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3MB Ageing > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A

Collection of rapidly developing symptoms that are indicative of focal (sometimes global) brain damage with a vascular origin

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2
Q

Is stroke a diagnosis?

A

No - it leads to a diagnosis i.e. the underlying cause of it

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3
Q

What are the 3 main things you must note in a stroke history?

A

Time of onset
Symptoms
Progression

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4
Q

Why is it important to note time, symptoms and progression?

A

Various conditions can mimic a stroke

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5
Q

Name some conditions that can mimic a stroke

A

Seizures (Todd’s paresis causes unilateral weakness)
Sepsis (in patients with cerebral scar tissue from previous stroke)
Metabolic/toxic disorders
Hypoglycaemia
Dementia
Delirium/confusion
Space occupying lesions e.g. brain tumours

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6
Q

What is the main screening tool for assessing the likelihood of a stroke?

A

ROSIER Score
<0 = less likely
>0 - 1 = more likely

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7
Q

What are the types of stroke?

A

Haemorrhagic
Subarachnoid haemorrhage
Infarct

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8
Q

Name causes of haemorrhagic stroke

A 
Structural abnormalities 
Extreme hypertension (causes vascular damage increasing risk of bleeding)
Amyloid angiopathy (deposition of amyloid protein makes vessels more friable and prone to bleed)
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9
Q

Name causes of subarachnoid haemorrhage stroke

A

Head injury

Ruptured aneurysm

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10
Q

Name causes of infarct stroke

A 
Structural abnormalities 
AF causing cardioembolic stroke 
Atherosclerosis causing Atheroembolic stroke 
Thrombophilia 
Small vessel disease
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11
Q

Can you clinically differentiate between each stroke type?

A

No, only through imaging

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12
Q

What is the first line imaging for stroke?

A

CT Scan

UNLESS:

  • Patient presents >1 week late
  • Stroke is minor (MRI more sensitive)
  • Stroke is posterior (increased bone presence causes interference on CT)
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13
Q

How does blood show on a CT?

A

Bright white, due to iron presence

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14
Q

What must be remembered regarding haemorrhage and CT?

A

Blood is reabsorbed within 3 weeks of haemorrhage leaving an empty space and scar tissue so may not always be obvious on CT

Conduct MRI if patient presents >1 week late

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15
Q

What must be remembered with infarcts and CT?

A

CT MAY BE CLEAR

For infarcts to show on a CT, necrosis and oedema must occur, which takes time. If CT is conducted prior to this stage, it will be clear.

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16
Q

What imaging modality is good for infarct stroke?

A

MRI

Look for unilateral areas of corresponding black and white (ischaemic tissue impairs iron and water flow, resulting in these black and white areas)

17
Q

List symptoms of stroke

A

Facial weakness and droopiness
Arm weakness
Slurred speech

18
Q

What is the name given to salvageable brain tissue?

A

Penumbra

Stroke is a dynamic process, meaning brain is initially salvageable

19
Q

What exam must always be done in ALL stroke patients?

A

Neurological exam

20
Q

How is haemorrhagic stroke managed?

A

Control BP

  • If patient presents in <6 hours and BP >150mmHg, give IV GTN
  • If >6 hours, give Amlodipine

Reverse anticoagulants if patient is on any

21
Q

How is infarct stroke managed?

A 
Thrombolysis/Thrombectomy
Swallowing Assessment 
Hydration and Nutrition 
Antiplatelets 
Stroke unit care 
DVT prophylaxis
22
Q

What antiplatelets are given in stroke?

A

300mg Aspirin OR Aspirin with Clopidogrel (better in minor strokes or TIA)

23
Q

What is thrombolysis?

A

Giving IV TPA to break down clots

24
Q

What must be remembered about thrombolysis?

A

Cut off is 4.5 hours
May not work on large or proximal clots
Age does not matter
Bleeding is a side effect (check for previous stroke, hypertension and diabetes)

25
Q

What is endovascular therapy?

A

Putting a wire through the clot and opening a stent around it to pull it out.

Done for large or proximal clots

26
Q

What are consequences of stroke?

A

Aspiration pneumonia due to loss of coordination of swallowing muscles

DVT due to immobility (intermittent compressions stockings for prophylaxis)

27
Q

What is a TIA?

A

Mini stroke and first aspect of the stroke spectrum which acts as a warning sign for future, more serious strokes

28
Q

Are TIAs benign?

A

NO

Sign of an underlying vascular issue that needs to be managed

29
Q

What are investigations for a TIA?

A

History
Blood tests
Carotid imaging for stenosis in the carotid arch, vessels and cerebral vessels
ECG

30
Q

What screening tool is used to assess the likelihood of TIA and recurrent TIAs?

A

ABCD2

Checks age, BP, clinical features and diabetes

31
Q

How is a TIA managed?

A

Immediate therapy starting from the GP office

Statin to reduce risk
300mg Aspirin or Aspirin with Clopidogrel
Carotid Endarterectomy for carotid stenosis

3MB Ageing (8 decks)

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