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Neurology- Clinical > Stroke (Investigations and Management) > Flashcards

Stroke (Investigations and Management) Flashcards

1
Q

It is difficult to establish between ischaemic and haemorrhagic stroke by clinical assessment alone. What is the definite way of distinguishing the two?

A

Neuroimaging

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2
Q

What is the first line investigation for suspected stroke?

A

Brain CT

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3
Q

What is the brain CT in suspected stroke used for?

A

To establish between ischaemic and haemorrhagic stroke and to identify any other intracranial pathology

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4
Q

What is important to be aware of, with regards to the initial CT scan, in ischaemic stroke?

A

The CT scan may be normal in the first few hours (especially in cases of POCS)

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5
Q

Though a CT is the first line investigation for a stroke, what imaging modality is more effective for visualising infarcts?

A

MRI

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6
Q

CT scans will rapidly visualise a haemorrhagic stroke and can also show other complications such as what?

A

Intraventricular extension of haemorrhage and mass effect

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7
Q

What colour will a haemorrhagic stroke appear on CT?

A

White

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8
Q

What colour will an ischaemic stroke appear on CT?

A

Dark (or possibly nothing at all)

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9
Q

At the time of a stroke, a CT scan is more sensitive for detecting what kind of stroke?

A

Haemorrhagic

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10
Q

What is important to be aware of, with regards to haemorrhagic stroke on CT?

A

After around 1 week, a CT scan is not sensitive to blood and the clot will look similar to a thrombus

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11
Q

Different types of ischaemic stroke will show different things on imaging. What type of ischaemic stroke will show a ‘fibrin dependent red thrombus’?

A

Cardioembolic

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12
Q

Different types of ischaemic stroke will show different things on imaging. What type of ischaemic stroke will show a ‘platelet dependent white thrombus’?

A

Atheroembolic

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13
Q

Different types of ischaemic stroke will show different things on imaging. What type of ischaemic stroke will show ‘atherosclerosis’?

A

Small vessel disease

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14
Q

Headache is more commonly a symptom of which type of stroke?

A

Haemorrhagic

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15
Q

Aneurysms where will always compress CNIII?

A

Posterior communicating artery

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16
Q

What clinical picture will emerge if CNIII is compressed?

A

3rd nerve palsy - down and out, ptosis, pupillary dilatation

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17
Q

What is the best first management of a stroke?

A

Early referral to acute stroke services for assessment, evaluation of suitability for thrombolysis, investigation and management

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18
Q

What are some neurological symptoms which are not common presentations of stroke?

A

Blackouts, dizziness, pain, changes in vision

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19
Q

Which two investigations can be used to determine between an ischaemic or haemorrhagic stroke?

A

CT or MRI

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20
Q

What are three further investigations which may be done to determine the cause of an ischaemic stroke?

A

Carotid imaging, cerebral angiography, ECHO

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21
Q

How is carotid imaging for ischaemic stroke performed? Why is this done?

A

By US, CT or MR angiography to assess for atherosclerotic narrowing

22
Q

Why is cerebral angiography performed for ischaemic stroke?

A

To assess for cerebral vascular stenosis

23
Q

Why is an ECHO performed for ischaemic stroke?

A

To assess for valvular heart disease, congenital defects and possible thrombus/embolus sources

24
Q

Why is an ECG performed on all stroke patients?

A

To arrhythmias, either as a mimic of stroke or as a cause of stroke

25
Q

If an aneurysm or AVM is suspected as the cause of a haemorrhagic stroke, what investigation must be done?

A

MR/CT/digital subtraction cerebral angiography

26
Q

What investigation is sometimes performed 6-8 after a haemorrhagic stroke? Why?

A

MRI- to determine if there was an underlying cause

27
Q

What are the 1st line blood tests taken in stroke patients to ascertain risk factors and guide acute care?

A

Glucose, electrolytes and cholesterol

28
Q

What are the 2nd line blood tests taken in stroke patients to assess for rare causes of stroke?

A

Thrombophilia screen, vasculitis screen, blood cultures

29
Q

What is the 1st line acute management of stroke if necessary?

A

ABCDE

30
Q

Following the CT scan, what is the best management of an ischaemic stroke?

A

Thrombolysis/thrombectomy

31
Q

Within what timeframe must thrombolysis/thrombectomy be performed?

A

Within 3.5-4.5 hours of stroke onset

32
Q

Following the CT scan, what medication is given to all patients with an ischaemic stroke?

A

300mg aspirin

33
Q

In what case should you wait 24 hours before giving a stroke patient aspirin?

A

If they have been thrombolysed

34
Q

Patients who have a stroke are at a high risk of what due to immobility? How is this managed?

A

DVT/PE - give LMWH

35
Q

All patients who have had a stroke should get screened for what?

A

Should get a swallow screen

36
Q

If a swallow screen is abnormal, what happens?

A

Patient should be assessed by SALT

37
Q

Stroke patients should be nil by mouth until when?

A

They are assessed by SALT

38
Q

If a patient has a poor swallow or cannot swallow at all, what are some management options?

A

Textured diet, thickened fluids or NG tube depending on how severe

39
Q

How long is aspirin given for if a patient has had a stroke? What is it replaced with after this time?

A

2 weeks, and then it is replaced by clopidogrel for life

40
Q

Which patients should receive warfarin anticoagulation following their 2 weeks of aspirin instead of clopidogrel (an anti-platelet)?

A

Those who have chronic non-valcular and non-rheumatic AF or another cardioembolic cause for their stroke

41
Q

As well as SALT, what other AHP should assess stroke patients? What tool do they use?

A

Nutritionists using the MUST scoring

42
Q

What is the treatment for intracerebral haemorrhagic stroke?

A

No specific medical treatment - stop any anti-coagulant or anti-platelet

43
Q

When is surgery used for treatment of stroke?

A

All cases of haemorrhagic stroke should be discussed with a neurosurgeon - ruptured aneurysms or other arterial tears/ruptures may need clipping or endovascular intervention

44
Q

Aside from anti-coagulants and anti-platelets, which other medications may be offered as secondary stroke prevention?

A

Statins and BP control

45
Q

What advise is offered as secondary stroke prevention?

A

Stop smoking, improve diet and increase exercise

46
Q

What happens in thrombolysis?

A

IV alteplase is given within 3.5 hours of the symptom onset

47
Q

What is the major complication of thrombolysis?

A

Precipitation of acute haemorrhage in an ischaemic/infarcted area

48
Q

What are some factors based around the onset of symptoms which would be contra-indications to thrombolysis?

A

Onset > 3.5 hours ago, seizure since onset, resuscitation required, minor/improving symptoms, significant co-morbid dependence

49
Q

What are some factors based around recent medical history which would be contra-indications to thrombolysis?

A

Invasiveor surgical procedure in the last 3 weeks, pregnant or recent obstetric delivery

50
Q

What are some bleeding disorders which are contra-indications to thrombolysis?

A

Previous intra-cranial haemorrhage, active bleeding, GI ulcer/bleeding, anticoagulation use, severe liver disease

51
Q

What are some cranial disorders which would be contra-indications to thrombolysis?

A

Stroke in the past 3 months, structural cerebrovascular disease, major infarct/haemorrhage on CT

52
Q

What are some cardiac disorders which would be contra-indications to thrombolysis?

A

Aortic dissection, severe hypertension > 220/130

Neurology- Clinical (31 decks)

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