Stroke Flashcards
What is a stroke?
Rapid decline in cerebral function due to inadequate blood supply + focal, and at times global signs lasting more than 24 hours
What is the difference between a TIA and stroke?
TIA is a short episode (less than 24hrs) caused by focal brain or retinal ischaemia with no evidence of acute infarction
INCREASED RISK OF STROKE IN NEXT WEEK
What are the 3 main types of stroke, and how common are they?
Haemorrhagic (10%)
Sub-arachnoid haemorrhage (5%)
Ischaemic (infarct) (85%)
What is usually the cause of haemorrhagic stroke?
Structural abnormality due to hypertension
Or amyloid angiopathy (protein deposits in brain with ageing, leading to degeneration)
What are usually the causes of ischaemic stroke?
Atherothrombosis (platelet dependant white thrombus)
Small vessel disease
Cardioembolic (fibrin dependant red thrombus)
List the main functions of the frontal lobe of the brain
Personality
Emotional response
Social behaviour
Which imaging is used to find the presence of a cerebral infarct or haemorrhage?
CT scan (good for haemorrhages) MRI (often needed to identify infarcts)
List supportive imaging that can help investigate aetiology of a stroke
Carotid scan
Angiogram
ECG (?AF)/ 24hr tape
Echocardiograph
What scale can be used for diagnosis of a stroke? What are the + signs and what are the -?
Rosier scale
Asymmetric facial/arm/leg weakness
Speech disturbance
Visual field defect
Loss of consciousness/syncope/ seizure activity
What would hypo- vs hyperattenuation suggest on a CT of the brain?
HYPO: Haemorrhage = white
HYPER: Infarct = dark (represents oedemous inflammatory response - water)
What surgical options are available for the treatment of stroke?
Thrombolysis/thrombectomy (within first four hours of an infarct) Carotid endarterectomy (atherosclerosis of carotid arteries)
What is involved in the acute management of stroke?
Antiplatelets
DVT prophylaxis
Dysphagia management/ swallow screen
Nutrition and hydration
What tool is used to screen for risk of malnutrition on admission?
MUST screen
Why is a swallow screen so important after a stroke?
Avoid aspiration of material into airway
What is the 1st line antiplatelet prescribed in stroke? What must be done first before prescribing?
Aspirin 300mg
CT (to exclude bleed)
What are the main methods of DVT prophylaxis?
Heparin (can increase bleeding risk)
TED stockings
Intermittent pneumatic compression
What are the main risk factors that need to be considered in stroke?
High cholesterol BP DM Smoking AGE CHF/ CHD Previous stroke/ TIA/ VTE Female
Anticoagulants are prescribed if not cardioembolic in secondary prevention of stroke. True/ False?
Give an example
False
If it is cardioembolic/ AF
Warfarin or NOAC (1st line = edoxiban) 10 days after
What medications are prescribed in secondary prevention of stroke with no cardioembolic cause?
Aspirin +
1st line = clopidogrel
2nd line = dysprimadole
What other medications may need to be prescribed in secondary prevention of stroke?
Statins
Anti-hypertensives
How can AF cause strokes?
Irregular heart beating causes blood to be whipped up and clots can be fired to brain
What score can be used to assess the risk of a stroke if you have AF?
CHA2DS2VASC Score
What score can be used to assess a person’s bleeding risk of they have AF?
HAS-BLED score (risk of anticoagulation)
What lifestyle advice can be given regarding stroke management?
5 or more fruit/veg per day 2 x oily fish per week Exercise Reduce salt intake 14 units max a week of alcohol Reduce sat fats and increase poly/monounsaturated fats
What type of stroke, using Oxford classification has the poorest prognosis?
TACI
What type of diet should be recommended for stroke patients?
Mediterranean diet
