Stroke Flashcards
What are the main causes of stroke?
Small vessel occlusion, thrombosis in situ, cardiac emboli, atherothromboembolism, CNS bleeds
What imaging result can indicate cardiac emboli?
Bilateral infarcts
What cardiac condition can cause cardiac emboli?
Atrial fibrillation, MI, valve disease, IE
What are risk factors for an ischaemic stroke?
Age, male, HTN, smoking, DM, past TIA, heart disease, combined oral contraceptive pill
What clinical presentations suggest haemorrhage?
Meningism, severe headache, coma
What clinical presentations suggest a cerebral infarct?
Contralateral sensory loss, contralateral hemiplegia that’s initially flaccid but becomes spastic, dysphasia, homonymous hemianopia, visuo-spatial deficit, UMN facial weakness that’s forehead sparing
What clinical presentations suggest a brainstem infarct?
Quadriplegia, locked-in syndrome, facial numbness/paralysis, gaze/vision disturbances, dysarthria and speech impairment, altered consciousness
Where are lacunar infarcts?
Basal ganglia, internal capsule, thalamus, pons
What are the 4 clinical presentations that suggest a lacunar infarct?
Ataxic hemiparesis, unilateral motor weakness, sensory loss, dysarthria/clumsy hand
In which lacunar stroke is consciousness/cognition not intact?
Thalamic strokes
When would you do a diffusion-weighted MRI?
If diagnosis is uncertain
How would you check for a cardiac embolus?
ECG
What blood tests should you do?
Glucose, FBC, U&Es, Cholesterol, INR if on warfarin
How would you check for vasculitis?
ESR increased
What are some differential diagnoses?
Head injury, hypo/hyperglycaemia, subdural haemorrhage, Intracranial tumours, hemiplegic migraine, encephalopathy
How can you test perceptual function?
Point to a named part of the body
How can you test spatial ability?
Copying matchstick patterns
How can you test apraxia?
Dressing, copying a clock face
How can you test agnosia?
Picking out and naming easy objects from a pile
How can you monitor progress?
Time taken to sit up and transfer to a chair
What are some potential complications due to immobility?
Pressure sores, aspiration pneumonia, constipation, contractures
What primary prevention is there?
Control risk factors, exercise, lifelong anticoagulation AF and prosthetic heart valves
What secondary prevention is there?
Control risk factors, antiplatelets, anticoagulation after stroke from AF
What areas does Barthel’s index of activity of daily living cover?
Bowels, bladder, grooming, toilet use, feeding, transfer, mobility, dressing, stairs, bath/shower
How do you distinguish between an ischaemic and haemorrhagic stroke?
An urgent CT/MRI
What is the first thing you should do once a haemorrhagic stroke is excluded?
Aspirin 300mg
What antiplatelet therapy would you start after an ischaemic stroke?
Aspirin 300mg daily for 2 weeks then clopidogrel
When would you start anticoagulation?
If the patient has AF
How soon must you do thrombolysis?
Within 4.5 hours of symptoms onset
How is thrombolysis done?
IV Alteplase
Why must thrombolysis be done within 4.5 hours?
It can cause massive bleeds so benefits outweigh risk only within this time
Other than thrombolysis, what is a management option?
Mechanical thrombectomy
How would you manage an intracerebral haemorrhage?
Stop anti-coagulants immediately, control BP, reduce ICP
How can you reduce ICP?
Mechanical ventilation, IV mannitol
What is the first thing you would do?
CT imaging of the head
