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3. Senior Block- Integrated Care > Stroke > Flashcards

Stroke Flashcards

1
Q

Give 6 risk factors for Stroke

A 
>55 years old 
Hypertension 
Diabetes
Smoking 
Excess alcohol 
High fat diet 
Family history 
Heart disease
High cholesterol 
South Asian or African 
Atrial fibrillation 
Women= high oestrogen, pre-eclampsia, gestational diabetes
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2
Q

What is the pathophysiology of an ischaemic stroke?

A

Blood clot blocks an artery to the brain.

Clots occur from either via a thrombosis in situ, atherosclerosis from the carotids or cardiac emboli secondary to AF, IE, MI or prosthetic valves

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3
Q

What is the pathophysiology of a hemorrhagic stroke?

A

Blood vessel in the brain bursts and there is a bleed around the brain.

Due to hypertension, trauma, aneurysm rupture, anticoagulation or thrombolysis

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4
Q

Describe a TACS (total anterior circulation stroke)

A

Large cortical stroke affecting areas of the brain supplied by the anterior and middle cerebral arteries

All 3 of:

  • Unilateral weakness +/- sensory deficit of the face, arm and leg
  • Homonymous hemianopia
  • Higher cortical dysfunction (dysphagia, visuospatial disorder)
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5
Q

Describe a PACS (partial anterior circulation stroke)

A

Less severe form of TACS- only anterior cerebral artery affected

Need 2 of:

  • Unilateral weakness +/- sensory deficit of the face, arm and leg
  • Homonymous hemianopia
  • Higher cortical dysfunction (dysphagia, visuospatial disorder)
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6
Q

Describe a POCS (posterior circulation syndrome)

A

Damage to the area of the brain supplied by the posterior circulation. Affects cerebellum and brainstem

Need 1 of:

  • Cranial nerve palsy + contralateral motor/sensory nerve deficit
  • Bilateral motor/sensory deficit
  • Conjugate eye movement palsy (horizontal gaze palsy)
  • Cerebellar dysfunction (nystagmus, vertigo, ataxia)
  • Isolated homonymous hemianopia
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7
Q

Describe Lacunar Syndrome (LACS)

A

Subcortical stroke that occurs secondary to small vessel disease. No loss of higher cerebral functions eg. dysphasia

1 of:

  • Pure sensory stroke
  • Pure motor stroke
  • Sensorimotor stroke
  • Ataxic hemiparesis
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8
Q

What does FAST stand for in stroke management?

A

Face- fallen on one side, cannot smile?
Arms- can they raise them both above their head?
Speech- slurred?
Time- ring 999 immediately

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9
Q

Give 5 symptoms of a stroke

A 
Sudden loss of vision/ blurred vision 
Dizziness
Confusion 
Hemiparesis
Poor balance and coordination 
Dysphagia
Difficulty understanding 
Sudden severe headache
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10
Q

Give examples of primary prevention measures for stroke

A 
Manage hypertension 
Statins- reduce cholesterol 
Manage BMs
Stop smoking 
Increase exercise
Good diet 
Anticoagulation?
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11
Q

How is whether or not to start anticoagulation decided after an AF diagnosis?

A

CHADSVASc

HAS-BLED score

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12
Q

What factors are involved in the CHADSVASC Score?

A 
Chronic Heart Failure/LV dysfunction (1) 
Hypertension (1) 
Aged >75 years (2) 
Diabetes (1) 
Stroke/TIA (2) 
Vascular disease (1) 
Aged 65-74 years (1)
Sex= female (1)

Anticoagulate if score >2, patient choice if >1

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13
Q

What factors are involved in the HAS-BLED score?

A 
Hypertension (1)
Abnormal liver/renal function (1+1)
Stroke (1)
Bleeding tendency (1)
Labile INR (1)
Elderly- aged >65 (1)
Drugs/alcohol excess (1+1)

> 3= high risk of bleeding caution in prescribing anticoagulation

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14
Q

How is a stroke managed acutely?

A

Protect airway
Nil by mouth until swallow is assessed
Maintain homeostasis- aim for BMs 4-11mmol/L and BP <185/110
CT head/MRI within 1 hour

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15
Q

Why is a CT/MRI head done in acute stroke management?

