Stroke Flashcards
What is a stroke
Vascular in origin
Rapidly developing symptoms with signs of focal (or global) loss of brain function lasting more than 24hrs
Is a stroke painful
Not normally
Occasionally some arm pain but extremely rare
List some stroke mimics
Seizure Sepsis Toxic/metabolic (e.g. blood glucose) Space occupying lesion (usually progress gradually but can have sudden onset if it bleeds) Pre-syncope/syncope Acute confusion/delirium Vestibular dysfunction Functional disorder – get neuro symptoms but no actual pathology/brain damage Dementia
List some symptoms of stroke
Asymmetric facial weakness
Asymmetric arm or leg weakness
Speech disturbance
Visual field defect
What are the different types of stroke
Infarct - ischemic
Haemorrhagic
Subarachnoid haemorrhage
What can cause a brain haemorrhage
Amyloid angiopathy
AV malformations
Hypertension
Trauma
What is the most common cause of cardioembolic stroke (ischaemic type)
Atrial fibrillation
Clots are thrown off and lodge in the brain
What is the most common cause of ischemic stroke
Artheroembolic
What is the first investigation for stroke
CT of the head
Blood will show up as white (including dense clots)
Infarcts are darker areas - may not appear instantly
What is a TIA
Same as a stroke but on a shorter scale
Typically last less than 1 hour
It is not benign - still damages the brain
What is the acute management of stroke
Imaging Thrombolysis/thrombectomy (only if ischaemic) Swallow assessment Nutrition and hydration Antiplatelet Stroke unit care DVT prevention
Why would someone need a swallow assessment after stroke
There is often an aspiration risk – pneumonia is a massive complication of stroke
Speech and language can assess
May need NG tube or textured diet
Which factors would make you unlikely to use thrombolysis
Age
Length of time since symptoms started - no benefit after 5 hours
High blood pressure
Atrophic changes
What are the benefits of MRI in stroke imaging
More sensitive so shows smaller infarcts
Can show flow issues
Shows up remnants of a bleed for much longer
How is aspirin used in stroke
Once CT has confirmed a clot, give 300mg ASAP
Wait 24hrs if they’ve also had thrombolysis
