Stroke/TIA Flashcards
How should a stroke be managed generally?
ABC, give 02 by mask, check BP, look for source of emboli
Consider thrombolysis - brain imaging (CT)
How should an ischaemic stroke be managed?
Give aspirin (300mg/day) and thrombolysis (alteplase) if suitable, within 3 hours of stroke.
Intrarterial clot retrieval (thrombectomy)
How should a haemorrhagic stroke be managed?
DO NOT GIVE THROMBOLYSIS, neurosurgery may be required
How should a stroke be managed long-term?
Secondary prevention - treat CAUSE (drugs for htn, heart disease, raised cholesterol and other medical conditions), antiplatelets (aspirin, clopidogrel), smoking cessation, anticoagulants (heparin, warfarin)
What is stroke?
Acute disturbance of cerebral function of presumed vascular origin causing a neurological deficit lasting longer than, or causing death within, 24 hours.
What is the ischaemic penumbra?
An area around the infarct with residual blood supply which can maintain functioning, albeit at a lower level, for a few hours. This area can recover if the clot is removed by thrombolysis
What is the main cause of a TIA?
Atherosclerotic thromboembolus in the carotid or vertebrobasilar arteries
What is the ABCD2 score?
A classification score for how likely a stroke will follow a TIA, looking at age, BP, clinical features, duration and diabetes mellitus
What are the characteristics of TACS?
Higher cerebral dysfunction AND homonymous hemianopia AND hemiparesis
What are the characteristics of PACS?
2/3 of higher cerebral dysfunction, homonymous hemianopia, and hemiparesis
OR higher cerebral dysfunction alone
What are the characteristics of LACS?
Pure motor stroke OR pure sensory stroke OR sensori-motor stroke OR ataxic hemiparesis
What are the characteristics of POCS?
Ipsilateral CN palsy and contralateral motor deficit OR bilateral motor/sensory deficit OR conjugate eye movement disorder OR isolated homonymous visual field defect OR cerebellar dysfunction
What is the ROSIER scale?
A scale used to evaluate stroke in the emergency room
Which factors would give +1 on the ROSIER scale?
Leg weakness Arm weakness Speech disturbance Facial weakness Visual field defect Acute onset
Which factors would give -1 on the ROSIER scale?
Convulsive fits
LOC
Confusion
Dizziness
What are the most likely stroke mimics? (differential diagnoses)
TIA Hemiplegic migraine Seizures (Todd's paresis) Hypoglycaemic episode Space-occupying lesion Functional neurological deficit Syncope Hypertensive encephalopathy
What are the differential diagnoses of TIA?
Migraine Focal epilepsy Hypoglycaemia MS Peripheral nerve lesion Psychological
How can ADLs post stroke be measured?
Barthels index of ADLs
What causes SAH?
- Rupture of berry aneurysms in the circle of willis
- AV malformations
What are the symptoms and signs of an SAH?
Symptoms - thunderclap headache, drowiness, seizures
Signs - kerning’s, neck stiffness, focal neurology
What is a sentinel headache?
A headache felt prior to the SAH, due to a small warning leak from the aneurysm
What would the CSF in an SAH look like?
Bloody at first, and then becomes xanthocromic (yellow) after several hours due to bilirubin break down
How is an SAH managed?
- CT head scan
- IV fluids
- Nimodipine (calcium channel blocker that reduces vasospasm)
- Endovascular coiling (promotes blood clotting)
- Intracranial stents
What causes a subdural haematoma?
Bleeding from bridging veins between the cortex and venous sinuses
What are the RF for SDH?
Acute - trauma
Chronic - elderly/alcohol
What are the symptoms of an SDH?
Insidious onset, headache, confusion, personality change, altering levels of consciousness
What causes an extradural haematoma?
Tearing of the middle meningeal artery or its branches, following head injury, causing bleeding into the space between the dura and the skull
What are the symptoms of an EDH?
Sudden LOC followed by a lucid interval
What is the characteristic CT of an EDH?
Biconvex haematoma
Increased confusion in an elderly patient who has been repeatedly falling
Sudural haematoma
Patient who has sustained a head injury playing rugby and is now very drowsy 8 hours later
Extradural haematoma
Old lady with atrial fibrillation who has developed left side weakness
Intracranial haemorrhage
