Stroke Flashcards
d: stroke
Acute onset of
Focal neurological symptoms and signs
Due to disruption of blood supply
Name the 2 types of stroke?
Haemorrhagic
Ischaemic
What type of stroke is more common?
Ischaemic
What is the main cause of Haemorrhagic stroke?
hypertension
How may a blood vessel become weakened?
structural abnormalities like aneurysm, arteriovenous malformation(AVM) inflammation of vessel wall(vasculitis)
d:hypoperfusion
due to reduced flow of Blood due to stenosed artery rather than occlusion of the artery
Are clots in arteries formed via Virchow’s triad?
no atherosclerosis
veins are the triad
Risk factors for stroke
Age Family history of stroke Gender Race Previous stroke
Modifiable risk factors of strokes
Hypertension Hyperlipidaemia Smoking Prior history of TIA especially if recent and recurrent Atrial fibrillation Diabetes Congestive heart failure Alcohol excess Obesity Physical inactivity Poor socioeconomic status
The reduction of Systolic BP via 10mm reduces the risk of CV events by over _____%
20
What type of therapy is recommended in hyperlipidaemic patients who have had an ischaemic stroke?
statin
Why do some people recover well after stroke and they’ve had brain damage?
they are young and the brain that’s left will take on the function of what’s died
Name 6 questions to ask when investigating and stroke?
Is this a stroke?
What kind of stroke is this?
What caused this stroke/TIA?
Have I tried my best to answer question 3?
Is the patient on the appropriate secondary prevention following investigations?
Have I answered any questions the patient has?
Name some things that mimic a stroke
Hypoglycaemia
Seizure- postictal states
Migraine
Other metabolic –hyperglycaemia, hyponatremia
Space occupying lesions like brain tumours
Functional hemiparesis
what is the only way to differentiate between ischaemic and haemorrhagic stroke?
brain imagaing
Name some brain scans
CT
MRI with DWI
MRI with SWI
Name the investigations for ischaemic stroke
Blood tests- glucose, lipids, thrombophillia screen in young patients
Assess for hypertension
Any other suggestion that the patient has blood vessel disease like coronary artery disease or peripheral vascular disease- suggests that the stroke may be due to blood vessel disease rather than embolus from heart
What is an atherosembolism?
embolism from a thrombus forming on a atherosclerotic plaque- platelet rich clots
infarcts in same side as affected carotid artery
What is a cardioembolism?
embolism from a clot formed in the heart(usually left atrium)
clotting factor rich clots
infarcts in more than one arterial territory, bilateral
What sort of scanning would an atheroembolism require?
carotid scanning, CT/MR angiogrphy of aortic arch
What sort of testing would you do for cardioembolism?
ECG- ?AF, ?old ischaemic changes(mural thrombus)
?LVH (suggests uncontrolled hypertension-commonest cause of AF)
Echocardiogram (transthoracic, transoesophageal, bubble contrast study to look for interatrial connection)
24 hour- 5 day ECG monitor tests (Paroxysmal AF)
If the patient is hypertensive? where is he clot?
usually deep in the brain
If the patient is young and not hypertensive what do you need to examine for?
investigate underlying aneurysm AVM
multiple haemorrhages
vasculitis, Moya Moya disease, cerebral amyloid angiopathy
What can be done to reverse disability? and timings?
Thrombolysis- upto 4.5 hrs from onset of symptoms
Thrombectomy- upto 6 hrs from symptom onset, usually after having started thrombolysis
treatment if atheroembolic or due to thrombus?
Antiplatelets(Aspirin 75 mg + Dipyridamole MR 200 mg twice daily/Clopidogrel 75 mg daily)
Statins to treat high lipids
Diabetes management
Hypertension management
Lifestyle adviceif its due to atrial fibrillation, what is the treatment?
Warfarin (Vitamin K antagonist)
Direct acting oral anticoagulants (act by inhibiting clotting factors directly like factor X and thrombin)
Rivaroxaban, Dabigatran, Apixaban, Edoxaban
Name some surgical treatments for stroke?
Haematoma evacuation
Relief of raised intracranial pressure
Obstructive hydrocephalus
Large total MCA infarctions
Carotid endarterectomy
>70% stenosis in same sided internal carotid artery(as affected side of brain)d: Transient Ischaemic Attacks
Temporary neurological symptoms due to occlusion of artery stopping flow of blood
- temporary b’cos arteries are capable of dissolving small clots
Why are TIAs treated as emergencies?
as stroke risk after is very high
in what type of stroke do you not give anticoagulants?
haemorrhagic
What is better for stroke imaging CT/MRI?
CT
