Stroke Flashcards
What are risk factors for a haemorrhage stroke?
Trauma Male, older age, FHx Arteriovenous malformation Cerebral amyloid antipathy Hypertension Haemophilia Anticoagulation therapy Illicit sympathomimetic drug use (cocaine)
Weak risk factors: Thrombocytopenia, NSAIS, heavy alcohol use
what are the causes of an ischaemic stroke?
thrombus (atheromatous plaque)
embolus (AF)
arterial dissection
what is the definition of a stroke ?
sudden onset of focal or global neurological deficit which lasts > 24 hours with evidence of infarction
what classification system is used for stroke?
Bamford/ Oxford classification
what is the diagnostic criteria of a TACS and PACS?
TACS: (all 3 of)
- unilateral weakness in arms, legs or face
- homonymous hemianopia
- higher cerebral dysfunction (i.e. dysphagia, visiospacial disturbance)
PACS: (2/3 of TACS)
what are the diagnostic criteria of a LACS?
1 of the following;
- pure motor
- pure sensory
- mixed sensor-motor
- ataxia hemiapresis
(no higher cerebral dysfunction)
what are the diagnostic criteria for a POCS?
1 of the following;
- cranial nerve palsy with contralateral sensorimotor deficit
- bilateral motor/sensory deficit
conjugate eye movement disorder (e.g. horizontal gaze palsy)
cerebellar dysfunction (e.g. ataxia, vertigo, nystagmus)
isolated homonymous hemianopia
what artery is affected in a TACS?
anterior and middle cerebral artery
what artery is affected in a POCS?
vertebrobasillar arteries
what artery is affected in a LACS?
deep perforating arteries - branches of middle cerebral artery
infarction of what artery causes locked in syndrome?
basilar artery
infarction of what artery causes Wallenberg syndrome?
posterior inferior cerebellar artery
what clinical syndrome occurs from occlusion of the posterior inferior cerebellar artery?
Wallenberg syndrome / lateral medullary syndrome
- ipsilateral horners syndrome
- ipsilateral loss of pain and temperature in face
- contralateral loss of pain and temperature in body
what scoring system is used to predict outcome in stroke?
NIH Stroke Scale
- score out of 42
what score of the NIHSS is contraindicative of thrombolysis?
score > 26
how is a haemorrhage stroke managed?
small bleed - no surgery.
large bleed - decompressive hemicraniotomy
how is an ischaemic stroke managed?
Onset < 4.5 hours then thrombolysis (i.e. Alteplase)
Followed by 75mg Clopidogrel 24-48hrs after thrombolysis
Thrombectomy can be combined with thrombolysis
If thrombolysis contraindicated;
300g Aspirin for 2 weeks followed by 75mg Clopidogrel
at what NIHSS score is thrombolysis indicated?
> 5 (or equal to) and < 26
what is the ongoing management for ischaemic stroke?
HALSS
Hypertension: manage with antihypertensives > 2 weeks post-stroke
Anti-platelet therapy: 75mg Clopidogrel or Warfarin if AF
Lipid lowering drug: 20-80mg atorvastatin
Sugar: test and manage diabetes
Surgery: carotid artery stenosis 70-90% considered for endarectomy
what are the early complications of stroke?
death haemorrhage cerebral oedema seizure cardiac arrhythmia venous thromboembolism aspiration pneumonia
what are the late complications of stroke?
swallowing difficulties mobility issues bladder/bowel dysfunction cognitive problems pain fatigue emotional and psychological issues
what is malignant MCA infarction?
rapid neurological deterioration due to cerebral oedema following a MCA territory stroke
may require urgent decompressive hemicraniotomy
what are the presenting features of a haemorrhage stroke?
headache nausea/vomiting seizure altered consciousness focal neurological deficit depending on location of bleed hypertension
what investigations would you carry out in a suspected stroke?
immediately:
- CT head
bedside:
- Blood glucose
- ECG (possible AF)
bloods:
- FBC
- U&E
- LFT
- Bone profile
- Clotting profile
- Lipid profile
- HbA1c
- ESR
imaging:
- CT head +/- CT angiography
