Stroke - Therapy Flashcards
What is the most important think to acknowledge when assessing and treating stroke patients?
time!
time lost = brain lost
What is the penumbra?
The area surrounding an ischaemic event such as thrombotic or embolic stroke. Immediately following the event, blood flow and therefore oxygen transport is reduced locally, leading to hypoxia of the cells near the location of the original insult..
What happens to brain cells during an ischaemic stroke?
4
- reduced O2 and glucose
- release of Ca2+
- cells swell (brain swells)
- apoptosis
What is the mnemonic used to recognise stroke?
FACE
Facial weakness
Arm weakness
Speech impairment
Time to call 999
What would be the first thing you would want to do for a potential stroke patient?
(3)
- arrange urgent head CT
- contact stroke unit
- ensure no contraindications to thrombolysis
What are the advantages of CT over MRI?
- quick
- shows up blood
What would you consider as a primary treatment measure for acute ischaemic stroke?
thrombolysis
What is the aim of thrombolysis in the treatment of strokes?
to restore perfusion before cell death occurs (salvage penumbra)
What drug might you use for thrombolysis?
alteplase
What are the risks associated with thrombolysis?
What percentage of patients are affected by this?
haemorrhage
3%
It can be devastating
What scoring system might be used to establish whether thrombolysis would be a suitable treatment plan?
ASPECTS
8+/10 = good score
How does alteplase help reduce the negative effects of stroke?
- converts plasminogen to plasmin.
- plasmin breaks down fibrin in thrombus.
What does the severity of stroke depend on?
- collateral circulation
- size of penumbra/infarct
- time
How might a stroke appear on a head CT?
white = occlusion/clot in artery
black area = penumbra/infarct/increased water
How does a stroke appear on an MRI in the acute early stages?
white
When is thrombolysis treatment given for strokes?
<4.5 hours
What are the risk factors for haemorrhage after thrombolysis treatment of stroke?
(7)
infarct size vessel occlusion diabetes BP age stroke severity antiplatelets (e.g. aspirin)
What are the different types of stroke?
3
- TIA (mini stroke)
- ischaemic stroke
- haemorrhage stroke
What are the contraindications to thrombolysis?
- age (<80)
- CVS (hypertensive, recent MI)
- recent surgery (antiplatelets)
What are the interventional/surgical treatments for stroke?
endovascular thrombectomy
What might be did for a patient who has suffered from an acute MCA territory ischaemic stroke with cerebral oedema complications?
hemicraniectomy
What kind of strokes are treated with thrombectomy and IVT?
large vessel occlusion stroke
How is a TIA similar to a stroke, in terms of secondary prevention measures?
- chance of recurring stroke is same for both
- both require essential secondary prevention measures.
What other medication is often given along with rTPA?
aspirin
Which patients are most at risk of a secondary stroke?
patients with a past stroke/TIA
What are the prevention measures to prevent reoccurence?
3
- antiplatelets
- statin
- antihypertensives
What antiplatelet drugs might be used for secondary prevention?
What dosages?
aspirin (100mg/2wks)
clopidogrel (75mg/day)
What are the therapeutic effects of statins?
What are the side effects?
lower blood cholesterol
muscular pains, association with type 2 diabetes
What are the therapeutic effects of aspirin?
What are the side effects?
antiplatelet, antithrombosis
haemorrhage, dyspepsia
What are the therapeutic effects of clopidogrel?
What are the side effects?
antiplatelet, antithrombosis
haemorrhage, diarrhoea
Other than a throbectomy, what would be another surgical procedure which could prevent stroke?
Carotid endarterectomy
