Stroke Flashcards
What does focal neurological symptoms refer to?
The signs ans symptoms can tell you which part of the brain is affected
What is the definition of a stroke?
Acute onset of focal neurological symptoms and signs due to disruption of blood supply
What is the incidence rate of strokes?
4th commonest cause of death in Uk and third biggest in Scotland
What are the two types of stroke?
-haemorrhagic and ischemic
What causes an ischemic stroke?
blockage of an artery in the brain
What causes a haemorrhagic stroke?
blood vessel tears and bleeds into the brain causing damage and associated ischemic damage due to lack of blood flow to other areas
What is the most common type of stoke?
Ischaemic
What is the most common cause of haemorrhagic and ischemic stroke?
-high BP
What can cause haemorrhagic stroke?
- high BP
- weakened blood vessel wall due to
- aneurysm, inflammation etc
What are the types of ischemic stroke?
- thrombotic
- embolic
- hypoperfusion
What causes a hypoperfusion stroke?
reduced flow of blood due to stenosed artery rather than occlusion of artery
What are the risk factors for strokes?
- older age
- family history of CVD
- Male
- Race ie south Asian
- previous stroke
Why is the age of stroke diagnosis decreasing?
Due to modifiable risk factors such as smoking and drinking
What are the modifiable risk factors for stroke?
- hypertension
- smoking
- lack of exercise
- diabetes
- alcohol
What type of stroke does high cholesterol cause?
ischemic stroke
What is an example of a rare cause of stroke?
-protein S,C Antithrombin III deficiency
What is the treatment for acute presentation of stroke?
Thrombolysis or Thrombectomy
How can the next stoke be avoided?
By identifying the cause of the stoke and starting appropriate treatment
What are stroke mimics?
conditions that present acutely with focal neurological signs but are not due to interrupted blood flow
What conditions cause stroke mimics?
- hypoglycaemia
- seizure
- migraine
- other metabolic
- lesions ie tumour
- functional hemiparesis
How to determine the type of stroke?
Brian imaging such as
-CT or MRI with or without contrast
What investigations could be carried out to discover the cause of ischemic stroke?
- blood tests (glucose, lipids, thrombophilia)
- BP
- ECG
What is an atheroembolism?
embolism from a thrombus forming on an atherosclerotic plaque on an artery
What is a cardioembolism?
embolism from a clot formed in the heart (usually left atrium)
What part of the brain will be affected by an atheroembolism?
the same side as the affected carotid artery
What part of the brain will be affected by a cardioembolism?
will affect more than one arterial territory
If bleed is deep whats the most likely cause of a haemorrhagic stroke?
hypertension
If bleed is superficial what is the most likely cause of a haemorrhagic stroke?
aneurysm
If there are multiple bleeds what conditions could you expect to cause haemorrhagic strokes?
- vasculitis
- Moya Moya disease
- cerebal amyloid angiopathy
How late after onset of symptoms can you do thrombolysis?
up to 4.5 hours
How late after onset of symptoms can you do thrombectomy?
up to 6 hours
What is an example of a thrombolytic drug?
t-PA
How is t-PA administered?
IV
How does a thrombectomy work?
-mesh around the clot and then pull it out
When is a thrombectomy used?
in patients where the catheter can reach the clot ie in more proximal areas in small arteries not distal
If the stroke was atheroembolic or due to a thrombus, what treatment should be given to prevent the next stroke?
- antiplatelet
- statins
- diabetes management
- hypertension management
- lifestyle advice
What is the antiplatelet treatment for prevention of next stroke?
-aspirin 75mg AND -Dipyridamol MR 200mg twice daily OR -Clopidogrel 75mg daily
If the stroke was due to AF, what treatment should be given to prevent the next stroke
- warfarin
- oral anticoagulants ie rivaroxaban, dabigatran, etc
- antihypertensives
When is surgery indicated?
dead part of brain swells and can affect the normal part of brain due to compression within skull- surgeons may open cranium to allow swelling out of compressed area to save life
What is a TIA?
Temporary neurological symptoms due to occlusion of artery stopping flow of blood
Why is a TIA temporary?
arteries are capable of dissolving small clots
