Ttime - ‘Time to call 999 if you see any single one of these signs.’
What is the stroke score used by health professionals?
ROSIER score
What must you exclude first before the ROSIER score is started?
hypoglycaemia
What is ROSIER score? (7)
Loss of consciousness or syncope - 1 point Seizure activity - 1 point New, acute onset of: • asymmetric facial weakness + 1 point • asymmetric arm weakness + 1 point • asymmetric leg weakness + 1 point • speech disturbance + 1 point • visual field defect + 1 point
What score is a stroke likely?
> 0
Indications for thrombolysis?
ischaemic stroke
patients present with 4.5 hours of onset of stroke symptoms
the patient has not had a previous intracranial haemorrhage, uncontrolled hypertension, pregnant etc
Mx of ischaemic stroke <4.5 hrs of onset of symptoms?
Thrombolyse with tissue plasminogen activator – IV alteplase
Mx ischaemic stroke >4.5 hrs of onset of symptoms?
Start 300 mg aspirin immediately
Carotid doppler
What score is used to assess TIA?
ABCD^2:
Age: >= 60 yrs (1pt)
BP: >= 140/90 mmHg (1pt)
Clinical features: unilateral weakness (2pts)
speech disturbance (1pt)
Duration of symptoms: >60 mins (2 pts)
10-59 mins (1pt)
Diabetes present (1pt)
High risk score for patients with suspected TIA ?
4 or above
Mx of patients with suspected TIA with a score of 4 or above? (3)
aspirin (300 mg daily) started immediately
specialist assessment and investigation within 24 hours of onset of symptoms
measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors
Carotid doppler
Mx of hemorrhagic stroke?
What should be stopped?
- fresh frozen plasma or prothrombin complex concentrate
- vitamin K
Anticoagulants and anti-thrombotic medication (e.g. warfarin & clopidegrel)
