Stroke II Flashcards
What are the causes of ischaemic stroke? [5]
50% is large and medial atherosclerosis
Carotid dissection
AF - clot forms in the left atrial appendage and then moves into cerebral.
Arteriolarsclerosis (25%)
State what is meant by the Roiser Scale [1]
The ROSIER tool (Recognition Of Stroke In the Emergency Room) gives a score based on the clinical features and duration. Stroke is possible in patients scoring one or more.
Which symptoms are most likely not associated with stroke? [3]
Confusion
LOC
Convulsive fits
The FAST tool is used as a simple way to identify stroke in the community. What does this stand for? [4]
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)
What are the demographic, lifestyle, medical risk factors for stroke? [+]
Demographic
- Age, male (x1.25), race (x2), socioeconomic status
Lifestyle
- Smoking (x2), weight (x1.64), inactivity (x1.5), alcohol (x3)
Medical
* Hypertension (50% of all stroke)
* Hypercholesterolaemia
* Diabetes (x2)
* Vascular disease (PVD, IHD & CVD)
* Cardiac (Atrial fibrillation (x5); ASD/PFO)
Describe what the modified Rankin score (MRS) classifies [6]
Thrombectomy cut off is mRS 2 (i think)
Describe what is meant by an ASPECT score [1]
Measure of how much infarction there is in MCA territory
- for this score is divided to save by the score
- e.g. 10 score: 10 areas possible to save
How would you distinguish Bell’s palsy from a stroke?
Bell’s palsy is another condition that can be mistaken for stroke due to its presentation with facial weakness. However, Bell’s palsy typically affects only the lower motor neurones of the facial nerve leading to unilateral facial weakness including the forehead - this differentiates it from stroke where forehead sparing is more common due to bilateral upper motor neuron innervation.
Moreover, patients with Bell’s palsy may also experience hyperacusis or altered taste on the anterior two-thirds of their tongue
May be suitable for thrombolytic therapy
Offer (rather than consider) anticoagulation with warfarin or new oral anticoagulants (NOACs)
Decrease in GCS, headache and nausea/vomiting are often seen
give aspirin 300mg + arrange specialist review in TIA clinic within 24 hours
Give aspirin 300mg + supportive therapy
aspirin (lifelong) & dipyridamole (lifelong), no other antiplatelets
Consider (rather than offer) anticoagulation with warfarin or new oral anticoagulants (NOACs)
Ischaemic stroke (no drug allergies) - antiplatelets: clopidogrel (lifelong), no other antiplatelets
Posterior cerebral artery
An example is a patient who presents with isolated unilateral hemiplegia without vision or speech defects
Posterior inferior cerebellar artery
Cannot drive for 4 weeks
What are methods of remembering Webers and Wallenburg sx? [+]
Weaky weber (weakness in the muscles)
and
Wobbly wallenburg (ataxia, and altered sensation)
and
for both of them it is ipsilateral in the head, contralateral in the body
Total anterior circulation infarcts - involves middle and anterior cerebral arteries
Neuroimaging confirms occlusion of the proximal anterior circulation - offer thrombectomy +/- thrombolytic therapy
involves vertebrobasilar arteries
