Stroke Flashcards
What percentage of people die within 1 month of having a stroke?
23%
What percentage of people die within 3 years of having a stroke?
60-70%
What is the difference between a stroke and a TIA?
TIA symptoms resolve within 24 hours
Define stroke.
Rapidly developing clinical signs of disturbance of cerebral function lasting for over 24 hours with no apparent cause other than that of vascular origin
How does an ischaemic stroke occur?
Cerebral thrombosis from atherosclerotic disease or distal embolism breaking off and reaching the brain, eventually causing occlusion
How does an intracerebral haemorrhagic stroke occur?
Rupture of a small vessel in the brain
How does a subarachnoid haemorrhagic stroke occur?
Rupture of intracranial aneurism
Which type of stroke is most common?
Ischaemic accounts for 70% of strokes
What are the symptoms of stroke?
Facial weakness
Arm/leg weakness
Speech slurred
What scale is used to recognise stroke in an emergency room?
ROSIER scale
What may be a differential diagnosis for stroke?
Seizure
Drug toxicity
Brain tumour
Spinal cord lesin (MS)
How does age affect stroke risk?
Risk doubles with every decade over 55
How does gender affect stroke risk?
Men at higher risk
More fatal in women
How does ethnicity affect stroke risk?
Afro-Caribbean more at risk
What co-morbidities can increase stroke risk?
Hypertension
Atrial fibrillation
Diabetes
What may be seen on a CT scan in stroke?
Ischaemic- demarcated hypotenuse zone (often difficult to spot)
Haemorrhagic- clearly visible areas of high attenuation
When may an MRI scan be useful in stroke?
When investigating a TIA
What investigations should be carried out in stroke?
Blood pressure ECG FBC U&Es Blood glucose Inflammatory markers
What acute treatment can be given in stroke?
Nothing administered until CT results back
What is thrombolysis?
Acute treatment for ischaemic stroke
Alteplase licensed and given within 3 hours of symptom onset
Describe the treatment after thrombolysis in ischaemic stroke.
Aspirin 300mg given after bleed is ruled out, continued for 14 days
High intensity statin as soon as patient can swallow
Describe blood pressure control in ischaemic stroke.
Should be less than 185/110mmHg for thrombolysis
To manage, use IV infusion f short acting hypertensive i.e. GTN, labetolol
Describe the treatment in haemorrhagic stroke.
Surgical intervention in ongoing bleed
Anticoagulants stopped and reversed if INR >1.4 with vitamin K and prothrombin complex concentrate
Statins started if indicated by CV risk
Describe blood pressure control in haemorrhagic stroke.
Blood pressure to be managed if greater than 150mmHg up to 6 hours after symptom onset
To manage, use IV infusion f short acting hypertensive i.e. GTN, labetolol
Aim for 140mmHg for at least 7 days
