Stroke - acute limb weakness Flashcards
During an acute stroke, how many neurons die each minute until blood flow is restored ?
1.9 million a minute !
In the scenario of an acute stroke, should you take a patient to the closest hospital or the city’s acute stroke unit/centre ?
The stroke centre!
because they are trained as specialists and can deliver emergency stroke treatment immediately on arrival.
What is the most common form of imaging used in acute strokes ?
non-contrast CT
(MRI is also used and is more sensitive, but less readily available)
What is the time frame for giving thrombolysis in a case of acute stroke ?
- within 4.5hrs of clear symptom onset
- or between 4.5 - 9hrs of known onset with evidence of salvageable brain tissue on CT/MR perfusion scans
What drug is the first line thrombolytic agent for use in acute ischaemic stroke ?
alteplase via IV injection
What scale is used to measure neurological deficits in the case of acute stroke ?
NIHSS
(national institute of health stroke scale)
Which patients qualify for a CT angiogram alongside their CT head in investigation of an acute stroke ?
patients who have clinically had a stroke with an NIHSS score of 6+
What does a CT angiogram look for in the case of an acute stroke ?
evidence of large vessel occlusion, that would indicate eligibility for thrombectomy
What are the inclusion criteria for thrombectomy following a stroke ?
- modified ranking score 0-2
- NIHSS score of 6+
- evidence of large vessel occlusion on CT angiogram
What is the main risk associated with thrombolysis ?
bleeding
What is the percentage risk of
a) haemorrhage
b) angioedema
in thrombolysis of acute stroke ?
6% risk of haemorrhage
7% risk of angioedema
What is a barthel index/score used to measure ?
ADL ability and mobility
(0-100) higher score = more independent
What are the two types/mechanisms of stroke ?
- ischaemic (embolus/thrombus) 85% of strokes
- haemorrhagic (bleed on brain) 15% of strokes
What are the 4 main subtypes of strokes?
- TACS (total anterior circulation stroke)
- PACS (partial anterior circulation stroke)
- POCS (posterior circulation syndrome)
- LACS (lacunar syndrome)
Where does a TAC (total anterior circulation) stroke effect ?
large cortical stroke affecting MCA or ACA
Where does a PAC (partial anterior circulation) stroke effect ?
cortical stroke affecting MCA or ACA
What is a LAC (lacunar syndrome) stroke ?
subcortical stroke due to small vessel disease
What is the diagnostic criteria for diagnosing a TAC (total anterior circulation) stroke ?
all of the following:
- unilateral weakness and/or sensory loss of face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
What is the diagnostic criteria for diagnosing a PAC (partial anterior circulation) stroke ?
2 of the following:
- unilateral weakness and/or sensory loss of face, arm and leg
- homonymous hemianopia
- higher cerebral dysfunction (dysphasia, visuospatial disorder)
What is the diagnostic criteria for diagnosing a POC (posterior circulation) stroke ?
1 of the following:
- cerebellar or brainstem syndrome
- LOC
- isolated homonymous hemianopia
What is the diagnostic criteria for diagnosing a LACS (lacunar syndrome) ?
1 of the following:
- unilateral weakness (and/or sensory deficit of face and arm, arm and leg, or all 3)
- pure sensory stroke
- ataxic hemiparesis
What are some differentials when someone presents with symptoms of a stroke ?
- TIA
- migraine
- seizure with Todd’s paralysis
- hypoglycaemia
- brain tumour
dysarthria vs dysphagia
dysarthria = difficulty speaking
dysphagia = problem with speech centre - difficulty finding meaningful words
