Stroke (zero to finals) Flashcards
What is another name for a stroke?
Cerebrovascular accident
What are the 2 types of cerebrovascular accident?
Ischaemia or infarction of the brain tissue secondary to a disrupted blood supply (ischaemic stroke) = around 85% of cases
Intracranial haemorrhage, with bleeding in or around the brain (haemorrhagic stroke) = around 15% of cases
What is ischaemia and infarction?
Ischaemia refers to an inadequate blood supply.
Infarction refers to tissue death due to ischaemia.
What can blood supply to the brain be affected by?
A thrombus or embolus
Atherosclerosis
Shock
Vasculitis
What is a transient ischaemic attack?
Involves temporary neurological dysfunction (lasting less than 24 hours) caused by ischaemia but without infarction.
What is a typical symptom of TIA?
Symptoms have a rapid onset and often resolve before the patient is seen.
TIA’s may precede a stroke. True/false?
True
What are crescendo TIA’s?
Two or more TIAs within a week and indicate a high risk of stroke.
Typical onset and pattern for stroke symptoms?
A sudden onset of neurological symptoms suggests a vascular cause (e.g., stroke).
Stroke symptoms are typically asymmetrical.
Typical presentation of stroke?
Limb weakness
Facial weakness
Dysphasia (speech disturbance)
Visual field defects
Sensory loss
Ataxia and vertigo (posterior circulation infarction)
Risk factors for stroke?
Previous stroke or TIA
Atrial fibrillation
Carotid artery stenosis
Hypertension
Diabetes
Raised cholesterol
Family history
Smoking
Obesity
Vasculitis
Thrombophilia (abnormal tendency to develop blood clots)
Combined contraceptive pill
COCP carries an increased risk of stroke. True/false?
True
The combined contraceptive pill carries a tiny increased risk of stroke.
The risk is higher in patients with migraines with aura, smokers over 34 years or those with a history of stroke or TIA.
With COCP there is an increased risk of stroke. What specific factors can further heighten the risk of stroke with COCP?
Migraine with aura
Smokers over 34 years of age
Those with a history of stroke or TIA
Those with a history of VTE (venous thromboembolism)
What tool can help to identify stroke within the community?
FAST tool
Face
Arm
Speech
Time (act fast and call 999)
What is the initial management of TIA?
Symptoms should have completely resolved within 24 hours of onset. Initial management involves:
- Aspirin 300mg daily (started immediately)
- Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)
- Diffusion-weighted MRI scan is the imaging investigation of choice.
What is the initial management of stroke?
- Exclude hypoglycaemia
- Immediate CT brain to exclude haemorrhage
- Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
- Admission to a specialist stroke centre
When is thrombectomy used?
Considered in patients with a confirmed blockage of the proximal anterior circulation or proximal posterior circulation.
It may be considered within 24 hours of the symptom onset and alongside IV thrombolysis.
In ischaemic stroke, lowering blood pressure is considered always. True/false?
False
Lowering the blood pressure can worsen the ischaemia.
High blood pressure treatment is only indicated in hypertensive emergency or to reduce the risks when giving intravenous thrombolysis.
Blood pressure is aggressively treated in patients with a haemorrhagic stroke.
Blood pressure is aggressively treated in patients with a haemorrhagic stroke. True/false?
True
Treated aggressively in haemorrhagic stroke.
Only treated with in ischaemic stroke when there is a hypertensive emergency or to reduce the risks when giving IV thrombolysis.
What underlying issues are patients with TIA or stroke checked for?
Investigated for carotid artery stenosis and atrial fibrillation
Top risk factors for TIA and stroke and how are these investigated for?
Carotid artery stenosis and atrial fibrillation
All patients with a TIA or stroke will have carotid imaging and ECGs to identify these.
Secondary prevention of stroke and TIA?
Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole)
Atorvastatin 20-80mg (not started immediately – usually delayed at least 48 hours)
Blood pressure and diabetes control
Addressing modifiable risk factors (e.g., smoking, obesity and exercise)
