Stroke Flashcards
Definition?
Rapid onset, focal neurological deficit due to a vascular lesion lasting >24h
2 types?
due ischaemia (80%) or
intracerebral haemorrhage (20%)
causes of ischaemic stroke?
↑BP, Atheroma, Embolis
causes of haemorrhagic stroke?
↑BP, Trauma, Aneurysm rupture
30% of strokes are due to cardiac emboli - what are they?
AF, endocarditis, MI Atherothromboembolism
Modifiable Risk Factors?
smoking HTN DM heart disease (AF, ischaemic, valvular) PAD
SIGNS
Haemorrhagic stroke:
Ischaemic stroke
Haemorrhagic stroke:
o Meningism
o Severe headache
o Coma
Ischaemic stroke o Carotid bruit o AF o Past TIA o IHD
Cerebral infarcts (50%):
o May be contralateral sensory loss or hemiplegia (floppy limb)
o Homonymous hemianopia
o Visuo-spatial defect
Brainstem infarct (25%):
o Quadriplegia
o Locked-in syndrome (aware but unable to respond).
Lacunar infarcts (25%):
o Ataxic hemiparesis
o Dysarthria/clumsy hand
Ix for Stroke?
what if its an acute infarct?
how do you exclude a primary haemorrhage stroke?
Urgent CT (/MRI)
Diffusion-weighted MRI is most sensitive for acute infarct
by doing the CT
once haemorrhagic stroke is excluded and if within 4.5 hours of onset of symptoms - what do you do?
coontraindications to this treatment?
• Thrombolysis: Alteplase is the drug of choice – do CT 24h post-lysis to identify bleeds.
CI to thrombolysis is major infarct/haemorrhage on CT.
once haemorrhagic stroke is excluded but not within 4.5 hours of symptoms?
what do you give along side this medication?
give aspirin 300mg (continue for 2 weeks then switch to long term antithrombotic treatment) - clopidogrel.
aspirin + PPI (to prevent peptic ulcer)
thrombolysis = condition is that is must be initiated within?
can it be done before confirmation by CT?
what do you start 24 hours after thrombolysis?
4.5 hours
NO - risk of thrombolysing a haemorrhagic stroke
aspirin
Site of the lesion: Associated effects of :
Anterior cerebral artery
Contralateral hemiparesis and sensory loss,
lower extremity > upper
