Stroke + Anti-Ischaemic agents Flashcards
What evidence is left behind after a TIA?
None
Difference between a storke and TIA
Stroke lasts longer than 60mins and leaves radiological evidence
Both cause the same symptoms
What is the most common type of harmorrhagic stroke + its most common cause?
Subarachnoid
ruptured aneurysm 85% cases
Sudden diffuse headache and decline in consciousness
rapid onset nausea and vomiting
Most likely haemorrhage stroke
Symptoms of ishcemic stroke
Usually have more localised lesion causing focal neurological deficits
Name given to the area surrounding the pinpoint of infarct
Penumbra
- will lack oxygen
Why do neurons in the penumbra suffer milder insult initially at the point of infarct
Collateral vessels provide residual perfusion so the cells die more gradually
what % of stroke patients die in the a year?
30%
what is the main mechanism by which fibrinolytic therapies work?
Drugs used are enzymes to convert plasminogen to plasmin.
* normally done by tPA
All given IV
Disadvantage to using streptokinase?
Alternative used?
A bacterial protein
Develop immunisation / antibodies
must wait 3yrs to use it again
- Instead IV Recombinant tPA is used
When is recombinant tPA effective?
Given within 3hrs of symptom onset
after 3hrs don’t give, complications outweigh clinical benefit
Complication of recombinant tPA ?
6.6% patients will have symptomatic intracranial haemorrhage - subarachnoid
Side effects of fibrinolytic therapies?
- Nausea and vomiting
- Bleeding
- Reperfusion arrhythmias
- Hypotension
- Back pain
- Allergic reactions
( esp streptokinase )
Is heparin okay to use with fibrinolytic therapies?
No, contraindicated if heparin was used within the previous 48hrs
Increased risk of haemorrhage
What INR value would make fibrinolytic therapies contraindicated?
INR>1.7
