Stroke Week Flashcards
If we’re considering thrombolysis for a stroke patient, what are 3 things we need to have?
- Imaging
- <4.5 hours after onset
- No contraindications
What are the 4 different types of stroke in the oxford stroke classification and what are the clinical features of each?
Total Anterior Circulation Stroke - TACs
Occlusion of a large cerebral artery (Internal carotid or middle cerebral)
All three of:
- Hemiplegia contralateral to the cerebral lesion, usually with ipsilateral hemi sensory loss
- Hemianopia Contralateral to cerebral lesion
- New disturbance of higher cerebral function (aphasia, visuospatial problems - neglect)
Lacunar Stroke - LACs
Occlusion of a single deep perforating artery
High recurrence rate and often missed
Pure motor loss, OR pure sensory loss, OR ataxic hemiparesis i.e. a single deficit
Partial Anterior Circulation Stroke - PACs
Occlusion of a branch of the middle cerebral artery
High recurrence rate
Diagnosis requires 2 out of 3 TACS deficits, OR higher cerebral dysfunction alone, OR monoparesis, for example:
- Motor/sensory deficit + Hemianopia
- Motor/sensory deficit + new higher cerebral dysfunction - New higher cerebral dysfunction alone
Posterior Circulation Stroke - POCs
Occlusion of a posterior vessel (basilar/ vertebral/posterior cerebral) leading to cerebella/ brainstem/ occipital infarcts
Complex presentation due if brainstem involved due to decussation of various tracts e.g.
- Ipsilateral cranial nerve palsy (single/multiple) with contralateral motor and /or sensory deficit
- Disorders of conjugate eye movement (horizontal/vertical)
- Cerebellar dysfunction without ipsilateral long tract sign
- Isolated hemianopia or cortical blindness
What is the primary choice of imaging for a stroke patient? Why is this carried out?
CT head
- Rule out bleeding
- Rule out alternative diagnoses
- Assess suitability for reperfusion therapy
For patients with an acute ischaemic stroke who present within 6 hours of symptom onset are most likely to receive ‘reperfusion therapy’. What does this aim to achieve and how is it carried out?
Reperfusion therapy:
Aims:
- Unblock occluded artery
- Restore blood flow
How?:
- Intravenous thrombolysis- plasminogen activator
- +/- mechanical thrombectomy (interventional radiologist to visualise and pull out thrombus)
Thrombolysis= most effective within 3 hours but safe up to 6 hours
Out of those receiving thrombolysis for a stroke, how many make a complete recovery and how many improve compared to if they had not received it?
1 in 8= complete recovery
1 in 3= improve compared to if they had not received it
What % of stroke patients are usually eligible for thrombolysis?
15-20% of patients
What is the most serious risk when carrying out thrombolysis with a stroke?
Risk: Haemorrhage (1 in 20)
Mechanical thrombectomy can be used to treat strokes in patients with a clot in which arteries?
Larger blood vessels;
Internal carotid
Middle cerebral artery
Basilar artery
Can be used alongside thrombolysis or when it is contraindicated
For a mechanical thrombectomy following a stroke, what is the number needed to treat to have reduced disability?
Number needed to treat to reduce disability= 2.6 people
Can be of benefit up to 24hrs post symptom onset
What should a patient have to be considered for a referral for mechanical thrombectomy following a stroke?
- Onset < 6hours
- NIHSS (National Institutes of Health Stroke Scale) >4
- Large vessels occlusion on CT angiogram
What are the 3 main goals of the initial management of an intracerebral haemorrhage?
- Identify and reverse any coagulopathy
- Control BP (aim systolic <150mmHg)
- Consider neurosurgery in selected patients
What is a stroke?
Rapidly developing clinical syndrome
of
acute focal or global impairment of brain function
Lasting >24hours
Of vascular origin
For a TAC stroke, what is the mortality at 1 year?
Mortality at 1 year= 60%
What is the mortality rate for a PAC stroke at 1 year?
16% mortality at 1 year
State some of the modifiable and non-modifiable risk factors for strokes.
How is stroke severity graded? (Good for management choices and to review outcomes)
National institute of health stroke scale
List the members of a stroke multidisciplinary team.
Stroke physicians
Stroke nurse
OT
Social worker
Speech and Language therapist
Physio
Radiographer
Radiologist
HCAs
Dieticians
Stroke co-ordinators
What are some of the skills and behaviours required for shared decision making?
With relation to strokes, what does plasticity mean?
Plasticity= brains ability to reorganise neural pathways throughout experience
What questions should we be asking ourselves during the initial assessment of stroke patients?
What does the FAST acronym stand for with relation to strokes?
What are the mortality rates like for the 4 different types of strokes (oxford classification)?
What should be present for someone to qualify for intravenous thrombolysis? (only 20% of patients= eligible)
Clinical diagnosis of acute ischaemic stroke
causing 1+ of
- NIH 4+
- Aphasia
- Binocular visual field defect
- Swallowing deficit
- Imaging consistent with ischaemic stroke*
- Symptom onset within 4.5 hrs*
- Old benefit as much as young*
What does the following CT scan show?
Intracerebral haemorrhage
What is the management plan for patients that have had an intracerebral haemorrhage ?
Avoid:
- Surgery (if possible)
- Steroids
- Platelets
- VTE prophylaxis
- LMWH
- Compression stockings
- Aspirin
