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Long-term Conditions > Stroke & TIA > Flashcards

Stroke & TIA Flashcards

1
Q

What is the difference between a stroke & TIA?

A

Sudden onset/ rapidly-developing focal or global neuro disturbance

Stroke: lasts >24 hours or leads to death
TIA: lasts <24 hours

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2
Q

What are the two types of haemorrhagic stroke?

hint: where is the bleed?

A

Intracerebral: within the brain
Subarachnoid: between brain & arachnoid

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3
Q

What % of strokes are ischaemic & haemorrhagic?

A

85% ischaemic

15% haemorrhagic

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4
Q

What are the two main causes of ischaemic stroke?

A

Occlusion from a thrombus (complication of atherosclerosis)

Embolus of blood clot (complication of AF)

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5
Q

What are some rarer causes of harmorrhagic stroke?

one in young people/ neck trauma & one associated with prothrombotic tendency

A

Carotid artery dissection (younger people/ neck trauma)

Cerebral venous thromobosis (in those with a prothrombotic tendency )

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6
Q

Give some mobility problems associated with stroke

HAFS

A

Hemiparesis/ hemiplegia

Ataxia

Falls

Spasticity (muscles continually contracted)

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7
Q

What are the two types of dysphasia? & areas of the brain associated with them?

A

Receptive (wernicke’s)

Expressive (broca’s)

Broca’s area is anterior to wernickes

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8
Q

What are some cognitive problems associated with stroke?

A

Dyspraxia
Impaired concentration
Hemispatial neglect

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9
Q

How may a posterior circulation stroke present?

A

Symptoms of acute vestibular syndrome:

Acute persistent continuous vertigo with nystagms, N&V & new gait unsteadiness

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10
Q

When can antiplatelet treatment be started?

A

Only once haemorrhagic stroke has been ruled out by a brain scan

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11
Q

How should you manage someone before stroke is confirmed?

A

ABC approach

Give oxygen if sats are <95%

Maintain blood glucose of 4-11

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12
Q

How do you manage a confirmed ischaemic stroke?

A

Oral aspirin

Thrombolysis with alteplase

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13
Q

What is alteplase & how does it work?

A

Fibrinolytic: activates plasminogen to degrade fibrin & break up thrombus

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14
Q

How is alteplase delivered?

A

IV injection

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15
Q

What is the target time for thrombolysis with alteplase?

A

Within 4.5 hours of stroke onset

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16
Q

What dose of aspirin should be given?

A

150-300mg

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17
Q

How long post-stroke should aspirin be continued?

A

For 2 weeks, before long-term anti-thrombotic treatment is commenced

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18
Q

What can be given if patient is allergic to aspirin?

A

Clopidogrel

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19
Q

What is the indication for thrombectomy

A

Confirmed occlusion in the proximal anterior circulation

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20
Q

What is the immediate management of haemorrhagic stroke?

A

If on an anticoagulant, consider administering a reversal agent
e.g. Vitamin K (takes 4 hours to work)
Or OCTUPLEX (works in 30 minutes)

21
Q

What are the ABCDE for secondary prevention of stroke?

A 
A - antiplatelet (clopidogrel)
B - blood pressure control
C - cholesterol control (statin)
D - diet
E - exercise
22
Q

What common side effects can people get from statins?

A

Headache

GI upset

23
Q

Do ischaemic stroked always show up on CT?

A

No, <50% don’t show up

24
Q

Cushing’s triad is a late sign of raised ICP. What is cushing’s triad?

A

HTN
Bradycardia
Altered respiratory rate (cheyne stokes)

25
Q

What further test should be carried out if ?SAH but CT head does not show blood?
What would you be looking for?

A

Lumbar puncture (12 hours post-onset)

Looking for xanthochromia (used to differentiate in vivo haemorrhage from traumatic LP)

26
Q

Why is lumbar puncture contraindicated in raised ICP?

A

Risk of coning

27
Q

What is the most common visual defect in stroke?

A

Homonymous hemianopia

28
Q

Which artery is most commonly affected in stroke?

Why is this?

A

MCA

Least resistance, big vessel, continuation of the internal carotid

29
Q

What are the 4 classifications of stroke in the Bamford classification?

A

TACS - total anterior circulation stroke
PACS - posterior anterior circulation syndrome
POCS - posterior circulation syndrome
LACS - Lacunar syndrome

30
Q

What are the 3 features of TACS?

A

unilateral weakness
Homonymous hemianopia
Higher cerebral dysfunction

31
Q

How is PACS classified?

A

2 of the features of TACS (homonymous hemianopia/ unilateral weakness/ higher cerebral dysfunction

32
Q

How is POCS classified?

A

One of:
Cerebellar or brainstem syndromes
Loss of consciousness
Isolated hemianopia

33
Q

What are the later signs of stroke on examination?

A

UMN signs: hypertonia, hyper-refleia, flexed arm & extended leg, clonus

34
Q

What is the ROSIER score?

A

Recognition of stroke in the emergency room score
Score >0: investigate for stroke
There are also negative scores

35
Q

What scale can be used to grade stroke severity?

A

NIHSS (national institute of health stroke scale)

36
Q

What are the 3 ways to treat an acute ischaemic stroke?

A

Aspirin
Thrombolysis
Thrombectomy

37
Q

When would aspirin be indicated over thrombolysis?

A

If INR is too high/ more than 4.5 hours post-CVA

38
Q

How is alteplase delivered?

A

IV

10% given as a bolus, then the rest IV over 1 hour

39
Q

What does systolic BP need to be under for thrombolysis?

A

Systolic BP <185

40
Q

Give 3 complications of thrombolysis

A

Bleeding (haemorrhagic transformation)
Anaphylaxis
Hypotension

41
Q

When is thrombectomy indicated?

A

Proximal anterior circulation clot

42
Q

How soon should thrombectomy be done?

A

Within 6 hours of stroke onset

43
Q

How soon after the stroke should patients be switched to clopidogrel?

A

after 2 weeks

44
Q

What should you consider as a cause in younger patients? (e.g. 18 y/o with a DVT)

A

VSD (ventricular septal defect)

45
Q

Following TIA, who should be seen by a specialist?

A

Everyone

46
Q

What is the management of TIA?

A

Aspirin 300mg

Refer for assessment in 24 hours in TIA clinic

47
Q

What is used for secondary prevention of TIA?

A

Clopidogrel, 75mg once daily

48
Q

How can you differentiate between an UMN lesion and Bell’s palsy (LMN)?

A

Forehead sparing in UMN lesion

In Bell’s palsy the whole half of the face is affected

Long-term Conditions (21 decks)

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