Stroke Flashcards
stroke is
a clinical syndrome where blood supply to part of the brain is restricted with by a) blockage b) haemorrhage
causes of ischaemic stroke
embolus and thrombus
Most common cause of embolus formation
Plaque formation in the carotid arteries –> ruptures –> clot formation
Rarer sources of an embolus
- atrial myxoma
- paradoxical emboli from patent ductus arteriosus
Causes of haemorrhagic strokes? (6)
- Hypertension
- Amyloid angiopathy
- Aneurysms
- Cerebral arteriovenous malformations
- Blood vessels in tumours
- Taking warfarin medx
What ions build up within neurones in the ischaemic cascade?
Calcium + sodium
What does raised intracellular Calcium result in?
release of glutamate (excitatory neurotransmitter)
+
protease release
What does raised intracellular Sodium result in?
swelling of the neurone = cytotoxic oedema
vascular risk factors for ischaemic stroke? (6)
- diabetes
- hypertension
- ischaemic heart disease
- peripheral vascular disease
- smoking
- carotid stenosis
thrombotic risk factors for ischaemic stroke? (4)
- AF
- Combines OCP
- Polycythaemia
- Clotting disorders
aim of the FAST compaign
aims to increase the recognition of symptoms of TIA + stroke
What stroke scale is used in assessment?
NIHSS
National institute of Health Stroke Scale
what is the NIHSS used for?
a tool used by healthcare professionals to quantify the impairment caused by a stroke, to assess the severity of it; consists of 11 items
NIHSS score 0
no stroke symptoms
NIHSS score 1-4
minor stroke
NIHSS score 5-15
moderate stroke
NIHSS score 16-20
moderate to severe stroke
NIHSS score 21-42
severe stroke
hyperacute findings - CT ischaemic stroke
visualisation of clot seen immediately
sign on non-contrast CT of ischaemic stroke representing direct visualisation of clot within lumen
hyperdense artery
name 4 stroke mimics
- seizures
- hypoglycaemia
- sepsis
- syncope
contraindications for thrombolysis treatment for ischaemic stroke relating to recent surgery + bleeding
Recent surgery
- major head surgery or non head trauma in last 2 weeks
Bleeding
- history of any intracranial haemorrhage, AVM or cerebral aneurysm
contraindication for thrombolysis treatment relating to anticoagulant use?
Contraindicated if Heparin or NOAC within last 48 hours OR
INR > 1.4 on Warfarin
If haemorrhagic stroke has been excluded what should be given straight away?
300mg Aspirin
When should thrombolysis be given?
within 4.5 hours of the onset of stroke symptoms
what thrombolysis is recommended?
Alteplase
0.9 mg/kg via IV infusion
what is alteplase
recombinant tissue plasminogen activator
name 4 coagulopathies that can cause a stroke
- Thrombocythemia
- Polycythaemia
- Hyperviscosity states
- Haemophilia
2 complications of thrombolysis treatment
angioedema + haemorrhage
4 investigations required on following up patients post ischaemic stroke for secondary prevention
- Carotid doppler
- Blood pressure
- Total cholesterol
- 5 day ambulatory ECG
at what level should a statin be started post stroke?
3.5 mmol/L
treatment for carotid stenosis 50-99%
Referral within 1 week for carotid endarterectomy, with treatment within 2 weeks
Treatment of carotid stenosis < 50%
no surgery, just medical management
2 subtypes of haemorrhagic stroke
intracranial haemorrhage + subarachnoid haemorrhage
management of haemorrhagic stroke
- neurosurgical consultation for surgical assessment
- lower BP acutely
- reversal of anticoagulation
- stop antithrombotic (clopidogrel) + anticoagulant (warfarin) medx
Disorder of language =
Dysphasia
Disorder of speech =
Dysarthria
Receptive dysphasia =
difficulty understanding language being spoken
Expressive dysphasia =
difficulty putting words together to be spoken
Dysarthria =
difficulty articulating words + pronounciation
Cerebellar lesions produce what type of language deficit
slurred, scanning, sticcato speech
Wernicke’s aphasia =
good fluency + poor comprehension
receptive dysphasia
Broca’s aphasia =
good comprehension + poor fluency
expressive dysphasia
