Stroke Flashcards
define stroke
acute onset (symptoms are sudden)
focal (what part of the brain is affected) neurological symptoms and signs
due to disruption of blood supply (due to blockage or tear of blood vessel)
describe the types of stroke
haemorrhagic
ischaemic - (most common)
describe haemorrhagic stroke
bleeding occurs inside or around brain tissue
raised BP
weakened blood vessel due to;
structural abnormalities like aneurysm, arteriovenous malformation
inflammation of vessel wall (vasculitis)
do not give patients statins for treatment !
describe ischaemic stroke
clot blocks of blood flow to an area of the brain (no oxygen)
thrombotic - clot blocking artery at site of occlusion
embolic - clot blocking artery has travelled to artery it occludes from somewhere more proximal in the arteries of the heart
hypoperfusion - due to reduced blood flow due to stenosed artery rather than occlusion of artery (no blockage but brain not receiving sufficient oxygen)
Virchow’s triad
relating to veins (thrombosis);
endothelial injury
circulatory staisis
hyper-coagulable state
risk factors of stroke - non-modifiable
age - older family history gender race - south asians previous stroke
risk factors of stroke - modifiable
hypertension
hyperlipidemia
smoking
prior history of TIA especially if recent and recurrent
atrial fibrillation diabetes congestive heart fialure alcohol excess obesity physical inactivity poor socioeconomic status
describe management of stroke
thrombolysis or thrombestomy in ischaemic stroke
identify the problem of the stroke and begin appropriate treatment in order to stop another stroke
stroke causes irreversible brain damage and so multidisciplinary assessment and rehabilitation is used to adjust the patient to their disability
differential diagnosis of stroke
hypoglycaemia
seizure - postictal states
migraine
other metabolic - hyperglycaemia, hyponatremia
space occupying lesions like brain tumours
functional hemiparesis
describe first tests for suspected stroke
brain imaging - differentiates between ischaemic and haemorrhagic stroke;
CT
MRI
describe tests for ischaemic stroke
blood - glucose, lipids, thrombophillia
BP - hypertension
describe atheroembolism
embolism from a thrombus forming on a atherosclerotic plaque - platelet rich clots
infarcts in same side as affected carotid artery
describe cardioembolism
embolism form a clot formed in the heart (usually left atrium) - clotting factor rich clots
infarcts in more than one arterial territory, bilateral
describe tests for haemorrhagic stroke
investigate cause of bleeding via imaging
hypertensive - deep in the brain
young patients - underlying aneurysm
multiple haemorrhages - vasculitis, moya disease, cerebral amyloid angiopathy
describe drug treatment of stroke - due to atheroembolic or thrombus
antiplatelet (aspirin + dipyridamole MR/Clopidogrel) statins diabetes management hypertension managment lifestyle advice
