Stroke Flashcards
which is the most common type of stroke?
ischaemic (80-90%)
haemorrhagic is only 10-20%
TIA - clinical effects will resolve within?
24 hours
what usually causes a TIA ?
micro emboli
what is hemiparesis ?
weakness
most common stroke involves what artery?
middle cerebral
do you get pain?
no, there are no pain receptors in the brain itself
strokes most common at which time of day?
morning
absolute contraindications to thrombolysis ?
Major surgery Active internal bleed Prolonged CPR Pregnancy Severe liver disease Hypertension Cerebral neoplasm
which drugs can cause stroke?
cocaine and OTC cold remedies that contain vasoconstrictors
how would you visualise Carotid artery Stenosis?
angiogram of head/neck
80% of TIAs due to?
thromboembolus
what is Amaurosis fugax?
sudden loss of vision in one eye, caused by an infarct in the retinal artery(ies). You can sometimes see the obstruction on ophthalmoscopy, which is useful clinically, as the same symptoms is seen in migraine – where the arteries will always appear normal. Thus if a defect is visible, it is highly likely to be the result of a TIA
After TIA, can check brachial artery pressures, A difference of more than 20mmHg between arms suggests
subclavian artery stenosis
which score predicts the likelihood of a further CVA event
ABCD2 score
follow up investigations after stroke
carotid doppler scan
echo - to check for cardiac emboli source
ECG
brain imaging?
what is the management of a TIA and when would you commence treatment ?
high dose aspirin
once diagnosis is confirmed – usually after CT has confirmed there is no haemorrhage stroke (if symptoms have resolved then almost certainly has been ischaemic rather than haemorrhagic)
if symptoms resolve within 24 hours, what does this suggest about the nature of event?
its ischaemic, not haemorrhagic
what would clinical picture be from stroke arising from middle cerebral artery?
Hemiparesis
Hemiplegia
Limbs usually floppy, and reflexes reduced/absent
Facial weakness (not always)
Hemianopia – visual field defect in which vision is lost in half of the visual field in one/both eyes.
Aphasia – when the dominant hemisphere is affected
Important to ask about left and right handedness!
These symptoms usually develop rapidly, over a period of minutes, or less commonly they can develop over a few hours.
lacunar infarct, where is emboli?
deep arteries of brain
infarctions will show up as what shape on both MRI and CT?
wedge shape
what is the onset of a stroke like
sudden (a few mins)
In stroke, what should be maintained in normal limits?
blood glucose, hydration, oxygen saturation and temperature
should be given as soon as possible if a haemorrhagic stroke has been excluded?
aspirin
why can children not be given aspirin?
it increases the chance of reyes syndrome
with regards to AF, when should anti coagulation be commenced?
until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke’
what time frame should thrombolysis only be given in ?
within 4.5 hours
thrombolysis should only be given if wha is excluded?
haemorrhage
what drug is given as thrombolysis?
alteplese
if patient has seizure at onset of stroke, can they get thrombolysis?
no
if patient has had previous TBI or stroke in last 3 months, or suspected? cannot have thrombolysis?
subarachnoid haemorrhage
what is recommended as secondary prevention of stroke?
clopidogrel
in acute stroke patients, in the absence of haemorrhage, anticoagulation therapy should be commenced after how long in AF?
2 weeks
when would patients be on lifelong clopidogrel?
TIA, isachaemic stroke or peripheral arterial disease
types of AF?
paroxysmal, permanent, fast
continuous atrial fibrillation which cannot be cardioverted or if attempts to do so are deemed inappropriate. which type of AF?
permanent
what happens during ischaemic stroke ?
blood supply to an area of the brain is reduced, resulting in tissue hypoperfusion
can you get atherosclerosis in the brain vessels?
yes
the two subtypes of haemorrhage stroke?
intracerebral haemorrhage
sub arachnoid haemorrhage
in SAH, where does the blood collect?
between arachnoid and pia (below the arachnoid)
intracerebral can be sub classified into two. what are these?
intraparenchymal (within the brain tissue)
intraventricular (bleeding within the ventricles)
4 types of stroke in oxford classification?
TACS
PACS
POCS - posteroir circulation syndrome
LACS
what there things need to be present for a diagnosis of TACS?
unilateral weakness
homonomous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
which one would you get cerebellar signs in?
POCS
pure sensory stroke?
lacunar
what is dysphasia?
marked reduction in the generation of speech
