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yr3 medicine- geriatrics > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a TIA?

A

Transient ischaemic attack= transient episode of neurological dysfunction secondary to cerebrovascular pathology without acute infarction. Symptoms resolve within 24 hours (often, symptoms actually resolve in minutes to hours)

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2
Q

What is a stroke?

A

Sudden onset of a focal neurological deficit attributed to an acute foacl injury of the CNS by a vasculaar cause. Signs & symptoms last for more than 24 hours.

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3
Q

State some risk factors for stroke & TIAs

A
  • Cardiovascular disease such as angina, myocardial infarction and peripheral vascular disease
  • Previous stroke or TIA
  • Atrial fibrillation
  • Carotid artery disease
  • Hypertension
  • Diabetes
  • Smoking
  • Vasculitis
  • Thrombophilia
  • Combined contraceptive pill
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4
Q

State some symptoms of a TIA or stroke

A

In neurology, suspect a vascular cause where there is a sudden onset of neurological symptoms.

Stoke symptoms are typically asymmetrical:

  • Sudden weakness of limbs
  • Sudden facial weakness
  • Sudden onset dysphasia (speech disturbance)
  • Sudden onset visual or sensory loss
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5
Q

What system/score do we use to determine the risk of a subsequent stroke following a TIA? Include:

  • Name of scoring system
  • Components of scoring system
  • What socre indicates high risk
A

ABCD2 screening tool:

  • Age >/= 60
  • Blood pressure >/=140/90
  • Clinical features:
    • Unilateral weakness (2 points)
    • Slurred speech, absence of motor weakness
  • Duration of symptoms
    • >60mins (2 points)
    • 10-59 mins
  • Diabetes

Score greater than or equal to 4 indicates high risk

*everything scores one point unless specified that it scores 2

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6
Q

What is crescendo TIA?

How should you treat cresendo TIA?

A
  • Pt presents with two or more TIAs within a week
  • Should be treated as high risk regardless of ABCD2 score, therefore:
    • 300mg daily aspirin immediately
    • Specialist assessment & investigation within 24hrs
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7
Q

Discuss the treatment of a pt with a suspected TIA and an ABCD2 score of:

  • Greater than or equal to 4
  • Three or lower
A

Greater than or equal to 4

  • 300mg daily aspirin immediately
  • Specialist assessment & investigation within 24hrs

Three or less

  • 300mg daily aspirin immediately
  • Specialist assessment and investigation when possibel but no later than 1 week after onset of symptoms
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8
Q

Discuss the treatment of TIA

A

Conservative

  • Lifestyle:
    • Smoking cessation
    • Weight loss
    • Healthy diet
    • Reduce alcohol
    • Regular exericse

Pharmacological

  • Antiplatelets: treat with 300mg aspirin for 2 weeks. Should then be switched to aspirin & dypyridamole
  • Secondary prevention for CVD risk factors: treat hypertension, hypercholesterolaemia, diabetes etc…

Surgical

  • Carotid endarterectomy
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9
Q

What investigations might be done for a pt with TIA?

A
  • Blood tests
  • Carotid dopler
  • CT or MRI brain
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10
Q

What assessment tool can be used in the public to help identify stroke early?

A

FAST:

  • Facial dropping
  • Arm weakness
  • Slurred speech
  • Time to call 999
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11
Q

Remind yourself of the Oxford/Bamford classification of stroke

A
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12
Q

When considering the underlying aetiology of strokes or TIAs due to infarction we can use the TOAST classification; state the TOAST classification

A
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13
Q

What assessment tool can be used by medical staff to distinguish between a stroke and a stroke mimic?

A stroke is likely if the score is above….?

A

ROSIER scale, commonly used in A&E:

A stroke is likely if pt scores anything above 0

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14
Q

What investigation must you do before you can start treating a stroke?

A
  • CT head (as treat ischaemic & haemorrhagic strokes differently)
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15
Q

What assessment tool can be used as a measure of stroke severity?

A

National Institute of Health Stroke Scale: an assessment tool which gives a quantitative measure of stroke-related neurological deficit. It can be used as a measure of stroke severity.

It assess 11 key components:

  • Level of consciousness & communication
  • Eye movements
  • Visual fields
  • Facial palsy
  • Upper limb motor
  • Lower limb motor
  • Limb ataxia
  • Sensation
  • Langauage/aphasia
  • Dysarthria
  • Extinction/inattention

Score ranges from 0 to 42

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16
Q

Discuss the management of an ischaemic stroke

A
  1. Thrombolysis using alteplase
  2. Get SALT to do urgent swallow assessment
  3. Asprin 300mg (orally if can swallow, rectaly if swallow impaired). Continue aspirin for 2 weeks then switch to clopidogrel 75mg once daily (aspirin + dypridamole is equally effective combination)
  4. When stable, consider carotid endarterectomy
  5. Post stroke management:
    • Early mobilisation
    • If in AF anticaogualtion should be commensce 2 or more weeks after initial ischaemic stroke
    • Risk factor optimisation e.g. statins, bp lowering drugs etc..
    • Refer to appopriate therapy e.g. physio, occupational, speech
17
Q

Discuss the management of a haemorrhagic stroke

A

Refer to neurosurgeons

18
Q

CT head is the urgent investigation required for stroke; once you have done CT head and commenced appropriate management. What are some other investigations you may consider, include:

  • Bedside
  • Bloods
  • Imaging
A

Bedside

  • ​Blood pressure
  • ECG to assess for AF

Bloods

  • FBC
  • U&Es
  • ESR
  • Glucose
  • Lipids

Imaging

  • ECHO: check for emobli, valvular disease
  • Duplex ultrasound of carotid artery: look for stenosis
19
Q

What are the rules regarding driving after strokes and TIAs?

A
  • Following a stroke or TIA you cannot drive for 1 month. After this time you may do so providing there is no neuroloigcal sequale.
  • If you have recurrent TIAs you cannot drive for 3 months and you must be assessed by a doctor before you resume driving
20
Q

State some conditions that can mimic strokes

A
  • Seizures
  • Space occupying lesions
  • Hemiplegic migraines
  • MS
  • Sepsis in those with pre-exiiting neurological weakness
21
Q

What is the gold standard imaging technique used to determine territory of stroke?

A

Diffusion weighted MRI- CT is an alternative

22
Q

Pts with severe middle cerebral artery infarction can be at risk of what syndrome?

A

Maligntnat MCA syndrome= rapid neurological deterioration due to the effects of space occupying cerebral oedema following middle cerebral artery (MCA) territory stroke. Early neurological decline and symptoms such as headache and vomiting should alert the clinician to this syndrome, supported by radiological evidence of cerebral oedema and mass effect in the context of large hemispheric infarction

23
Q

If a pt has had a severe middle cerebral artery infarct there is risk of malignant MCA syndrome and hence pt should be considered for decompressive craniectomy if there is any deterioration in their clinical condition/decreasing conscious levels.

  • Within how many hours, from onset of symtoms, should they be referred?
  • Within how many hours, from onset of symptoms, should they be treated?
A
  • Refer within 24hrs of onset of symptoms
  • Treated within 48hrs
24
Q

State the criteria for a decompressive hemicraniectomy as treatment for malignant MCA syndrome (3)

A
  • <60yrs
  • CT infarct of at least 50% MCA territory
  • NIHSS of above 15
25
Q

See Stroke decks in Sem 4: Neuro to complete revision

A

yr3 medicine- geriatrics (8 decks)

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