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3RD YEAR - Long Term Conditions/FOCP > Stroke/TIA > Flashcards

Stroke/TIA Flashcards

1
Q

How should a stroke be managed generally?

A

ABC, give 02 by mask, check BP, look for source of emboli

Consider thrombolysis - brain imaging (CT)

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2
Q

How should an ischaemic stroke be managed?

A

Give aspirin (300mg/day) and thrombolysis (alteplase) if suitable, within 3 hours of stroke.

Intrarterial clot retrieval (thrombectomy)

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3
Q

How should a haemorrhagic stroke be managed?

A

DO NOT GIVE THROMBOLYSIS, neurosurgery may be required

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4
Q

How should a stroke be managed long-term?

A

Secondary prevention - treat CAUSE (drugs for htn, heart disease, raised cholesterol and other medical conditions), antiplatelets (aspirin, clopidogrel), smoking cessation, anticoagulants (heparin, warfarin)

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5
Q

What is stroke?

A

Acute disturbance of cerebral function of presumed vascular origin causing a neurological deficit lasting longer than, or causing death within, 24 hours.

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6
Q

What is the ischaemic penumbra?

A

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

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7
Q

What is the main cause of a TIA?

A

Atherosclerotic thromboembolus in the carotid or vertebrobasilar arteries

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8
Q

What is the ABCD2 score?

A

A classification score for how likely a stroke will follow a TIA, looking at age, BP, clinical features, duration and diabetes mellitus

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9
Q

What are the characteristics of TACS?

A

Higher cerebral dysfunction AND homonymous hemianopia AND hemiparesis

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10
Q

What are the characteristics of PACS?

A

2/3 of higher cerebral dysfunction, homonymous hemianopia, and hemiparesis

OR higher cerebral dysfunction alone

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11
Q

What are the characteristics of LACS?

A

Pure motor stroke OR pure sensory stroke OR sensori-motor stroke OR ataxic hemiparesis

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12
Q

What are the characteristics of POCS?

A

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

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13
Q

What is the ROSIER scale?

A

A scale used to evaluate stroke in the emergency room

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14
Q

Which factors would give +1 on the ROSIER scale?

A 
Leg weakness
Arm weakness
Speech disturbance
Facial weakness
Visual field defect
Acute onset
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15
Q

Which factors would give -1 on the ROSIER scale?

A

Convulsive fits
LOC
Confusion
Dizziness

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16
Q

What are the most likely stroke mimics? (differential diagnoses)

A 
TIA
Hemiplegic migraine
Seizures (Todd's paresis)
Hypoglycaemic episode
Space-occupying lesion
Functional neurological deficit
Syncope
Hypertensive encephalopathy
17
Q

What are the differential diagnoses of TIA?

A 
Migraine
Focal epilepsy
Hypoglycaemia
MS
Peripheral nerve lesion
Psychological
18
Q

How can ADLs post stroke be measured?

A

Barthels index of ADLs

19
Q

What causes SAH?

A
  • Rupture of berry aneurysms in the circle of willis

- AV malformations

20
Q

What are the symptoms and signs of an SAH?

A

Symptoms - thunderclap headache, drowiness, seizures

Signs - kerning’s, neck stiffness, focal neurology

21
Q

What is a sentinel headache?

A

A headache felt prior to the SAH, due to a small warning leak from the aneurysm

22
Q

What would the CSF in an SAH look like?

A

Bloody at first, and then becomes xanthocromic (yellow) after several hours due to bilirubin break down

23
Q

How is an SAH managed?

A
  • CT head scan
  • IV fluids
  • Nimodipine (calcium channel blocker that reduces vasospasm)
  • Endovascular coiling (promotes blood clotting)
  • Intracranial stents
24
Q

What causes a subdural haematoma?

A

Bleeding from bridging veins between the cortex and venous sinuses

25
Q

What are the RF for SDH?

A

Acute - trauma

Chronic - elderly/alcohol

26
Q

What are the symptoms of an SDH?

A

Insidious onset, headache, confusion, personality change, altering levels of consciousness

27
Q

What causes an extradural haematoma?

A

Tearing of the middle meningeal artery or its branches, following head injury, causing bleeding into the space between the dura and the skull

28
Q

What are the symptoms of an EDH?

A

Sudden LOC followed by a lucid interval

29
Q

What is the characteristic CT of an EDH?

A

Biconvex haematoma

30
Q

Increased confusion in an elderly patient who has been repeatedly falling

A

Sudural haematoma

31
Q

Patient who has sustained a head injury playing rugby and is now very drowsy 8 hours later

A

Extradural haematoma

32
Q

Old lady with atrial fibrillation who has developed left side weakness

A

Intracranial haemorrhage

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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