Stroke |X Flashcards
What is the WHO definition of stroke?
A clinical syndrome, of presumed vascular origin, typified by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24 hours or leading to death
What are 2 causes of stroke? What % are they?
- Cerebral infarction - 80%
2. Cerebral haemorrage - 20%
What are 2 causes of cerebral bleeds?
- Intracranial haemorrhage
2. Sub-arachnoid haemorrhage
What are common risk factors for a cerebral infarction (5)?
What are 4 less common risk factors for a cerebral infarction?
Common
- Hypertension
- Atrial fibrillation
- Smoking
- Hypercholesterolaemia
- Diabetes
Less common
- Pro-thrombotic conditions
- Infective endocarditis
- Alcohol
- Intravenous drug use
What 4 lifestyle changes can you make to reduce the incidence of stroke?
- Good bp control
- Diabetes
- Hyperlipidaemia
- Stopping smoking
What are the ddx of a stroke?
- Subdural haematoma
- Epilepsy
- Hypoglycaemia
- Brain tumours
- Migraine
- Encephalitis
- Cerebral abscess
How do you differentiate between a subdural haematoma from a stroke (3)?
- Subdural haematoma usually more gradual onset with fluctuating s+s, drowsiness
- Often preceded by hx of trauma or blood thinning agents
- CT scan will make diagnosis
How do you differentiate epilepsy from a stroke (2)?
- Collateral history - Todd’s paresis can develop in those who have had a fit
- More rapid recovery (24 hours)
How do you differentiate hypoglycaemia from a stroke (1)?
Check BM
How do you differentiate brain tumours from a stroke (2)?
- Usually more insidious (days-weeks) with a stuttering or slowly progressive course
- CT scan shows tumour
How do you differentiate migraines from a stroke (2)?
- Migraine can occasionally cause transient weakness which rapidly improves
- Headache usually prominent feature
How do you differentiate encephalitis from a stroke (3)?
- May be an antecedent feature of infection
- Fitting and fluctuation are more common with encephalitis
- Electroencephalogram most useful
How do you differentiate cerebral abscess from a stroke (2)?
- Think cerebral abscess if infective features, longer prodrome, headache and reduced consciousness
- CT
What are the classic symptoms of stroke (6)?
- Speech disturbance
- Expressive/receptive dysphasia
- dysarthria - Other higher cortical dysfunction
- dysphagia
- parietal lobe signs - Limb weakness
- Sensory disturbance
- Visual impairment
- Brainstem symptoms
How fast is the onset of symptoms of stroke?
Abruptly, usually without warning
What is a transient ischaemic attack (TIA)?
A clinical syndrome characterised by an acute loss of focal cerebral or ocular function with symptoms lasting less than 24 hours (often only a few hours)
What is expressive dysphasia?
Understanding is preserved and the patient tries to convey meaningful responses to the questions asked. Reading and writing may be impaired, but understanding is intact.
What is receptive dysphasia?
Receptive dysphasia is due to a lesion in Wernicke’s area of the brain and results in the inability to understand language correctly.
What is dysarthria?
Dysarthria is motor disturbance of speech individuals know what they want to say, but cannot get the words out correctly, because of weakness to the tongue or facial muscles.
What are parietal lobe signs?
Sensory neglect - the patient has intact sensation when tested unilaterally but when confronted by bilateral stimuli, ignores the affected side
What are features of brainstem signs (3)?
- Cranial nerve palsies
- Cerebellar signs (ataxia)
- Locked-in syndrome
What are cerebellar signs (5)?
- Dysarthria
- Nystagmus
- Intention tremor
- Past pointing
- Broad based staggering gait
What is a commonly accepted method of classifying a stroke?
Oxford Stroke Classification
What are the classifications in the Oxford Stroke Classification?
*****8
- Lacunar (LACS)
- Motor or sensory deficit only - Partial anterior circulation (PACS)
- 2 of following: motor or sensory deficit; higher cortical dysfunction; hemianopia - Total anterior circulation (TACS)
All of: motor or sensory; cortical; hemianopia - Posterior circulation (POCS)
Isolated hemianopia; brain stem signs; cerebellar ataxia
Which type of stroke has the worst prognosis?
TACS
Roughly what % of people become dependent after a stroke?
30%
What is the mortality of stroke?
- TACS
- Others
- 60%
2. 10-20%
What is the acute investigation of a stroke?
- Checking stability of patient
- Diagnostic testing
Checking stability of patient
- BP, pulse
- BM
- O2 sats
- Temp
Diagnostic testing
- CT/MRI of brain
- ECG - AF
- Carotid US - detects stenosis
- Echocardiogram - detect thrombus in heart
- Bloods
- FBC, INR, lipid profile, U+E glucose, TFT/TSH, cholesterol - CXR
- Urine dip/MSU
What is the acute treatment of an ischaemic stroke?
Thrombolysis:
tPA (tissue plasminogen activator) - dissolves blood clots
What is the timeframe in which you need to start treating a stroke patient?
3 hours
-but to be evaluated and receive treatment, they need to be in hospital within 60 mins
In the medium term management of stroke, what medications do they need to be on?
- Aspirin 300mg for 2 weeks, then 75mg PO
- Paracetemol iv prn
- Metoclopromide iv prn
What is the non-pharmacological management of stroke in the medium term?
- IV fluids
- O2
- Dietician
- Physiotherapy
- OT
- Speech therapy and swallowing assessment
- Rehabilitation
- consultant determines what type of therapy is best for patient:
a. rehab unit
b. subacute rehab
c. extended care facility
d. home care with PT/OT
What does rehab following a stroke involve?
Planned programmes of specialist rehabilitation support and enable individuals to maximise their independence following an illness, accident or after hospital or care home admission.
What do care plans following discharge in a stroke patient involve (9)?
- Treatment and advice on pain control.
- Exercises to improve balance or muscle strength or joint movement - walking indoors, outdoors and
- Medication management.
- Promotion of a healthy lifestyle.
- Wound management
- Support to improve meal preparation, washing, dressing, doing housework and getting out and about.
- Ways to increase confidence in abilities.
- Continence management.
- Address any changes that are needed in the home environment.
What is the mneumonic to recognise stroke in the community?
F - acial weakness
A - rm weakness
S - peech problems
T - ime to call 999
