Stroke - Therapy Flashcards
How is stroke mortality changing year on year?
It is falling
Why are stroke units important?
Patients do better up to 10 years after their admission
Why do stroke units allow patients to do better up to 10 years after their admission?
Mobilise them as soon as possible
Concentrate on simple things such as swallowing, positioning
Early therapy
Concentrating of expertise
What percentage of stroke patients present with swallow problems?
50%
How does mobilising stroke patients as soon as possible improve their prognosis?
Probability of returning home decreases by 20% for each day the patient is not mobilised
What does time is brain mean?
Every minute in which a large blood vessel ischaemic stroke is untreated the patient loses neurons
What does the patient lose per minute of untreated large vessel ischaemic stroke?
- 9 million neurons
- 8 billion synapses
12km of axonal fibres
What is used to restore perfusion before cell death occurs?
Thrombolysis
What is thrombolysis used for?
To restore perfusion before cell death occurs
What is thrombolysis?
The dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood
What is the dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood called?
Thrombolysis
What is usually unexpected after thrombolysis?
Haemorrhage
What are risk factors for haemorrhage after thrombolysis?
Infarct size
Vessel occlusion
Diabetes
Blood pressure
Age
Stroke severity
Tissue changes
Antiplatelets
What are some findings about using thrombolysis to treat stroke?
The benefit outweights the risk when used up to 4.5 hours after the onset of symptoms
The benefit is entirely time dependent and therefore minimising the time to the start of treatment is critical in ensuring the best outcome
When does the benefit of using thrombolysis to treat stroke outweight the risks?
Up to 4.5 hours after the onset of symptoms
What are some of the practicalities of fast treatment?
Stroke symptoms recognition
Calling for help
Altering hospital team
Alerting CT/radiology team
Keeping the patient/relatives informed
Who is the treatment of stroke managed by?
Stoke teams
What is another treatment, other than thrombolysis, for the treatment of stroke?
Endovascular clot retrieval
What is endovascular clot retrieval?
Procedure that removes a blood clot that is blocking the blood flow to the brain
What is a procedure that removes a blood clot that is blocking the blood flow to the brain?
Endovascular clot retrieval
What are contraindications to thrombolysis?
Age
License currently limited to <80 years old
Stroke outcomes worse anyway in over 80s
What is an example of a thrombolysis?
Alteplase
What is secondary prevention of strokes done by?
Antiplatelets
Statin
Blood pressure drugs
Carotid endarterectomy
What are examples of antiplatelets?
Aspirin
Dipyridamole
Clopidogrel
What is a sign that a stroke is to come?
Transient ischaemic attack
What percentage of people who have a transient ischaemic attack will have an acute stroke in the future?
33%
