Strokes Flashcards
What are the types of stroke?
Ischaemic
Haemorrhage
What can blood supply be disrupted by>
Thrombus
Atherosclerosis
Shock
Vasculitis
What is the presentation of a stroke?
Sudden onset of neurological symptoms
Asymmetrical
-limb weakness
-facial weakness
-dysphasia
-visual field defects
-sensory loss
-ataxia and vertigo
What are risk factors for stroke?
Prev stroke or TIA
AF
Carotid artery stenosis
Hypertension
Diabetes
Increased cholesterol
FH
Smoking
Obesity
Vasculaitis
Thrombophilia
Combined contraceptive pill
What is the FAST tool?
Face
Arm
Speech
Time
What is a TIA?
Temporary neurological dysfunction
Ischaemia without infarction
Rapid onset but may resolve quickly
May precede stroke
What is a crescendo TIA?
2 or more TIAs within a week and indicate high risk of stroke
What is the management of TIA?
Aspirin 300mg daily
Refer to specialist within 24 hrs
Diffusion weighted MRI scan is imaging investigation of choice
What is the initial management of a stroke?
Exclude hypoglycaemia
Immediate CT brain to exclude haemorrhage
Aspirin 300mg daily for 2 weeks
Admit to specialist stroke centre
What is considered once a haemorrhage is excluded?
Thromolysis with alteplase
What is thrombolysis?
Tissue plasminogen activator that rapidly breaks down clots
When should thrombolysis be given?
Within 4.5 hrs of symptom onset
What does thrombolysis require?
Close monitoring for complication
When is thrombectomy considered?
In patients with confirmed blockage in the proximal anterior or posterior circulation
When should thrombectomy be used?
Within 24 hrs of symptoms alongside IV thrombolysis
When is BP treatment indicated?
In hypertensive emergency to reduce risk in thrombolysis
In haemorrhagic stroke
How are strokes assessed?
Assess for underlying cause
What are causes of strokes?
Carotid artery stenosis
AF
what is used to investigate stroke causes?
Carotid imaging
ECG
What should be initiated in AF?
Anticoagulation
What should be considered in carotid artery stenosis?
Surgery:
- carotid endartectomy
-angioplasty and stenting
What is secondary prevention in strokes?
Clopidogrel 75mg once daily
Atorvastatin 20-80mg
Bp and diabetes control
Address modifiable factors
