Stroke Features and Managmeent Flashcards
What are causes of stroke?
Small vessel occlusion or thrombosis in situ
Cardiac emboli
Atherothromboembolism (e.g. from carotids)
CNS bleeds
- hypertension, trauma, aneurysm rupture, anticoagulation, thrombolysis
Carotid artery dissection Vasculitis SAH Venous sinus thrombosis Antiphospholipid syndrome Thrombophilia
What are risk factors for stroke?
Modifiable: Smoking Obesity DM HTN Heart disease - valvular, ischaemic, AF alcohol Carotid bruit COCP Increased clotting PVD
Non-modifiable
Male
Increasing age
What are signs of cerebral infarcts?
Depends on site there may be contralateral sensory loss
Contralateral hemiplegia - initially flaccid (floppy limb) becoming spastic (UMN)
Dysphasia
Homonymous hemianopia
Visuo-spatial deficit
What are signs in brainstem infarcts?
Varied
Include: quadriplegia, disturbances of gaze and vision, locked in syndrome
Where are lacunar infarcts? What are signs of lacunar infants?
Basal ganglia, internal capsula, thalamus and pons
Ataxic hemiparesis Pure motor Pure sensory Sensorimotor Dysarthria/clumsy hand
Cognition/consciousness intact except in thalamic strokes
What are the two main types of stroke?
ISchaemic >24 hours = ischaemic stroke, <24h - TIA
- blockage in blood vessel stops blood flow
- can be thrombotic or embolic
Haemorrhagic
- blood vessel bursts leading to reduction in blood flow
What should be assessed for Oxford Stroke Classifications?
Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
Homonymous hemianopia
Higher cognitive dysfunction e.g. dysphasia
What arteries are involved in TACI? What is the criteria
Middle cerebral artery, Anterior cerebral artery
All 3 of:
Unilateral hemiparesis and/or hemisensory loss of face/arm and leg
Homonymous hemianopia
Higher cognitive dysfunction e.g. dysphasia
What arteries involved in PACI? Features?
Involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
2 of:
- Unilateral hemiparesis or hemisensory loss of the face/arm and leg
- Homonymous hemianopia
- Higher cognitive dysfunction e.g. dysphasia
What arteries are involved in LACI? Features?
Involves the perforating arteries around the internal capsule, thalamus and basal ganglia
Presents with one of:
- Unilateral weakness (and/or sensory deficit) or face and arm, arms and leg or all three
- Pure sensory stroke
- Ataxic hemiparesis
What arteries are involved in POCI? Features?
Invovles the vertebrobasilar arteries
PCA, vertebral arteries, basilar artery
Presents with one of:
- Cerebellar or brainstem syndromes
- Loss of consciousness
- Isolated homonymous hemianopia
What symptoms suggest a patient to have suffered haemorrhage
Decrease in level of consciousness
Headache is more common
Nausea and vomiting is common
Seizures
What investigation in stroke?
Urgent CT
MRI
What is the management for ischaemic stroke?
Protect the airway - avoids hypoxia/aspiration
Maintain homeostasis : BM, BP - only treat if there is hypertensive emergency or thrombosis is considered as treating high BPs may result in reduced cerebral perfusion
CT/MRI within 1 hour helps to rule out haemorrhage
Aspirin 300mg - anti platelet (continue for 2 weeks then switch to long term antithrombotic treatment)
Thrombolysis:
Consider if:
Patient present within 4.5 hours of onset of symptoms
Best results within 90 mins
Alteplase
Always do CT 24h post-lysis to identify bleeds
Thrombectomy: Intra-arterial mechanical thrombectomy provides additional benefit for those with large artery occlusion in the proximal anterior circulation.
What are CI to thrombolysis
Major infarct or haemorrhage on CT Mild/non-disabling deficit Recent surfery, trauma or artery/vein puncture at uncompressible site Previous CNS bleed Ateriovenous malformation Aneurysm Severe liver disease, varies or portal hypertension Seizure in last 3 months GI or GY tract haemorrhage in last 21 days Known clotting disorder Anticoagulants or INR > 1.7 Platelets < 100 History of intracranial neoplasm Rapidly improving symptoms BP> 180/105
