Stroke Flashcards
What parts of a history make an event sound like a stroke?
Rapid development of symptoms
Focal => certain part of brain is affected and is causing symptoms in specific places (not generalised)
Loss of brain function (e.g. pain is a positive symptom therefore not a sign of lost brain function)
What 3 thing should you establish when a patient presents to you with a suspected stroke?
– Time of onset?
– What were/are the symptoms?
– How did they progress?
What fraction of stroke presentations are made up by mimic presentations of a stroke?
1/3
What can cause a mimic of a stroke presentation?
- Seizure (weakness down one side can occur here)
- SEPSIS
- Toxic/ metabolic causes (=> check blood glucose)
- Space occupying lesions in brain can bleed and cause stroke mimic
What is the ROSIER score?
“Recognition of Stroke in the Emergency Room” Score
Checklist of symptoms/signs experienced by patient
A score of >0 indicates probable stroke
What are the 3 main types of stroke?
Infarct (85%)
Haemorrhagic (10%)
Sub-arachnoid Haemorrhage
What are the different causes of Haemorrhagic stroke?
- Structural abnormality in brain
- Hypertensive
- Amyloid deposition (makes blood vessels fragile & bleed)
What are the different subtypes of infarct stroke?
Athero-embolic => plaques in aorta create emboli which travel upwards
Small vessel => clots form in small vessels of brain due to normal cardio risk factors (BP and cholesterol)
Cardio-embolic => AF creates clots which travel upwards
Clinically we are able to tell the difference between haemorrhagic and infarct strokes. TRUE/FALSE?
FALSE
Imaging used to work this out
What type of scans are used on admission with a suspected stroke?
CT head
MRI
Why is CT a useful scan to complete first?
- Quick to complete
- Usually machines available readily in acute need
- Good at picking up blood (white) in haemorrhagic stroke
- can show if blood is occupying significant amount of space in the brain
What can be interpreted on a CT head showing an infarct stroke?
- non-symmetrical brain (dark patch often seen)
- dark patch resembles oedema produced from necrotic tissue
An infarct stroke may not always be seen on imaging. TRUE/FALSE?
TRUE
If imaging is taken very soon after stroke is suspected then no oedema may have formed as the brain tissue is not yet dead
clots in cerebral arteries can sometimes be visualised which show a risk of stroke
What strokes are poorly imaged by CT?
Posterior strokes
- bone gets in the way of the radiation
How do MRIs look for abnormalities in the brain?
They use diffusion-weighted technology
=> look for abnormalities in the diffusion of fluid and ions in the brain
- 2 different types of image are compared and look for a corresponding abnormal patch to diagnose a stroke
How long after a haemorrhagic stroke will blodd not be picked up by CT?
roughly after 2-3 weeks the blood has been resorbed and therefore shows up minimally (if at all) on the scan
Why do patients not consider strokes as serious as something like a heart attack, and delay their admission to hospital?
It doesn’t cause them any pain, so they think the symptoms will eventually subside
What acute management is given in a stroke?
- Thrombolysis/thrombectomy (for infarct strokes) – Imaging – Swallow assessment – Nutrition and hydration – Antiplatelets – DVT prevention
What is the biggest consequence of a poor swallow following a stroke?
Aspiration pneumonia
How many synapses in the brain are lost every second during an infarct stroke?
230 million
What is the main long term benefit of thrombolysis?
Patients much more likely to be independent at 3 months post-stroke
What drug is given during thrombolysis and how is it given?
- Tissue plasminogen activator (TPA)
- Given IV up until 4.5 hrs after event
- UNLESS - haemorrhagic stroke or BP >185/105
What does the Act FAST campaign encourage elderly patients to look for in a stroke?
F - facial weakness
A - arm weakness
S - speech problems
T - Time to call 999
What is endovascular therapy for stroke?
Used on cases where thrombolysis hasn’t worked (often proximal clots)
Stent tree is inserted to mesh with clot and allow interventional radiologist to dislodge and remove it
this procedure is not yet available in Scotland
Patients having care in a stroke unit has proven to be beneficial. TRUE/FALSE?
TRUE
How soon should antiplatelets be started after a patient suffers a stroke?
ASAP (unless thrombolysed, then wait 24 hrs)
Aspirin 300mg for 2 weeks
or some pts now receive aspirin and clopidogrel dual therapy
What treatments can be used to prevent DVT after stroke?
Pneumatic compression stockings (up to thigh with pump to inflate and deflate)
TED stockings showed no overall benefit
In what cases would you NOT give patients stockings to prevent a DVT?
If they have unresolving leg ulcers
If the patient has peripheral arterial disease which would be affected
If a patient is deemed to have an impaired swallow, what options are there for nutrition?/
Thickened fluids OR textured diet
NG tube if completely unable to swallow
What is a TIA?
transient ischaemic attack
previously known as a stroke lasting <24 hours
A TIA lasting only 0.1 hours can still show damage to the brain on an MRI. TRUE/FALSE?
TRUE
What score can be used to assess a patients risk of TIA?
ABCD2 score
Age BP Clinical features (weakness and speech impairment) Duration Diabetes
How is a haemorrhagic stroke treated?
Reverse any previous anticoagulation medications the patient was taking with Vitamin K
Optimise blood pressure
If systolic >150mmHg on admission give IV labetalol or GTN to lower it within 1st hour
What treatment is given as secondary prevention of an infarct stroke?
- Anticoagulants if cardioembolic/AF
- Antiplatelets if not cardioembolic
- Statins
- Stop smoking
- Manage BP
- Diet and lifestyle advice
What investigations should be carried out to find out the aetiology of a stroke?
- Carotid scan
- angiogram
- ECG/24 hour tape
- echo
- transcranial doppler
- Lipid profile
- BP