A

Work out if stroke is ischaemic or haemorrhagic
Severity
Area of brain affected

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16
Q

Give the positive and negatives of doing a CT head in acute stroke management (compared to a MRI head)

A

+ = faster, readily available, less expensive, can do in patients with a pacemaker, less claustrophobic, haemorrhage clearly visible for up to 72 hours

  • = high radiation dose
17
Q

Give the positive and negatives of doing a MRI head in acute stroke management (compared to a CT head)

A

+ = see anatomy in greater deal, can detect early ischaemia, differentiate between old and new ischaemia

  • = more expensive, time consuming
18
Q

How is an ischaemic stroke managed?

A

Thrombolysis= Alteplase dissolves blood clots if given within 4.5 hours of stroke occuring.
Thrombectomy- large clots removed via catheter in femoral artery fed up to the brain

Antiplatelets- aspirin 300mg for 2 weeks
Anticoagulation- long term use of warfarin, apixaban, dabigatran or rivaroxaban

Secondary prevention- antihypertensives, statins

Carotid endarterectomy- reduce carotid stenosis

19
Q

Give 4 contraindications of thrombolysis

A 
Haemorrhage on CT
Recent surgery 
Trauma
Previous CNS bleed 
Aneurysm 
Liver disease
Hypo/hyperglycemia 
Seizures at presentation 
Recent GI haemorrhage 
Known clotting disorder
INR >1.7
20
Q

How is a hemorrhagic stroke managed?

A

Antihypertensives
Reverse anticoagulation
Craniotomy- part of skull removed to repair blood vessels and remove clots. Skull replaced with metal plate.

21
Q

What long term supportive management can be given to a patient who has suffered a stroke?

A

NG tube feeding
O2 therapy
IV fluids
Compression stockings

22
Q

Give some long term physical effects of a stroke

A

Weakness
Stiff muscles
Loss of muscle function

23
Q

What is aphasia?

A

No longer able to understand or use language appropriately

24
Q

What is dysarthria?

A

Not able to use facial muscles well so difficult to speak clearly

25
Q

What is post-stroke fatigue?

A

Extreme tiredness which does not improve with rest. Simple tasks require much more effort in stroke recovery.

26
Q

How is swallowing managed in a stroke patient?

A

SALT input
Thickened fluids- makes swallowing easier
May need NG tube or PEG feed

27
Q

What psychological conditions are commonly recognised after a stroke?

A

Anxiety

Depression

28
Q

When can a patient drive again after a stroke?

A

At least 1 month

GP decides how well they are to drive or whether they need further assessment.

29
Q

Give 8 people who might be involved in the stroke MDT

A 
Stroke physician 
GP 
ANP
Acute hospital nurses
Community hospital nurses 
SALT
OT
PT
Orthoptist 
Continence nurse
Psychologist 
Social services 
Carers
30
Q

Give 5 predisposing factors for a TIA

A 
Smoking 
Hypertension 
Obesity 
Diabetes 
High cholesterol 
Excess alcohol 
AF 
>60 years old
31
Q

What is the pathophysiology of a TIA?

A

Blood clot in the brain temporarily causes reduced blood flow to the brain but all symptoms resolve within 24 hours.

Most commonly due to a carotid embolism or a thrombus due to AF

32
Q

Give 5 potential symptoms of a TIA

A 
All resolve in 24 hours: 
Drooping face 
Weakness in 1 side of the body 
Slurred speech 
Dizziness and confusion 
Dysphagia 
Amaurosis fugax- curtain descending over vision.
33
Q

What is the ABCD2 Score in TIA management?

A

Age >60 years (1)
Blood pressure >140/90 (1)
Clinical features- unilateral weakness (2), speech disturbance (1)
Duration of symptoms >1 hr (2), <1 hr (1)
Diabetes (1)

Score >4 = high risk of early stroke so should be seen by a specialist within 24 hours. >6 hours predicts high risk of stroke in the next 2 days.

34
Q

What investigations should be done following a TIA?

A

FBC, U+Es, BM, Lipids, CXr, ECG, CT/MRI head, Echo, Carotid doppler

35
Q

How is a TIA managed?

A

Antiplatelets- 300mg aspirin for 2 weeks
Clopidogrel for life
Antihypertensives
Statins
Carotid endarterectomy- if carotid stenosis found
Cannot drive for 1 month

3. Senior Block- Integrated Care (7 decks)

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