Stroke Flashcards
Define stroke
- Rapidly developing clinical symptoms AND/OR
- Signs of focal/global loss of brain function AND
- Symptoms lasting more than 24hrs OR
- Leading to death with no apparent cause other than vascular origin
What score is used to see if a patient has had a stroke?
Rosier score
Is stroke a diagnoses?
NO
What are the 3 different classes of stroke?
Haemorrhage
Subarachnoid haemorrhage
Infarct
What is more common, a haemorrhagic stroke or an infarct stroke?
Infarct
When do infarcts tend to show up on CT?
24hrs after a stroke
What is the difference between a TIA and a stroke?
Vascular abnormality in the brain
If it lasts <24hrs = TIA
If it lasts >24hrs = stroke
Are TIAs based on pathology?
No, based on clinical presentation
Where are patients sent if they are suspected of having a stroke?
Rapid access neurovascular clinic
What assessments are carried out in patients suspected of stroke?
History
Carotid imaging
ECG
Bloods
What immediate therapy do patients with stroke get?
Meds (statin + antiplatelet) Carotid endarterectomy (if appropriate)
What is the management of a stroke? (acute management only)
Thrombolysis/ectomy Imaging Swallow assessment Nutrition/hydration Antiplatelets Stroke unit care DVT prevention
What antiplatelet is give ASAP after a stroke?
Aspirin
wait 24hrs if being thrombolysed
What should you do before giving an antiplatelet after a stroke?
CT - to exclude bleed
If a patient’s initial swallow screen is abnormal, who should the patient be assessed by?
Speech and language therapist
What tool is used to assess malnutrition in stroke patients?
MUST
What is used as secondary prevention of stroke?
Meds
Lifestyle
Carotid surgery
What type of stroke is characterised by a fibrin dependent red thrombus?
Cardioembolic
What type of stroke is characterised by a platelet dependent white thrombus?
Atheroembolic
What is a cardioembolic stroke?
Has fibrin dependent red thrombus
What is an atheroembolic stroke?
Platelet dependent white thrombus
Name the 3 different types of ischaemic stroke
Cardioembolic
Atheroembolic
Small vessel disease
What investigations should you order if you suspect a stroke?
CT scan, MRI with DWI/GRE/SWI Carotid scan Angiogram ECG 24hr tape Echo Bubble TCD/echo Lipid profile BP Glucose Smoking
What investigations will identify the presence of an infarct/haemorrhage?
CT or MRI (weighted)
What investigations will identify the aetiology of the stroke?
Carotid scan
Angiogram
ECG/24hr tape
Echo
What investigations will identify the risk factors for stroke?
Lipid profile
BP
Glucose
Smoking?
What would you give a patient long term if they had a cardioembolic stroke or AF?
Anticoagulant e.g. warfarin
What would you give a patient if they had a non-cardioembolic ischaemic attack longterm?
Antiplatelet
First line = clopidogrel
What do you give to all stroke patients as secondary prevention?
Smoking advice
Statins
Manage BP
Diet & lifestyle
How long after a stroke can you start an anticoagulant?
10 days after
How long after a stroke can you start an antihypertensive?
10 days after
What does the CHADS2 score assess?
Risk of stroke in AF
