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OPIC > Stroke - WB > Flashcards

Stroke - WB Flashcards

1
Q

What is ABCD2 tool?

A
  • Estimates the risk of stroke after a suspected transient ischemic attack (TIA)
  • Includes factors such as age, BP, clinical features of TIA, duration and history of diabetes
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2
Q

CHAD2DS2VASc score

A
  • Score for AF stroke risk
  • Score of 2 or more = anticoagulate
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3
Q

HASBLED score

A
  • Estimates major risk of bleeding for patients on anticoagulants for AF within 1yr
  • Weighs up risk vs benefit
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4
Q

NIHSS score

A

Severity of stroke. Includes:
* Alertness
* Ability to answer age and current month
* Can blink eyes and squeeze hands
* Visual field defect?
* Facial palsy?
* Motor of arms and legs
* Ataxia
* Sensation changes

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5
Q

Key questions to answer when assessing ?stroke patient

A
  • Is it a stroke?
  • What caused it?
  • Complications? Any likely?
  • Treatment needed and when?
  • How well is outcome likely to be?
  • When can they safely leave acute care?
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6
Q

What causes stroke symptoms?

A
  • Dysfunction of neurovascular unit - relationship between neurones, glial cells and endothelial lumens
  • Hypoperfusion –> reduced ATP –> no energy for cell for membrane transport –> no AP’s
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7
Q

Stroke syndrome features

A
  • Sudden onset
  • Focal
  • Predominantly negative - loss of function
  • Fit into vascular territory
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8
Q

What suggests stroke is NOT the cause?

A
  • Isolated presentation feature (eg vertigo)
  • Migration - of symptoms, slow
  • Sterotyping - repeated episodes previously of same thing over weeks (could be intracranial stenosis or capsular warning syndrome though)
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9
Q

Unknown cause of stroke name

A

Cryptogenic

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10
Q

Typical cause of PACS presentation

A

Embolisation from cardiac emboli (eg in AF, valvular heart disease, HF, endocarditis)

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11
Q

Large vessel emboli typical cause

A

Carotid atheroma emboli
Peripheral vascular disease

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12
Q

LACS typical cause

A

Fibrinolytic necrosis if hypertensive/diabetic (endothelial damage and blockage)

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13
Q

TOAST criteria

A

Classification of ischaemic stroke causes

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14
Q

Classification of haemorrhagic strokes

A
  • Central/deep vs lobar
  • Central/deep are typically primary due to HTN
  • Lobar tend to be secondary - inc vascular anomalies, mass, cerebral amyloid angiopathy
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15
Q

Complications/likely complications of stroke

A
  • Premature death - often due to post stroke complications
  • Recurrent stroke and extension of stroke - extension due to loss of ischaemic penumbra (still viable but then dies), recurrent due to not addressing cause/RF
  • Raised ICP - haematoma expansion, malignant oedema, haemorrhagic transformation, hydrocephalus
  • Infections - aspiration pneumonia, UTI
  • Immbolity complications - VTE, constipation, pressure sores
  • Mood and cognitive function - affect rehab
  • Post stroke pain/fatigue - spasticity, neuropathic pain, poor sleep, brain damage
  • Spasticity, contractures, secondary epilepsy
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16
Q

Preventing post-stroke complications

A
  • Routine NEWS
  • Observations
  • Mood
  • Bowel and urine function
  • Reviewing stroke impairments
  • Sleep
  • Legs/calves review ?DVT
  • Monitoring bloods
17
Q

Contents of stroke bundle

A
  • Admit to stroke unit
  • Revascularisation
  • Optimise physiology (surveillance, prevention, early intervention of complications and nutrition support)
  • Secondary prevention
  • Rehab and reablement
18
Q

How well will a patient recover?

A
  • Prognosis can be derived from NIHSS and OCSP class
  • Functional prognosis best informed by recovery trajectory - will continue until a patient reaches functional plateau
19
Q

Functional plateau groups

A
  • Early, high functioning plateau - extreme version of this is TIA/minor stroke, excellent functional prognosis
  • Early, low functioning plateau - TACS with no meaningful improvement as time passes, poor proognisis
  • Delayed and medium functioning plateau - define recovery in most moderate strokes, benefit from change at sustained rehab efforts until plateau occurs
20
Q

driving post stroke

A
  • 4 week restriction for cars
  • 1 year for HGV licenses
  • Residual VF defects are seperate requierments
  • If persistent/residual disbaility - refer to regional driving assessment centres to allow car modifcation and allow resumption
21
Q

When is decompresisve hemicraniectomy done?

A
  • Malignant oedema in under 60s
  • Can be considered if biologically fit and older than this
  • Neurosurgical units manage
22
Q

IC haemorrhage main concern

A
  • Raised ICP
  • Can be from haematoma expansion or hydrocephalus
  • Blood pressure control and correct clotting abnormalities necessary
  • Evac haematoma and ventricular drains can be used
23
Q

Investigations prior to anticoagulation for AF, thrombophilis, venous sinus thrombosis

A
  • ECG
  • MRV/CTV
  • 24hr BP
  • Echo
  • Thrombophilia screen
24
Q

Carotid endarterectomy - when?

*

A
  • Management of symptomatic carotid disease - after TIA with good recovery of more than 50% lumen reduction (NASCET) on carotid USS
  • Need good BP control <130/80, high dose statin, DAPT before surgery
  • = plaque stabilisation
25
Q

Left atrial appendage closure - when?

A
  • Option for secondary prevention of stroke in those with AF who cannot have anticoagulation
26
Q

NG/PEG feeding for stroke patients - when?

A
  • Temporary measure for when unsafe swallow currently
  • Assess swallow with flexible endoscopic evaluation of swallowing (FEES) and video fluroscopy
  • Not to be used to prolong suffering at end of life
27
Q

Palliation options post stroke

A
  • Address pain
  • Mouth care
  • Tube and IV feeding not appropriate - feed orally for pleasure (feed at risk)
28
Q

ASPECT score

A
  • Alberta stroke program early CT score
  • 10 point CT scan score used in patients with MCA stroke
  • Segmental assessment of MCA territory is made, 1 point deducted from initial score of 10 for every region involved - 0 = diffuse involvement
  • Used in revasculiration for patient selection and outcome prediction
29
Q

Modified rankin scale

A
  • Global disability used to assess baseline function, evaluate outcomes and treatment impact after interventions
  • 0-6
  • 0 = no symptoms
  • 6 = dead
30
Q

ROSIER scale

A

Differentiate between stroke and stroke mimic in hopsital

31
Q

Stroke mimic - 3 types

A
  • Visible on brain imaging (MS, subdural haematoma, SOL etc)
  • Distinct non-stroke syndrome features - BPPV, vestibular neuronitis, syncope syndrome, transient global amnesia (sudden temp loss of short term memory)
  • Specialist assessment often needed - migraine with aura, focal seizures, functional syndrome (EEG and MRI needed)
32
Q

What is apparent neurological deficit?

A
  • Neurological dysfunction in patients with chronic stroke but good recovery
  • Residual areas of scar tissue at site of previous damage
  • Symptoms can return due to underperfomance of glial tissue in scenarios (eg in infections, low BP, low glucose, fatigue)
  • Correction of underlying stressor –> return to baseline
33
Q

Features of early stroke on CT scan

A
  • Effacement of ventricles
  • Loss of grey/white matter differentiation
  • Increased density of relevent BV - clotted blood
34
Q

Hypertensive ICH location

A
  • DEEP
  • Eg in basal ganglia/cerebellum
35
Q
A

OPIC (30 decks)

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