Stroke Flashcards
Haemorrhage in the brain could be due to…
- Congenital weakness
- Aneurysm
- Hypertension
Brain circulation
Anterior circulation
Posterior circulation
Circle of Willis
Frontal lobe
Judgement, foresight, voluntary movement, smell
Broca’s area
Speech
Temporal lobe
Intellectual and emotional functions. Hearing
Brainstem
swallowing, breathing, heartbeat, wakefulness centre and other involuntary functions
Cerebellum
Coordination
Wernicke’s area
Speech comprehension
Occipital lobe
Primary visual inspection
Parietal lobe
Comprehension of language
Sensory cortex
Pain, heat and other sensations
Motor cortex
movement
Types of stroke causes
- Ischaemic stroke (85%)
2. Haemorrhage stroke (15%)
Modifiable Risk factors for stroke
High BP
AF
Non-modifiable risk factors for stroke
Age
Race
Family history
Risk factors for haemorrhage after stroke
Infarct size Vessel occlusion Diabetes Blood pressure Age Stroke severity Tissue changes Antiplatelets
How you can cause harm to someone with a stroke
Alteplase: fibrinolytic agent
Cause unexpected bleeding either in the brain if the tissue has established damage
If brain tissue is already dead then restoring blood supply isn’t going to help
Or bleeding elsewhere
SIGN guidelines for thrombolysis
Patients admitted with stroke within 4.5 hours of definite onset of symptoms who are suitable should be treated with IV rt-PA
Onset to treatment time should be minimised
Systems should be optimised to allow earliest possible delivery of IV rt-PA within the defined time window
Streptokinase SHOULD NOT be used in acute phase of stroke
Thrombolysis should be administered within the context of an acute stroke
Local protocols for the administration of thrombolytic therapy should be developed
Contraindications to thrombolysis
Minor neurological deficit or symptoms rapidly improving
Symptoms of ischaemic attack >4 hours prior to referral or when the time of onset is unknown
Severe stroke as clinically assessed or/and by imaging
Seizure at onset of stroke
Symptoms suggestive of an arachnoid haemorrhage even if CT is normal
On warfarin or administration of heparin in the last 48 hours and thromboplastin time exceeding the upper limit for normal laboratory
History of prior stroke or concomitant stroke
Prior stroke in last 3 months
Platelet count <100,000m3
Systolic blood pressure >185mmHg or is diastolic blood pressure >100mmHg or aggressive IV medication needed to reduce BP limits
Blood glucose <3 or >20mmol/L
Known haemorrhagic diathesis. manifest or recent severe or dangerous bleeding, known history of suspected intracranial haemorrhage
Age = most RTCs have excluded under 16s and over 80s. Licence limited under 80 yrs
MI; recent bleeding; very high BP etc
Acute stroke treatments
Stroke unit
Thrombolysis 0-3hrs
Aspirin 0-48hrs
Hemicrainectomy 0-48hrs
Importance of stroke units
Mobilise ASAP
Concentrate on simple things like swallowing, positioning etc
Early therapy
Concentrating of expertise
Secondary prevention of stroke
Urgent assessment and treatment of TIA and minor stroke
Clopidogrel 75mg/Aspirin 75mg plus dipyridamole MR 200mg bd
Statin
Blood pressure drugs even if BP is in normal range
Carotid endarectomoy
Clinical symptoms of a stroke
Dead numbness Loss of vision Loss of speech (comprehension or fluid of speech) Loss of power Loss of sensation Loss of coordination
Stroke subtypes
TACS
PACS
LACS
POCS
Investigations for stroke
Blood test; FBC, lipids
ECG
Imaging: CT, MRI, Carotid Doppler. Sometimes ECHO for if there is a clot in the heart
