Stroke Flashcards
What is a stroke?
Rapidly developing clinical symptoms and/or signs of focal and at time 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
What are important facts to elicit in clinical assessment of a stroke?
Time of onset
What were/are symptoms
How did they progress
What are some common stroke mimics?
Seizure Sepsis Toxic/metabolic Space occupying lesion Pre syncope Acute confusion/ delirium Vestibular dysfunction Functional Dementia
What is the rosier score?
If there has been a loss of consciousness or seizure activity you lose a point
Add a point for asymmetric facial, arm and leg weakness, speech disturbance and visual field defect
What are the 3 branches of stroke?
Haemorrhage
Subarachnoid haemorrhage
Infarct
What are the different types of haemorrhagic stroke?
Structural abnormality such as arteriovenous malformation
Hypertensive
Amyloid angiopathy
What are the different types of infarct stroke?
Cardioembolic - AF
Small vessel
Atheroembolic
Other
What is the 1st line investigation for a stroke?
CT head
What should be done if there is nothing on CT but clinically a stroke is still suspected?
MRI - infarct which is more common than haemorrhagic takes a while to show on CT as it shows as oedema etc whereas MRI is much more sensitive
When will a CT become insensitive to blood on the brain?
After 1 week - late presentation
What is the management of a stroke?
Thrombolysis Thrombectomy Imaging Swallow assessment Nutrition and hydration Antiplatelets Stroke unit care DVT prevention
What are things to thing about before thrombolysis?
Age Time since onset Previous intracerebral haemorrhage or infarct Atrophic changes BP Diabetes Potential benefit
What are commonly used thrombolysis drugs?
tPA
Alteplase
Why MUST you do a CT head before thrombolysis?
If haemorrhagic - DO NOT thrombolyse. Will make it MUCH worse
What time frame impacts the administration of IV tPA?
Limited to <4.5 hours from onset of symptoms
What is the recommended antiplatelet therapy post stroke?
Aspirin 300mg ASAP after stroke
Wait 24 hours if been thrombolysed
What is the recommended DVT prophylaxis post stroke?
Intermittent pneumatic compression
LMWH has showed little benefit that is outweighed by bleeding risk
How is dysphagia managed?
Initial swallow screen
If abnormal then assessment by a speech and language therapist
May require NG tube placement ot textured diet
What is the commonest complication post stroke?
Aspiration pneumonia from dysphagia
What is a TIA?
A brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia with clinical symptoms typically lasting less than one hour and without evidence of infarction
What is done at the rapid access TIA clinic?
History Carotid imaging ECG Blood test Aspirin +/- clopidogrel Statin
How is a haemorrhagic stroke treated?
If presentation within 6 hours and there is a systolic BP above 150 mmHg then it should be treated with either IV GTN or IV labetolol
How are anticoags reversed?
Vit K/ prothrombin for warfarin
Specific antidotes for DOACs
Tranexamic acid
