Stroke Flashcards
What are the two different types of stroke?
Haemorrhagic and ischaemic
What are the causes of ischaemic stroke?
Atherosclerotic disease causes cerebral thrombosis to form (plaque)
Atherosclerotic clot breaks off from coronary arteries and travels to brain (cardioembolic)
How would an ischaemic stroke be diagnosed from a CT scan?
Demarcated hypodense zone
What are the causes of haemorrhagic stroke?
Bleeding onto brain from vessel rupture or weakening
How is an ischaemic stroke prevented?
Lifestyle changes
Statin treatment
How is a haemorrhagic stroke prevented?
Controlled BP
Lifestyle changes
Exercise
What are the symptoms of strokes?
Facial dropping or paralysis
Difficulty moving limbs
Slurred speech
What could be non-stroke causes of the symptoms?
Seizures Drug toxicity Brain tumours Migraines Spinal cord lesions
What are the stroke risk factors?
Older age Male Family history Afro-Caribbean ethnicity Hypertension Hyperlipidaemia Diabetes Atrial fibrillation Smoking
Which regions result in disability if damaged and are they reversible?
Umbra (inner region) - Irreversible
Penumbra (outer region) - Potential for recovery
What is Anakinra and what is its use?
Interleukin 1-beta antagonist
IL1-beta stimulates release of tumour necrosis factor and IL-6
Inflammation from these exacerbates brain damage so Anakinra prevents further inflammation
What is a potential novel stroke treatment?
Injection of stem cells into brain to replace damaged cells
What is thrombolysis?
Dissolve clot in brain but only if patient has presented within 4.5 hours of symptom onset
Alteplase used
Only for ischaemic stroke
What is the acute treatment for ischaemic stroke?
High dose antiplatelet ASAP (if thrombolysed, wait 24 hours)
300mg aspirin
Continue for 14 days
What is the acute treatment for haemorrhagic stroke?
If bleed ongoing, neurosurgical intervention
Cease any drugs that may contribute to bleed
Vit K or prothrombin complex concentrate if INR >1.4
What are the acute secondary prevention measures if cardiovascular risk?
Lipid lowering
Give 20-80mg atorvastatin ASAP
How should BP be controlled following a stroke?
If thrombolysing, ensure BP is below 185/110mmHg
If systolic BP is >150mmHg within 6hrs of symptom onset treat with antihypertensives (for haemorrhagic stroke) - IV infusion of short-acting drug (nicardipine or GTN)
What is the long-term treatment plan for ischaemic stroke?
Antiplatelet or anticoagulant depending on atherosclerotic or cardioembolic
AP - Clopidogrel 1st line, aspirin and MR dipyridamole if not tolerated
AC - Novel anticoagulant or warfarin
What are the long-term cholesterol lowering treatments for stroke?
Simvastatin 40mg or if total cholesterol <4mmol/L atorvastatin
Only for haemorrhagic stroke patients if hyperlipidaemia or CV risk
What is the BP aim for patients following a stroke?
130mmHg systolic BP
What are the complications of strokes? How are they managed?
Swallowing problems - NG/PEG tube, thickened fluids, puree diet, review medication
Depression - Screen all patients, SSRI 1st line
Dry Mouth/Dribbling - Artificial saliva, good mouth hygiene/oral glycopyrronium, atropine eye drops in mouth, hyoscine patch
Seizures - Prophylactic antiepileptics if needed, valproate and levetiracetam
Spasticity - Skeletal muscle relaxants (baclofen, tizanidine)
