Stroke Features and Managmeent Flashcards

1
Q

What are causes of stroke?

A

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
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2
Q

What are risk factors for stroke?

A
Modifiable:
Smoking
Obesity
DM
HTN
Heart disease - valvular, ischaemic, AF
alcohol
Carotid bruit
COCP
Increased clotting
PVD

Non-modifiable
Male
Increasing age

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3
Q

What are signs of cerebral infarcts?

A

Depends on site there may be contralateral sensory loss
Contralateral hemiplegia - initially flaccid (floppy limb) becoming spastic (UMN)
Dysphasia
Homonymous hemianopia
Visuo-spatial deficit

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4
Q

What are signs in brainstem infarcts?

A

Varied

Include: quadriplegia, disturbances of gaze and vision, locked in syndrome

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5
Q

Where are lacunar infarcts? What are signs of lacunar infants?

A

Basal ganglia, internal capsula, thalamus and pons

Ataxic hemiparesis
Pure motor
Pure sensory
Sensorimotor
Dysarthria/clumsy hand

Cognition/consciousness intact except in thalamic strokes

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6
Q

What are the two main types of stroke?

A

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

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7
Q

What should be assessed for Oxford Stroke Classifications?

A

Unilateral hemiparesis and/or hemisensory loss of the face, arm and leg
Homonymous hemianopia
Higher cognitive dysfunction e.g. dysphasia

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8
Q

What arteries are involved in TACI? What is the criteria

A

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

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9
Q

What arteries involved in PACI? Features?

A

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
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10
Q

What arteries are involved in LACI? Features?

A

Involves the perforating arteries around the internal capsule, thalamus and basal ganglia

Presents with one of:

  1. Unilateral weakness (and/or sensory deficit) or face and arm, arms and leg or all three
  2. Pure sensory stroke
  3. Ataxic hemiparesis
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11
Q

What arteries are involved in POCI? Features?

A

Invovles the vertebrobasilar arteries
PCA, vertebral arteries, basilar artery

Presents with one of:

  1. Cerebellar or brainstem syndromes
  2. Loss of consciousness
  3. Isolated homonymous hemianopia
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12
Q

What symptoms suggest a patient to have suffered haemorrhage

A

Decrease in level of consciousness
Headache is more common
Nausea and vomiting is common
Seizures

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13
Q

What investigation in stroke?

A

Urgent CT

MRI

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14
Q

What is the management for ischaemic stroke?

A

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.

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15
Q

What are CI to thrombolysis

A
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
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16
Q

What is the management for haemorrhage stories?

A

Neurosurgical consolation
Supportive
Anticoagulants (e.g. warfarin) and antithrombotics (clopidogrel) should be stopped to minimise further bleeding
Revere anticoagulation
Lower blood pressure - labetalol infusion if unable to swallow