STROKE Flashcards
symptoms of stroke?
Loss of motor function
Loss of speech- dysarthia/ dysphasia
Loss of sensation- numbness
Loss of vision- hemianopia
Signs of STROKE
Clumsy speech, nonsense speech
gaze palsy
ataxia
nystagmus- wiggly eyes
Name the two main causes
Haemorrhage- 15% - due to rupture of a blood vessel- can see blood on CT
Ischaemic stroke- Blockage of blood by thrombus/embolism
What is the most common place for a clot to lodge?
the middle cerebral artery
Name the two main sources of blood to the brain?
The vertebral arteries- posterior
The carotid arteries- anterior
What stuctures do each blood vessels supply?
Vertebral- brainstem, cerebellum, occipital lobes
Carotids- most of cerebrum, deep white matter
What does Wernicke’s area control?
Comprehension of speech
What does Broca’s area control?
Makes sure that our speech makes sense
Parietal lobe?
Language comprehension
Temporal Lobe?
Emotional and personality
Occipital lobes?
Vision
What can happen if a clot appears in the deep white matter?
Lots of fibres within the pons so even a small stroke can cause locked in syndrome.
How many subtypes of stroke?
4
Name the most common type
PACS- partial anterior circulation
Occlusion is restricted to branches of the MCA
Mortality at 1 year= 16%
Which has the highest mortality?
TACS- Total anterior circulation
60% mortality at 1 year.
occlusion of proximal MCA or ICA
which type can be referred to as a silent stroke?
LACS- lacunar stroke
can be pure motor, pure sensory or ataxic hemiparesis
Which stroke may occur if the patient presents with Bilateral Sensory/ motor deficit, isolated hemianopia, cranial nerve palsy or horners?
POCS- posterior circulation
affects brainstem, occipital lobes or cerebellum.
Investigations?
Bloods- FBC, LIPIDS ECG CT MRI Carotid Doppler ECHO- check for clot in heart.
Treatment
Time Is BRAIN
thrombolysis - ALTEPLASE
Problems with ALTEPLASE?
Can cause bleeding if brain is already damaged.
- only use if within 4.5 hours
- don’t use if recent bleed trauma or MI
Other treatment?
Hemicraniectomy
- remove lid of skull
- allows decompression if cerebral oedema.
What can stroke units offer?
- Can help mobilise patients
- help with swallowing
- physio
Secondary prevention of stroke?
Clopidrogrel ( 75mg)
OR
ASA (75mg) + Dipyramide MR (200mg bd)
STATIN (even if no HTN)
If carotid occlusion is over 70%?
carotid endarectomy to reduce risk of CVA.
How do you know its not a TIA?
Symptoms lasting longer than 24hrs.
