Stroke Flashcards
what is the aetiology of ischaemic stroke?
small vessel occlusion thrombosis in situ cardiac emboli (AF) atherothromboembolism carotid artery stenosis
what is the aetiology of haemorrhagic stroke?
CNS bleeds
Trauma
aneursym rupture
anticoagulation
what are the features of a total anterior circulation stroke? what vessel(s) is affected?
all of;
- hemiparesis
- higher cortical dysfunction (dysphagia + visuospatial defect)
- homonymous hemianopia
MCA or ICA occlusion
what are the features of a partial anterior circulation stoke? what vessel(s) is affected?
2 of the following;
- hemiparesis
- homonymous hemaniopia
- higher cortical dysfunction
usually branch of MCA
what are the features of posterior circulation stroke. what vessel is affected?
one of the following
- cranial nerve palsy + contralateral motor/sensory defect
- bilateral motor/sensory deficit
- conjugate eye movement disorder
- cerebellar dysfunction
- isolated homonymous hemaniopa
usually vertebral, basilar, cerebellar or PCA infarct
what are the features of a lacunar stroke? what vessel is affected?
one of
- pure sensory stoke
- pure motor stroke
- sensorimotor stroke
- ataxic hemiparesis
small branches of MCA or brainstem supply
what investigations are done in stroke?
CT head
- darkness of brain parenchyma
- loss of grey-white matter differentiation and sulcal effacement
- brightness in artery = clot
Serum Glucose, U&E’s, creatinine, FBC
- ?cause
- exclude RF, anaemia or thrombocytopenia before initiating thrombolysis
ECG
- ?AF
Coag
- ?coagulopathy
CT angiogram
a patient presents <4.5 hours after stroke onset. How should they be managed?
maintain homeostasis
- Glucose betwen 4 and 11
- BP <185/110 (treating high BP may impair cerebral perfusion)
- 02 if requiring
Screen swallow and CT head
Antiplatelet (once haemorrhagic stroke ruled out by CT)
thrombolysis
- alteplase
a patient presents >4.5 hours after stroke onset. How should they be managed
maintain homeostasis
Screen swallow and CT head
Antiplatelet
Thrombectomy
DVT prophylaxis
what is a TIA?
an ischamic (usually embolic) neurological event with symptoms lasting <24hrs (usually much shorter).
what are the S&S of TIA?
unilateral weakness dyphagia ataxia, vertigo or loss of balance amaurosis fugax - unilateral progressive vision loss 'like a curtain descending' - retinal artery occlusion homonymous hemianopia
what investigations should be done in TIA?
FBC, U&E, ESR, glucose, lipids, ECG
Carotid doppler +/- angiography
CT/MRI head
Echo
what is the treatment for TIA?
control CV risk factors
- BP, Lipids, DM, smoking cessation
Antiplatelet
- aspirin 300mg for 2 weeks then clopidogrel 75mg
ABCD2 scoring
cant drive for a month
carotid endarectomy
what are the differentials for TIA?
hypoglycaemia migraine aura focal epilepsy hyperventilation retinal bleeds
