Stroke Flashcards
What is a stroke?
The experience of persisting neurological
complications of cardiovascular disease
NOT A DIAGNOSIS
What are the 3 main categories of a stroke?
Haemorrhagic
Subarachnoid haemorrhage
Infarct
What are the 3 main types/causes of haemorrhage strokes?
- Structural abnormality
- Hypertensive
- Amyloid angiopathy
Name the 3 main types of strokes that come under the heading of infarcts.
- Atheroembolic
- Small vessel
- Cardioembolic
A TIA is more common than a stroke
FALSE - a stroke is more common that a TIA
Cerebrovascular strokes are more common than coronary vascular strokes
TRUE
1/3rd of all stroke presentations are stroke mimics. List some things that can mimic a stroke.
- Seizure
- Sepsis
- Toxic/metabolic
- SOL
- Syncope
- Delirium
Describe functional brain disease. What can it mimic?
There is no brain disease but there is signs that the brain is malfunctioning
There will be no signs on a scan
Mimics a STROKE
What score is used to diagnose strokes?
THE ROSIER SCORE
Indicate what different ROSIER results show.
Score >0 Stroke is likely. Scores of =0 have low possibility of stroke but not completely excluded
What two things cause you to lose a point in the ROSIER system?
- Loss of consciousness or syncope
* Seizure activity
What 5 things cause you to gain a point in the ROSIER system?
- Asymmetric face weakness
- Asymmetric arm weakness
- Asymmetric leg weakness
- Speech disturbance
- Visual field defect
What 4 things are needed to diagnose a stroke?
- Type
- Size
- Laterality
- Cause
What scan is good for seeing ‘new’ haemorrhagic stroke?
CT
What scan is good for seeing an haemorrhagic stroke after 2 weeks?
MRI
What scan is good for seeing an infarct stroke?
MRI
What colour does blood appear on a CT?
WHITE
What colour does an infarct appear on a CT? Why?
BLACK - due to oedema and fluid
A CT is not sensitive to blood after __ week?
1
What type of scan should be used to see blood after 1 week?
MRI
PACI
Posterior anterior circulatory infarct
TACI
Total anterior circulatory infarct
LACI
Lateral anterior circulatory infarct
POCI
Posterior circulatory infarct
What scan is always done first?
CT
Describe TACS.
Contraleral motor/sensory loss (i.e hemiplegia involving 2 of: face, arm leg +/- hemisensory loss)
Homonymous hemianopia
Dysphagia, neglect
What is the most severe type of stroke?
TACS
What is ‘neglect’?
Body loses awareness of the world
Describe PACS.
2 of the 3 components of TACS OR
- Isolated cortical dysfunction e.g dysphagia OR
- Poor motor/sensory signs
Describe LACS.
Lacunar infarcts are small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem
What causes LACS?
Caused by occlusion of a single deep penetrating artery
Affect 2 any two of face arm and leg
What type of stroke has the best prognosis?
LACS
Describe POCS.
- Cranial nerve palsies
- Bilateral motor and/or sensory deficits
- Conjugate eye movement disorders
- Isolated homonymous hemianopia
ANY 1 of:
- Isolated homonymous hemianopia
- Brain stem signs
- Cerebellar ataxia
95% of the population have a dominant ___ hemisphere?
LEFT
What may a stroke affecting the left side of the brain cause?
Language problems
Often needs rehab
What may a stroke affecting the right side of the brain cause?
Cortical events affecting spatial awareness
e.g neglect
In order of most to least common, list causes of Ischaemic Cerebrovascular Disease.
- Atheroembolism
- Small vessel occlusion
- Cardiac sources of embolism
- Rarer ones
Outline the series of events (briefly) that lead to a cerebrovascular stroke.
- Normal carotids
- Diseased carotids with plaque
- Thrombus occurs in carotid
- Thrombus dislodges and travels to cerebral artery in the brain
- Thrombus lodges in cerebral artery of the brain
- STROKE
What kind of imaging is good for seeing stenosis/clots in the carotid arteries?
