Stroke**** Flashcards
Define
What else in terms of time is important to differentiate it form a TIA?
What score is used for TIA’s to stratify the risk of a stroke in the future?
Rapid onset neurological deficit(s) resulting from altered blood supply to the brain and lasting >24 hours
ABCD2
Ischaemic stroke - Where can the emboli originate from?
Haemorrhagic stroke - causes?
Heart - AF, MI, IE, Valve disease
Aortic arch
Carotid artery (atheroma or dissection)
Vertebral artery (dissection)
Vascular abnormality (aneurysm, AVM)
HTN
Coagulopathy
Vasculitis
Signs and symptoms:
Main sign in both types of stroke?
Ischaemic - signs of a cause?
Haemorrhagic - specific signs
Focal neurological signs - e.g. weak, numb
Murmur - valve disease
Fever - infective endocarditis
Carotid bruit - carotid artery disease
Meningism
Headache
Coma within hours - due to coning of brainstem
Oxford (Bamford) Classification: - only for ischaemic strokes
What is occluded in an anterior circulation stroke? - 3
TACS - total anterior circulation stroke:
1st criteria?
What type of stroke would produce these signs on their own??
What does predominantly leg symptoms and predominately arm and face symptoms suggest?
Internal carotid (ICA) Middle cerebral (MCA) Anterior cerebral (ACA)
Motor or sensory deficit - contralateral to there lesion in 2 out of 3 of the face, arm and legs.
Lacunar stroke
ACA stroke
MCA stroke
TACS - total anterior circulation stroke:
2nd criteria is impaired higher function:
List some examples?
What does aphasia indicate?
What does hemispatial neglect indicate?
3rd criteria is visual field changes - what type of stroke would have this on its own? - main field change
Aphasia (if in dominant hemisphere) Apraxia Agnosia Hemispatial neglect (in non-dominant hemisphere) Altered level of consciousness
POCS
Homonymous hemianopia
POCS - posterior circulation stroke:
Which arteries become occluded?
How is PACS diagnosed using the Oxford classification?
READ THE LIST OF SOME PRESENTATIONS
A POCS is also addociated with an occupation that you bend your neck backwards a lot (painter, builder etc.) so vertebral artery dissection can occur leading to a stroke.
Vetebro-basilar system
Posterior cerebral artery
2 out of 3 of the criteria OR just impaired higher function
CN palsy Bilateral motor or sensory defect Eye movement problems Cerebellar lesions Locked-in syndrome - occlusion of basilar artery to pons
LACS - lacunar stroke:
Which circulation does it tend to effect?
Anterior circulation
Unilateral motor and/or sensory deficit
Ataxic hemiparesis
Dysarthria and clumsy hand
Risk factors:
Demographic and lifestyle?
Elderly
Male
Non-white
S+A, combined pill
Risk factors:
Vascular?
Abnormal clotting?
HTN
DM
Hypercholesterolaemia
HD, PVD, Prev stroke
Thrombophillia - ishcaemic
Coagulopathy - haemorrhagic
Risk factors:
Inflammatory and congenital
Vasculitis
Mitochondrial disease
Syphilis
Differentials:
M and 8S’s mneumonic
Migraine Sugar - hypoglycaemia Seizures Sepsis - encephalitis Syncope SDH Space occupying lesions Old (s)troke with intercurrent illness Somatisation
Investigations - Bloods
What do you look for in FBC and why?
Why do you do ESR/CRP?
Why do you do U&E’s and LFT’s?
Why do you do a coag screen?
What 2 other things can look at in the blood?
Polycythaemia
Thrombocytopenia (reduced platelets) - could be cause or CI of Rx
Vasculitis
Look for renal, electrolyte or hepatic cause of neurological symptoms
Looking for cause and prior to initiating thrombolysis or anti platelets
Glucose and cholesterol
Investigations - CV tests
Why do you do ECG?
What may an CXR show? - 3
Why do you do an echo?
AF - big risk factor for stroke
LVF from HTN (RF)
Large atria which could dbe source of embolus
Aspiration pneumonia
If you suspect embolic source
Neuroimaging:
Why do you do a CT and what will proceed if it’s negative?
Why do you do a CT angiography (CTA) and what will it allow you to do?
Why do an MRI?
Rules out haemorrhage or tumour
Allows thrombolysis to proceed if -ve
Detects large vessel occlusion
Can identify thrombectomy candidates
Can see infarction unlike CT
Management:
Acute stroke management:
In what time should imaging be done?
What should be done while waiting for imaging?
DVT prophylaxis should be given for anyone immobile.
What’s done first line and if someone is very high risk?
What MDT becomes involved?
Within 1 hr
Monitoring - preventing drop in oxygen, glucose and BP
DVT prophylaxis:
Intermittent pneumatic compression
LMWH
Speech and language therapy (SALT)
Physio
OT
