Treatment and Prevention of Stroke Flashcards
What needs to be thought of when diagnosing stroke?
Has a stroke occurred?
What type of stroke has occurred?
How severe is the stroke?
Can it be treated?
What is the underlying cause?
What to look out for when taking a history
Have these sort of symptoms happened before?
Do they have any other conditions?
Try and locate the blood vessel affected by assessing symptoms
What is the first test to do for a suspected stroke?
CT scan
Why would you do a CT scan?
To rule out a haemorrhage
What do you do if the CT scan suggests there is no haemorrhage?
Treat the stroke as ischaemic
Why can’t the CT scan confirm if it is a ischaemic stroke?
The brain injury from an ischaemic stroke cannot be picked up until at least half a day after the stroke has happened
Can a CT scan identify a haemorrhage?
Yes a bleed is easily identifiable on a CT scan
What test can confirm an ischaemic stroke?
MRI
As it looks at blood flow within the brain
What is the ischaemic core?
The area closes to the artery that has been blocked off
<20% blood flow to this area
Neuronal cell death - necrosis happens within minutes
Very difficult to treat
What is the ischaemic penumbra?
Region surrounding the ischaemic core
Some blood supply from the nearby arteries
Injury can be reversed if blood supply is repaired
Without treatment, cells die within hours
As time goes on, what happens to the core injury?
It continues to expand and therefore has a bigger effect
Treatment of ischaemic stroke
Given aspirin to prevent any further blood clots
Given tissue plasminogen activator
Surgical treatment may be considered if the thrombolytic doesn’t work
- MERCI Retreiver
- Suction removal
Tissue Plasminogen Activator (TIA)
Activates a compound in the blood called plasminogen
Once activated this is converted to plasmin
Plasmin breaks down the blood clot
When is TIA effective?
Within 3-4 hours of the stroke
Limitations of TIA
Limited therapeutic time window
Risk of haemorrhage
- Can be fatal
Need to consider other health issues/medications before use
MERCI Retriever
Mechanical Embolus Removal in Cerebral Ischemia
Insert a wire into the artery
Wire has a blue sheath which is retracted to reveal the wire
The wire coils up and the blood clot can be removed
Suction removal
Surgeon inserts a tube into the artery
The tube has a wire in it which is used to poke the clot
Suction is then used to suck up the broken-up bits of clot
Treatments of haemorrhagic stroke
Management of symptoms before considering surgical options
Goal is to reduce blood flow in the brain
Given antihypertensives to reduce blood pressure
Surgical options
- Aneurysm clipping
- Coil embolisation
Aneurysm clipping
Clip down the aneurysm to stop blood flow leaking out
Coil embolisation
Insert tube with a wire into the artery wall
Continue to push the wire until it fills up the aneurysm space
Eventually clots up and stops the bleed
Non-modifiable risk factors of stroke
Age
Gender
Ethnicity
Family history
How does age affect your risk of stroke?
The older you are the more at risk you are
Arteries become less flexible as you age and may weaken
Weakening can cause bleeding in the brain
Arteries also stiffen as you age which can cause clots
How does gender affect your risk of stroke?
Women prior to menopause have less chance of having a stroke due to protective feature of progesterone
After the menopause men and women become equally likely to suffer from a stroke, due to a post-menopausal drop in progesterone
As women live longer than men, they actually have a higher lifetime risk of stroke than men
How does ethnicity affect your risk of stroke?
Ethnic minorities are at a greater risk of stroke
This could be due to lifestyle factors which lead to hypertension and diabetes and are more common in ethnic minorities
