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3 Ageing > Stroke > Flashcards

Stroke Flashcards

1
Q

typical stroke presentation

A

history of hypertension and IHD
sudden onset right arm and leg weakness
difficulty speaking

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2
Q

what is stroke

A

rapidly developing loss of brain function with symptoms lasting more than 24 hours or leading to death with no apparent cause other than vascular

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3
Q

important things to note in stroke

A

time of onset
what were the symptoms
how did they progress

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4
Q

common stroke mimics

A 
seizure 
sepsis 
toxic/metabolic 
Space occupying lesions 
(pre) syncope 
Acute confusion/delirium 
Vestibular dysfunction 
Functional 
Dementia
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5
Q

Features of the rosier score

A

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

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6
Q

3 different types of stroke

A

Infarct
haemorrhage
Subarachnoid haemorrhage

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7
Q

causes of haemorrhage stroke

A

hypertension

amyloid antipathy - protein deposition in the brain making vessels more likely to bleed

structural abnormality

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8
Q

causes of infarct stroke

A

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

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9
Q

how to tell between infarct and haemorrhage stroke

A

CT scan - picks up blood easily

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10
Q

how does blood in a brain CT show up

A

bright white

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11
Q

where is weakness if there is a bleed on the right side of the brain

A

left arm and leg weakness

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12
Q

what does an infarct stroke look like on CT

A

increase in oedema - due to inflammatory response against necrotic fluid

shows as darker fluid

might not show up initially

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13
Q

when would you do an MRI in stroke

A

If small stroke
If posterior stroke
If CT was early and oedema has not developed

MRI picks up differences in ion and water diffusion

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14
Q

what does infarct look like on MRI

A

bright white

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15
Q

what does a haemorrhage stroke look like on CT 3 weeks after the bleed

A

darker almost like an infarct because blood has disappeared

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16
Q

how do you manage a stroke

A 
Thrombolysis/thombectomy 
Imaging 
Swallow assessment 
Nutrition and hydration 
Anti-platelets 
Stroke unit care 
DVT prevention
17
Q

what is thrombolysis

A

injecting TPA which breaks down clots in the body

needs delivered v quickly - time is brain

18
Q

side effects of thrombolysis

A

bleeding

19
Q

what puts patient at increased bleeding from thrombolysis

A

Age
Time since onset
Previous intracerebral haemorrhage or infarct
Atrophic changes
Blood pressure (if over 185)
Diabetes
Potential benefit to be gained by thrombolysis

20
Q

how long after symptom onset does thrombolysis stop being beneficial

A

5 hours - dont usually thromblyse after 4.5 hours

21
Q

why do you need a CT before you thrombolyse someone

A

to make sure it isn’t a haemorrhage stroke - bc then thrombolysis wouldnt help

22
Q

what clots are less likely to benefit from thrombolysis

A

large clots - need thrombectomy (endovascular therapy) by interventional radiology and a stent to pull the clot out

23
Q

what are the benefits of having stroke patients on the stroke unit

A

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

24
Q

what is important immediate therapy for infarct

A

Aspirin 300mg ASAP after stroke

then give 300mg for 2 weeks afterwards

25
Q

why are stroke patients at increased risk of DVT

A

due to immobility after stroke

26
Q

how do you reduce DVT risk in stroke patients

A

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

27
Q

how is dysphagia managed in stroke

A

Initial swallow screen
If abnormal - assessment by speech and language therapist
may need NG tube or textured diet and thickened fluids

28
Q

what is a TIA

A

transient ischaemic attack

29
Q

how do you differentiate between TIA and stroke

A

after 24 hours it is a stroke - before its a TIA

30
Q

is a TIA benign

A

NO- puts you at much higher risk of a significant stroke and also causes visible damage to brain

31
Q

what is in the rapid access neurovascular TIA clinic

A

need referral after a TIA

Rapid assessment 
-history 
-carotid imaging 
-ECG 
-Blood tests
Diagnosis 
-Immediate therapy 
-Medication 
-Carotid endarterectomy
32
Q

what is ABCD2

A

risk assessment for recurrent TIA

33
Q

how is haemorrhage stroke treated

A

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

3 Ageing (9 decks)

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