MRI Angiogram
Doppler US
What is done for micro bleeds?
Try reduce BP
MRI shows them
What is Leukoaraiosis?
White matter disease
What is the most common cause of clots forming in the heart?
AF
What type of stroke does AF cause?
Cardioembolic
Name 4 other problems that cause clots in the heart.
- Ventricular thrombus
- MI
- Rheumatic heart disease
- Prosthetic valves
What does AF cause?
5 fold increase in the risk of strokes
How is AF investigated?
ECHO
Describe PFO (patent foramen ovale).
In the womb there is connection between atriums, after you are born the FO closes, in some people it remains open (PFO)
What can PFO cause?
Strokes
What should people with PFO be on long term? Why?
Aspirin
To prevent clot formation
What can happen due to arterial dissection?
Arteries tearing can result in a thrombus and produce a clot
What can primary intracerebral haemorrhage (stroke) be due to?
- Hypertension
* Amyloid angiopathy
What can secondary intracerebral haemorrhage (stroke)be due to?
- Arteriovenous malformation
- Aneurysm
- Tumour
What can happen as a result of a haematoma?
The bleeding is continuous and expands, causing secondary haematoma due to oedema
Give an example of a full stroke diagnosis.
“Its a Right Hemispheric,
Cardioembolic, Partial Anterior Circulation
Infarction”
How is an ACUTE stroke managed?
Thrombolysis/thrombectomy Imaging Swallow assessment Nutrition and hydration Antiplatelets Stroke unit care DVT prophylaxis
Outline secondary prevention for a stroke?
Medication
Lifestyle
Carotid surgery
REHAB + RECOVERY
When is the biggest benefit of thrombolysis?
The sooner it is given
What are the 4 most common symptoms of a stroke (FAST)?
- Facial weakness
- Arm weakness
- Speech problems
- Test all three symptoms
DO NOT THROMBOLISE SOMEONE WHO HAS HAD A BLEED
TRUE
What should always be done before thrombolysing someone? Why?
CT
- to exclude a bleed
In the hyper-acute setting, a brain CT may be normal?
TRUE
What is done if someone has a clot that is too big for thrombolysis?
THROMBECTOMY
What investigations should be done for someone with a stroke?
Full Lipid Profile Blood Pressure Carotid Scan ECG Consider - 72 Hour ECG (or longer) and ECHO
What is given in a stroke caused by an INFARCT?
ANTI - PLATELET
e.g Aspirin 300mg
How long should you wait before giving 300mg Aspirin in someone who has been thrombolysed?
24 hours
Who should never get Aspirin?
A patient with a bleed
What is the secondary prevention for someone with a stroke caused by an infarct? For how long?
1st line: clopidogrel
2nd line: aspirin + dipyridamole
LIFE LONG
What is the ABC approach to stroke management?
Antithrombotic Therapy Antiplatelet Therapy Anticoagulant therapy Blood Pressure Cholesterol Diabetes Don’t Smoke
How is dysphagia managed?
- Initial swallow screen
What is done if initial swallow screen is abnormal?
Patient is referred to speech and language therapist
What may a patient need if swallow is abnormal?
May need NG tube placement or textured diet and thickened fluids depending on swallow
Outline the treatment of an ISCHAEMIC stroke.
- Aspirin 300mg
- Thrombolysis - tPA
Secondary Prevention:
- Cardioembolic / AF = Warfarin
- Non-cardioembolic = Clopidogrel
Outline the treatment of a HAEMORRHAGIC stroke.
- Anti-hypertensives (prevent compensatory inc. BP)
- Fresh frozen plasma (reverse blood thinners)
- Elevate back rest (reduce ICP to prevent mass effect)
What type of drug is aspirin?
NSAID and anti-platelet
