Stroke Flashcards
List typical stroke features
- Focal
- Sudden onset
- Vascular territory hypoperfusion can explain collection of symptoms
THEY DO NOT MIGRATE (unless capsular warning syndrome) and do no stereotype
Classify a TACS using the Oxford stroke classification
ICA or proximal MCA occlusion
- Hemiparesis
- Higher cortical dysfunction e.g. dysphasia, visuospatial neglect
- Homonymous hemianopia
Classify a PACS using the Oxford stroke classification
Branch of the MCA occlusion
- Isolated higher cortical dysfunction OR
any TWO of hemiparesis, higher cortical dysfunction and homonymous hemianopia
Classify a POCS using the Oxford stroke classification
Vertebral, basilar, cerebellar or posterior cerebral artery occlusion
- Isolated hemianopia, brainstem or cerebellar syndromes
Classify a LACS using the Oxford stroke classification
Small penetrating artery occlusion - usually lenticulostriate branches of MCA or supply to brainstem or deep white matter
- Pure motor stroke OR
- Pure sensory stroke OR
- Sensorimotor stroke OR
- Ataxic hemiparesis OR
- Clumsy hand dysarthria
What complications can you get following a stroke?
- Recurrent stroke
- Complications due to immobility
- Raised ICP
- Infections
- MOOD disorder
- Secondary epilepsy
What steps are involved in the treatment/intervention/information stages?
- Admission onto a stroke unit
- Revascularisation therapy
- Optimising physiology and surveillance, prevention and detection of early post stroke complications
- Nutritional support
- Secondary prevention and rehabilitation
What does revascularisation therapy involve?
- IV Alteplase - 4.5hr window - rapid assessment to confirm stroke assessment and exclude contraindication, get CT to exclude haemorrhagic stroke and give bolus)
- Thrombectomy - 6hr therapy window
This is used in selected patients with large vessel occlusion - CT angiogram
Give examples of secondary prevention
- Role of aetiology must be understood
- Antithrombotic therapy
- BP control <130/80
- Lipid control total cholesterol less than 4 and LDL <2
- HbA1c <7
- Potentially a carotid endarterectomy?
- Lifestyle modifications e.g. smoking cessation, sleep optimisation, exercise, weight loss
Within what timeframe would you perform a CT in a patient who has had a fall and is on warfarin?
CT within 8 hours
