Stroke Flashcards
How are strokes scored?
National institute of health stroke scale
Normal = 0
What are the commonest source of emboli for ischaemic stroke?
Heart and carotid artery
What are some exclusion criteria for thrombolysis?
Recent trauma or surgery
Aortic dissection
INR over 1.4
Pregnant
What are some inclusion criteria for thrombolysis?
Symptom onset in last 4.5 hours
Measurable deficit on NIHSS
No haemorrhage on CT
What are the risks of thrombolysis?
Haemorrhage
Angioedema
What are some stroke mimics?
Seizures
Sepsis
Hypoglycaemia
Migraine
Which arteries does TACS affect?
Middle and anterior cerebral arteries
What are the criteria for TACS?
All 3 of:
- Unilateral weakness of face, arm or leg
- Homonymous hemianopia
- Higher cerebral dysfunction
What are the criteria for PACS?
2 of:
- Unilateral weakness
- Homonymous hemianopia
- Higher cerebral dysfunction
Which arteries does POCS affect?
Posterior circulation
What are the criteria for POCS?
1 of:
- Cerebellar/brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia
What are the criteria for LACS?
1 of:
- Unilateral weakness
- Pure sensory stroke
- Ataxic hemiparesis
What is the definition of a TIA?
Sudden onset of neurological symptoms lasting less than 24 hours
What are crescendo TIAs?
2 or more within a week - high risk of stroke
What is the ABCD2 score used for?
Gives risk of stroke in next 48 hours
What are the criteria on abcd2?
Age over 60
BP over 140/90
Clinical - unilateral weakness, speech disturbance (2 points)
Duration - over 60 mins = 2, 10-59 mins = 1
Diabetes
What should be done in the community after a suspected TIA?
Give aspirin 300mg
Tell not to drive for 1 month
Arrange appointment at TIA clinic within 1 week
What tests should be done after a TIA?
Height, weight and BMI FBC, U&Es, LFTs, lipids Carotid artery US Doppler Blood glucose ECG - if AF do chads2vasc score
How should carotid stenosis be treated?
Over 70% - surgery within 2 weeks BP control Antiplatelets Statins Diet advice
What are primary prevention risk factors for ischaemic stroke/TIA?
Diabetes
Hypertension
Smoking
Hyperlipidaemia
What are secondary prevention risk factors for ischaemic stroke/TIA?
Prior event
CAD/PVD
Carotid stenosis
AF
What are risk factors for haemorrhagic stroke?
Hypertension Cerebral amyloid angioplasty Aneurysms Cerebral arteriovenous malformations Brain tumours
What are some complications of stroke?
Aspiration pneumonia
Brain haemorrhage
When is decompressive hemicraniotomy indicated?
MCA infarct Under 60 years NIHSS over 15 Reduced GCS CT shows infarct over 50% MCA territory
