Stroke Flashcards
typical stroke presentation
history of hypertension and IHD
sudden onset right arm and leg weakness
difficulty speaking
what is stroke
rapidly developing loss of brain function with symptoms lasting more than 24 hours or leading to death with no apparent cause other than vascular
important things to note in stroke
time of onset
what were the symptoms
how did they progress
common stroke mimics
seizure sepsis toxic/metabolic Space occupying lesions (pre) syncope Acute confusion/delirium Vestibular dysfunction Functional Dementia
Features of the rosier score
is there seizure activity (-1)
has there been loss of consciousness or syncope (-1)
is there new acute onset:
- asymmetric facial weakness
- asymmetric arm weakness
- asymmetric leg weakness
- speech disturbance
- visual field defect
score >0 means stroke is likely
3 different types of stroke
Infarct
haemorrhage
Subarachnoid haemorrhage
causes of haemorrhage stroke
hypertension
amyloid antipathy - protein deposition in the brain making vessels more likely to bleed
structural abnormality
causes of infarct stroke
Cardiometabolic - AF bits break off and get stuck in brain?
Atheroembolic - clots from other arteries (same process as MI)
Small vessels in the brain get damage over time and clots form within those vessels
how to tell between infarct and haemorrhage stroke
CT scan - picks up blood easily
how does blood in a brain CT show up
bright white
where is weakness if there is a bleed on the right side of the brain
left arm and leg weakness
what does an infarct stroke look like on CT
increase in oedema - due to inflammatory response against necrotic fluid
shows as darker fluid
might not show up initially
when would you do an MRI in stroke
If small stroke
If posterior stroke
If CT was early and oedema has not developed
MRI picks up differences in ion and water diffusion
what does infarct look like on MRI
bright white
what does a haemorrhage stroke look like on CT 3 weeks after the bleed
darker almost like an infarct because blood has disappeared
how do you manage a stroke
Thrombolysis/thombectomy Imaging Swallow assessment Nutrition and hydration Anti-platelets Stroke unit care DVT prevention
what is thrombolysis
injecting TPA which breaks down clots in the body
needs delivered v quickly - time is brain
side effects of thrombolysis
bleeding
what puts patient at increased bleeding from thrombolysis
Age
Time since onset
Previous intracerebral haemorrhage or infarct
Atrophic changes
Blood pressure (if over 185)
Diabetes
Potential benefit to be gained by thrombolysis
how long after symptom onset does thrombolysis stop being beneficial
5 hours - dont usually thromblyse after 4.5 hours
why do you need a CT before you thrombolyse someone
to make sure it isn’t a haemorrhage stroke - bc then thrombolysis wouldnt help
what clots are less likely to benefit from thrombolysis
large clots - need thrombectomy (endovascular therapy) by interventional radiology and a stent to pull the clot out
what are the benefits of having stroke patients on the stroke unit
for every 33 patients treated in the stroke unit there is one extra survivor
for every 20 one extra is discharged back to their own home
what is important immediate therapy for infarct
Aspirin 300mg ASAP after stroke
then give 300mg for 2 weeks afterwards
why are stroke patients at increased risk of DVT
due to immobility after stroke
how do you reduce DVT risk in stroke patients
can’t use heparin because the benefit is outweighed by bleed risk
intermittent pneumatic compression reduces risk of DVT - stocking with pumps in them to keep pressure
how is dysphagia managed in stroke
Initial swallow screen
If abnormal - assessment by speech and language therapist
may need NG tube or textured diet and thickened fluids
what is a TIA
transient ischaemic attack
how do you differentiate between TIA and stroke
after 24 hours it is a stroke - before its a TIA
is a TIA benign
NO- puts you at much higher risk of a significant stroke and also causes visible damage to brain
what is in the rapid access neurovascular TIA clinic
need referral after a TIA
Rapid assessment -history -carotid imaging -ECG -Blood tests Diagnosis -Immediate therapy -Medication -Carotid endarterectomy
what is ABCD2
risk assessment for recurrent TIA
how is haemorrhage stroke treated
BP management - less than 140 in first few hours with IV agents in first 6 hours
Stop any anticoagulation
Give fit K if on warfarin
