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CARD - 1 > Stroke Treatment > Flashcards

Stroke Treatment Flashcards

1
Q

Why are stroke units important?

A

Well established evidence that patients do better 10 years after their admission.

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2
Q

Why is it important to mobilise the patient ASAP?

A

The probability of returning home decreases 20% for each day the patient is not mobilised.

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3
Q

What are the modifiable risk factors for stroke?

A

High BP, atrial fibrilliation (common in population over 70) - L atrium dilated and not contracting properly so easy for bits to break off (emboli), cocaine use and diabetes.

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4
Q

What are the non-modifiable risk factors for stroke?

A

Age, race (far asian more at risk of intracerebral stenosis), family history.

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5
Q

What is stroke prevalence like in the genders?

A

Better in woman until after menopause (most men die of other causes after 70 where more strokes in woman than men).

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6
Q

What investigations would you do on a suspected stroke patient?

A

Blood tests - full blood count (platelets, red cells), lipids, ESR - making blood too thick?
ECG/ 24 hr ECG

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7
Q

What imaging may be useful in diagnosing a stroke?

A

Most patients will get a CT scan
Some get MRI
Carotid doppler to look at vessels for atheroma or dissection
Sometimes an echocargiogram (US of heart) can be helpful to look for clots in the heart

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8
Q

Discuss CT vs MRI.

A 
CT (uses Xray) - quick, shows up blood
MRI scan (uses magnet) - takes 30 mins, claustrophobic, shows up ischaemic stroke better than CT does
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9
Q

If you are wanting to know if it is an ischaemic stroke or haemorrhage what is the best imaging technique to use?

A

MRI.

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10
Q

What is the NIHSS?

A

A measure of the severity of stroke going from 0-32. 0 is a very mild stroke and 32 is the patient is barely alive.

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11
Q

How often to strokes happen in the UK?

A

152,000 strokes in the UK per year.
One every 5 mins.
Some people will cope very well and others (20%) die.

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12
Q

How much does stroke cost the UK per year?

A

ten billion pounds.

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13
Q

What kinds of things do you want to concentrate on helping patients do (to mobilise)?

A

Swallowing, positioning etc - prevent patient developing an aspiration pneumonia.

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14
Q

How many stroke patients will have swallowing problems and how do you deal with this?

A

50%

Concentrating on expertise and using specialists working together, e.g. physio and speech therapists.

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15
Q

How would you treat thrombolysis?

A

Give thrombolytic agents or removal of clot to restore area of infarction.

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16
Q

Why is time brain?

A

Every minute in which a large vessel ischaemic stroke is untreated the average patient loses 1.9 mil neurones, 13.8 bill synapses, 12km axonal fibres.

17
Q

What is the aim of thrombolytic agents or therapy?

A

To restore perfusion before cell necrosis occurs.

18
Q

How can you harm someone with a stroke?

A

Altepase - fibrinolytic agent.
Cause unexpected bleeding in the brain if tissue has established bleeding.
If brain tissue already dead not going to help supplying blood.
Bleeding else where e.g. GI tract.

19
Q

What are the risk factors for haemorrhage after thrombolysis?

A

Infarct size, vessel occlusion, diabetes, BP, age, stroke severity, tissue changes and anti platelets (aspirin/clopidogrel).

20
Q

Should streptokinase be used for the patients in the treatment of acute phase stroke?

A

No, increased risk of bleeding, and anaphylaxis because produced by mycobacterium.

21
Q

After how many hours is it not worthing giving thrombolysis as the risk of haemorrhage outweigh the benefits?

A

4 and half.

22
Q

After how many hours is it not worthing giving alteplast as the risk of haemorrhage outweigh the benefits?

A

4 and half.

23
Q

What are the practicalities of FAST treatment?

A 
Stroke symptom recognition
Calling for help
Altering hospital team 
Alterting CT/radiology team 
Keeping the patients/relatives informed
24
Q

What is FAST?

A 
Symptoms of stroke, advertised
Face - falling to one side
Arms - can't raise above head
Speech - dysathria, dysphasia 
Time - time is brain
25
Q

Describe the process of clot retrieval?

A

Go in with catheter into groin on brachial and use a net to stop the clot going further up to the brain and then suck the clot into the tube.

26
Q

What were some initial problems with clot retrieval?

A

Tearing of BVs.

27
Q

In large vessel occlusion stroke what is the most effective treatment?

A

IVT and thromboectomy together if possible.

28
Q

How many TIA patients will have another event in the next month?

A

7%.

29
Q

What is given to patients for secondary prevention?

A

75mg clopidogrel or 75mg aspirin +dipyridamole MR 200mg bd
Statin
BP drugs even if BP normal

30
Q

What is malignant MCA infarction and how is it treated?

A

Malignant MCA territory infarction most devastating form of stroke. Death or neurological devastating result from progressive swelling of infarct, brain tissue shifts and compartmentalised increase in the intracranial pressure.

In under 60s, mortality reduced to 27% by completing hemicraniectomy.

31
Q

What is a transient ischaemic attack?

A

Aetiology no different from definite stroke.
It’s a warning or ministroke with stroke like symptoms persisting less than 24 hours that clears without residual disability. Prompt evaluation needed.

32
Q

Which, of stroke and TIA, is more likely to have a recurrent stroke?

A

Identical risk for early recurrent stroke - up to 14% within the first 2 weeks.

33
Q

What are the chances of someone who’s had a TIA having an acute stroke in the future?

A

1/3.

34
Q

Why is important to treat a TIA or minor stroke rapidly?

A

Early treatment reduces risk of recurrent stroke.
TIAs and minor strokes should be considered as medical emergencies.
Early initiation of preventative treatment can reduce the risk of early recurrent stroke by 80%.

35
Q

Who should hemicraniectomy be offered to?

A

For individuals aged up to 60 years who suffer an acute MCA territory ischaemic stroke complicated by massive cerebral oedema, surgical decompression by hemicraniectomy should be offered within 48 hours of stroke onset.

36
Q

What is a hemicraniectomy?

A

Removal of part of the skull.

37
Q

What are some current contraindications for thromboylsis?

A

Age - only under 80s (stroke outcomes worse in over 80s anyway)
Recent bleeding, very high BP.

38
Q

What is key to remember when treating with alteplase?

A

It is time dependent and so critical to minimise start of time till treatment.

39
Q

What is alteplase?

A

Aka. tissue plasminogen activator - serine protease involved in breakdown of blood clots. Converts plasminogen to plasmin which breaks down clots.

CARD - 1 (28 decks)

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