stroke Flashcards
what is the definition of stroke?
- acute onset of focal neurological symptoms and signs due to disruption of blood supply
what are the two types of stroke?
- haemorrhagic
- ischaemic
what is an haemorrhagic stroke?
- raised blood pressure
- weakened blood vessel wall due to:
- structural abnormalities like aneurysm, arteriovenous malformation (AVM)
- inflammation of vessel wall (vasculitis)
what is an ischameic stroke?
- thrombotic = clot clocking artery at the site of occlusion
- embolic = clot blocking artery has travelled to artery it occludes from somewhere more proximal in the arteries or the heart
- hypoperfusion - due to reduced flow of blood due to stenosed artery rather than occlusion of artery
what are the non-modifiable risk factors for stroke?
- age
- family history of stroke
- gender
- race
- previous stroke
what are the potentially modifiable risk factors for stroke?
- hypertension
- hyperlipidaemia
- smoking
- prior history of TIA
- AF
- diabetes
- congestive heart failure
- alcohol excess
- obesity
- physical inactivity
- poo socioeconomic status
how does smoking affect your risk of stroke?
- doubles your risk
what are some rare causes of stroke, especially in younger patients?
- homocysteinemia
- vasculitis
how is stroke managed?
- trombolysis or thrombectomy
- identify what caused stroke and start appropriate treatment
what are stroke mimics?
- conditions that present acutely with focal neurological signs but are not due to interrupted blood flow
- eg hypoglycaemia, migraine, seizure-postical states
- functional hemiparesis - patient pretending to have a stroke
how do you work out what kind of stroke it is?
- brain scan
how to work out if it is thrombitic or embolitic?
- blood tests eg glucose, lipids, thrombophillia screen in young patients
- assess for hypertension
what is artheroembolism?
- embolism from a thrombus forming on an atheroscelotic plaque - plaque rich clots
- infarcts in same side as affected carotid artery
what is cardioembolism?
- embolism from a clot formed in the hear (usually left atrium) - clotting factor rich clots
- infarcts in more than one arterial territory, bilateral
if atheroembolism is suspected, what do i do?
- cartotid screening
- CT/MR angiography of aortic arch
if cardioembolism is suspected, what do i do?
- ECG
- LVH
- echocardiogram
how do you investigate the cause of bleeding in a haemorrhagic stroke?
- hypertensive = usually deep in the brain, older patients
- if young, not hypertensive and lobar haemorrhage - investigate for underlying aneurysm
what can be done to reverse disability in an ischaemic stroke?
- thrombolysis =upto 4-5 hours from onset of symptoms
- thrombectomy = up to 6 hours from symptom onset, usually after having started thrombolysis
both are time dependent treatments as brain tissue dies rapidly with any delay
how do you prevent the next stroke if atheroembolic or due to thrombosis?
- antihypertensies
- antiplatelets
- statins
- diabetes management
- hypertension management
- lifestyle advice
how do you prevent the next stroke if due to AF?
- warfarin
- oral anticoagulants
- antihypertensives
what are the surgical managements of stroke?
- haematoma evacuation
- relief of rained intracranial pressure
- carotid endarterectomy
what are TIAs?
- temporary neurological symptoms due to occlusion of artery stopping flow of blood
- ## temporary because arteries are capable of dissolving small clots
