Stroke; ischemic + haemorrhagic Flashcards
What is a stroke?
How long does it last?
Focal neurological, deficit lasting 24hrs with infarction
What are the 2 types of stroke and % of both occurring?
ischemic - 85%
haemorrhagic - 15%
What is an ischemic stroke?
Essentially very long TIA
Blocked artery due to carotid thrombo-emboli:
Thrombosis
AF emboli
Sudden and complete blockage of artery
What is a haemorrhagic stroke and causes of it?
Artery breaks (ruptured BV)
Trauma, htn, berry aneurysm rupture
Typically haemorrhagic strokes and where in the skull?
Intracerebral + subarachnoud
RF for stroke?
HTN, smoking, obesity, T2DM, AF, TIA
Also hyper-coagulability: COCP, Polycthemia, sickle cell
Sx of stroke?
Focal neurology like TIA
+ Haemorrhagic stroke show increased ICP therefore midline shift, risk of tectorial herniation/coning
+Lacunar strokes - very common type of ischemic stroke of lenticulostriate arteries (supply deep brain structures) - ischemia to basal ganglia, internal capsule, thalamus, pons
If a Px is on oral anticoags, what do we assume till proven otherwise?
suspect haemorrhagic
high ICP, always CI in?
Lumbar puncture taking
Dx of stroke?
What would be seen for each stroke?
NCCT Head
ischemic - mostly normal
haemorrhagic - hyper dense blood
Tx for ischemic stroke?
- Presents within 4.5 hours - clot buster (thrombolytics) - IV alteplase
- Aspirin 300mg for 2 weeks + lifelong clopidogrel 75mg
Tx for hemorrhagic stroke?
Neurosurgery referral (IV mannitol for high ICP)
What prophylaxis is given for both?
ATORVASTATIN AND RAMIPRIL
What is a specific sign seen in stroke called? What happens?
Pronator drift
Ask Px to lift arms to ceiling; pronators take over, arm on affected side will pronate + palm faces down
