STROKE MEDICINE Flashcards
Which factor would suggest a diagnosis of delirium rather than dementia?
Delirium involves an impairment of conscious level and often involves psychotic symptoms
Transient Ischaemic Attacks (TIA’s)
focal neurological deficits due to blockage of blood supply to a part of the brain (focal brain dysfunction) lasting less than 24 hours (but in practice most TIAs last much less than that).
The ABCD2 score ?
risk assessment tool designed to improve the prediction of short-term risk of a stroke after a (TIA).
calculated by summing up the points for 5 different factors including age, blood pressure, clinical features, duration of symptoms and the presence of diabetes.
ABCD2>=4 indicates a higher risk.
It is not a diagnostic tool.
what must ppl who have had a suspected TIA take?
aspirin (300 mg daily) started immediately
Ix and Mx for TIA
what is crescendo TIA ?
- blood tests, carotid Doppler and a brain scan
- Further investigations depend on the suspected pathophysiology.
- lifestyle modifications, treatment of hypercholesterolemia and hypertension,
- Medication>> antiplatlets
- Surgical intervention for carotid artery disease
- People with crescendo TIA (two or more TIAs in a week) should be treated as being at high risk of stroke
Stroke
Sudden onset of a focal neurological deficit lasting more than 24 hours or with imaging evidence of brain damage due to either infarction (emboli, in situ thrombosis or low blood flow) or haemorrhage.
how do we identify the vascular territory involved ?
Bamford classification
and subsequently with brain imaging and consider the underlying aetiology of infarcts
(TOAST classification) and bleeds (primary: hypertension, cerebral amyloid angiopathy; secondary: trauma, anticoagulation-associated, underlying structural abnormality).
Types of strokes:
worst prognosis?
o Total anterior circulation stroke (TACS)
o Partial anterior circulation stroke (PACS)
o Lacunar stroke (LAC)
o Posterior Circulation stroke (POCS)
what assessment tools are used for the rapid assessment of a patient presenting with a suspected stroke?
o FAST:
Face (facial drooping)
Arm (arm weakness)
Speech( speech slurred)
Time ( time to call 999).
o ROSIER: the rosier scale has been developed to help medical staff distinguish btw a stroke and a stroke mimic.
This is commonly used in the accident and emergency department.
The NIH stroke scale (NIHSS) is used for?
used as a clinical stroke assessment tool to evaluate and document neurological status in acute stroke patients.
The stroke scale can serve as a measure of stroke severity. It has 15 items which scores on levels of consciousness, language, neglect, visual-field loss, extra ocular movement, motor strength, ataxia, dysarthria and sensory loss.
Once an ischaemic stroke has been confirmed one of the treatment options available is?…..when is it gien
thrombolysis with alteplase.
up to 4.5 hours after the onset of ischaemic stroke
tissue plasminogen activator (tPA).
All people presenting with acute stroke who have had a diagnosis of primary intracerebral haemorrhage excluded by brain imaging should be given:
o aspirin 300 mg orally if they are not dysphagic or
o aspirin 300 mg rectally or by enteral tube if they are dysphagic.
how long should Aspirin 300 mg be continued ?
until 2 weeks after the onset of stroke symptoms, at which time definitive long-term antithrombotic treatment should be initiated.
can u drive after TIA? when can u defo NOT drive?
Following a stroke or TIA you are not permitted to drive for
1 month.
After this time you may do so as long as there are no permanent neurological sequale.
If you have recurrent TIA’s you cannot drive for 3 months and you must be assessed by a doctor prior to resumption of driving.
Patients with stable neurological symptoms from their stroke or TIA who have carotid stenosis of
50–99% according to the NASCET criteria, (North American Symptomatic Carotid Endarterectomy Trial)
OR
70–99% according to the ECST (European Carotid Surgery Trialists’ Collaborative Group) criteria on the side relating to the stroke should:
o Be assessed and referred for carotid endarterectomy within 1 week of onset of stroke or TIA symptoms
o do surgery within a max of 2 weeks of onset of stroke or TIA symptoms
o In both cases fitness for surgery should be assessed and there may be a small risk of stroke during surgery.
CHADS-VASC 2 ?
HASBLED score ?
what Anticoagulation r given?
CHADS-VASC 2 score is important in determining if someone is suitable for anticoagulation if they are in atrial fibrillation and are at risk of stroke.
This is useful when considered with a HASBLED score.
Anticoagulation now is divided into warfarin vs DOAC (Direct Oral Anti Coagulant)
e.g. Apixaban, Dabigatran, Rivoraxaban, Edoxaban .
