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Ageing > Stroke > Flashcards

Stroke Flashcards

1
Q

what is a stroke?

A

rapidly developing clinical symptoms and/or signs of focal and at times global loss of brain function with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin

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2
Q

key features?

A

rapid (few mins-hours)
focal (can identify lesion in part of brain causing symptoms)
loss of brain function (visual, speech, movement issues, not pain)
vascular

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3
Q

how common are stroke mimics?

A

1/3 of all stroke presentations

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4
Q

what can mimic stroke?

A 
seizures
sepsis
toxic/metabolic (glucose etc)
SOL (space occupying lesions)
syncope/pre-syncope
acute confusion/delirium
vestibular dysfunction
functional (neurological with no real pathological cause)
dementia
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5
Q

what is the rosier score?

A 
recognition of stroke in the emergency room
-1 point each for 
- loss of consciousness or syncope
- seizure activity
\+1 point each for
- asymmetrical facial weakness
- asymmetrical arm weakness
- asymmetrical leg weakness
- speech disturbance
- visual field defect
score >0 = likely stroke
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6
Q

what is the FAST score?

A 
aimed at public
Face
Arms
Speech
Time
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7
Q

Is stroke a diagnosis?

A

no

experience of persisting neurological complications of cardio disease

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8
Q

what are the 3 types of stroke?

A

haemorrhagic
subarachnoid haemorrhage
infarct

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9
Q

types of haemorrhagic stroke?

A

structural abnormality (poor quality vessels)
hypertensive
amyloid angiopathy

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10
Q

types of infarct stroke?

A

artheroembolic (same process as MI - plaque disease)
small vessels (damage to small vessels over time - hypertension, diabetes etc - cause clots to form and small vessels occlude easily)
cardioembolic (AF causing clots)

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11
Q

how can you tell between infarct and haemorrhage stroke clinically?

A

no real way until imaging

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12
Q

stroke imaging?

A

CT (quicker and sensitive to picking up blood)

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13
Q

how does haemorrhage appear in the brain on imaging?

A

white areas of blood

iron in blood absorbs X rays

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14
Q

how does an infarct stroke show on CT?

A

mushy, blurry, darker shadowy area of the brain
(increase in oedema and fluid caused by the inflammatory response to the necrosis of tissue after infarct appears darker)

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15
Q

infarct stroke may be missed initially on CT, why is this?

A

takes time for oedema etc to develop so CT can be clear if done very quickly

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16
Q

what is used if CT is clear but infarct stroke still suspected?

A

MRI
shows diffusion weighted abnormality (abnormalities of fluid and ion flow)
infarct shows as a white area or black area depending on type of MRI

17
Q

how may a haemorrhagic stroke appear on CT after 2-3 weeks?

A

darker, almost like an infarct as blood has disappeared but damage is seen

18
Q

what is done if imaging is performed weeks after symptoms?

A

MRI instead of CT

19
Q

acute management of stroke?

A 
thrombolysis/thrombectomy
imaging
swallow assessment (risk of aspiration pneumonia after stroke)
nutrition and hydration
antiplatelets
stroke unit care
DVT prevention
20
Q

how quickly is brain damaged in stroke?

A

230 million synapses lost per second

14 billion per min

21
Q

how can stroke damage differ in people?

A

some people have more of a collateral blood supply to the brain so can cope better and for longer with an occlusion

22
Q

what is used in thrombolysis?

A

inject artificial TPA which breaks down clots

23
Q

what is taken into account when deciding whether to thrombolyse?

A

age
time since onset (quicker = better benefit)
previous intracerebral haemorrhage or infarct (more risk of bleed)
atrophic changes (bleeding risk)
BP (bleeding risk, >185 = contraindication)
diabetes
potential benefit (possible QoL after)

24
Q

at what time after symptoms onset does thrombolysis stop being beneficial?

A

around 5 hours

don’t really thrombolyse after 4.5 hours

25
Q

why is imaging always performed before thrombolysis?

A

incase its haemorrhagic

establishes diagnosis

26
Q

what else might indicate infarct on CT?

A

hyperdense middle cerebral artery sign

single, asymmetrical which spot/blood vessels showing the clot

27
Q

what types of clots are less likely to benefit from iv tPA? what is done in this case?

A

large and proximal clots
endovascular therapy, interventional radiology
- put wire in through the vessel and through to other side of clot, open stent and then pull the clot out

28
Q

which is more successful, thrombolysis or endovascular therapy?

A 
endovascular therapy (thrombectomy)
not currently available in Scotland yet
29
Q

how effective is the stroke unit care?

A

1 extra survivor for every 33 people in the unit

1 person sent home for every 20

30
Q

important immediate therapy for infarct?

A

300mg aspirin ASAP to reduce risk of further infarct (don’t give for 24 hours after thrombolysis)
CT first to exclude bleed
300mg aspirin for 2 weeks after

31
Q

how is DVT prophylaxis delivered after stroke?

A

heparin (including LMWH) causes a bleeding risk
TED stockings don’t make a difference
best = intermittent pneumatic compression (stockings with pumps)

32
Q

how is dysphagia managed?

A

initial swallow screen
assess by speech and language therapist if abnormal
may need NG tube or textured diet and thickened fluids depending on swallow

33
Q

what is a TIA?

A

transient ischaemia attack
same process as stroke but shorter symptoms
technically should be under 24 hours

34
Q

is TIA safe?

A

no

still causes brain damage and risk of further stroke (almost the same risk as a minor stroke)

35
Q

what is involved in the rapid access neurovascular TIA clinic?

A 
rapid assessment
- history
- carotid imaging
- ECG
- blood tests
diagnosis
- immediate therapy - medication, carotid endarterectomy
hugely decreases risk of further stroke after TIA
36
Q

how can further stroke be prevented after TIA?

A

rapid access clinic
any statin
any antiplatelet (or dual antiplatelet - aspirin + clopidogrel)

37
Q

ABCD2?

A

risk assessment for recurrent TIA

38
Q

how is haemorrhagic stroke managed?

A

aggressive BP control (IV treatment if seen <6 hours)
stop any anticoagulant or reverse anticoagulation
- can give vit K if on warfarin

Ageing (9 decks)

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