Week 1 Clinical Relevance Flashcards
What is ambulatory blood pressure monitoring?
Ambulatory Blood Pressure Monitoring (ABPM) is when your blood pressure is measured as you move around, living your normal daily life. It is measured for up to 24 hours. A small digital blood pressure monitor is attached to a belt around your waist and connected to a cuff around your upper arm. ABPM isn’t indicated in the acute phase of a cerebrovascular accident.
CT head was performed. Figure 1 is an unenhanced CT image at the level of the bodies of the lateral ventricles. Match the labels 1-4 with the correct responses.
1) Left frontal bone
2) left lateral ventricle
3)left centrum semiovale
4) left frontal bone
5) Left sulcus
What is the diagnosis?
There is a large area of low attenuation in the right cerebral hemisphere within the middle cerebral artery territory indicating cerebral infarction.
So this is a middle cerebral artery infarct or PACS.
How do paradoxical emboli occur?
Thrombotic infarcts are most common overall.
Paradoxical emboli occur when thrombus in the venous system or right side of the heart enter the arterial circulation usually through a patent foramen ovale and cause infarction in the distal arterial circulation.
What is a stroke unit?
Stroke unit is a discrete area within the hospital that is staffed by specialist MDT with access to monitoring and rehabilitation equipment. There will also be a regular MDT for goal setting.
Brain cell death can occur due to…….
1) Blockage (ischaemia)
2) Bleeding (haemorrhage)
What is the risk stratification score for TIA cases?
The ABCD2 score.
How can we treat TIAs to reduce the risk of strokes? (pt presenting early)
If pt presents early within 24hrs:
Immediate aspirin 300mg stat, then 75mg OD.
Clopidogrel 300mg stat, then also 75mg OD for 2 weeks.
PPI cover also recommended.
Specialist assessment to be done in 24hr symptom onset.
Secondary prevention as soon as diagnosis is confirmed.
Carotid duplex scanning in anterior circulation events and carotid endarterectomy if significant carotid artery stenosed by 50%.
If pt presents late (in excess of a week) what is the treatment for suspected TIA case to prevent Stroke?
Specialist assessment ASAP.
MRI Imaging is the mode of choice to exclude haemorrhage.
Immediately initiate clopidogrel too.
Secondary prevention as soon as diagnosis is made too.
All should receive secondary preventative advice like lifestyle modification, smoking cessation, BP management and lipid controls.
what is the relation between systolic BP and the RR of stroke?
High sys bp= higher RR of stroke
When is carotid endarterectomy suggested?
As early as possible for symptomatic stenosis where the artery has stenosed by 50% or more.
Outline the ASPECTS Score for early ischaemic stroke imaging and describe the score results and meaning.
scored out of 10, score of 10 is normal, no CT evidence of acute ischaemic stroke. if score is below 7, there is a risk of sPICH after thrombolysis.
What is thrombolysis?
Thrombolytic therapy (also called thrombolysis) is the use of medications to dissolve blood clots. Thrombolysis reduces damage to your body’s organs and tissues when there are clots by improving blood flow.
You may need thrombolytic therapy:
If a blood clot suddenly blocks a major vein or artery.
If blood-thinning medications (anticoagulants) haven’t reduced blood clots related to DVT, pulmonary embolism (PE) or PAD.
What are the contraindicated population who cannot have thrombolysis?
Healthcare providers don’t recommend thrombolytic therapy if you have conditions related to an increased risk of bleeding, such as:
Active bleeding.
Recent brain bleed/hemorrhage (intracranial hemorrhage).
Recent brain surgery or spine surgery.
Severe high blood pressure (hypertension).
Severe kidney disease.
Recent traumatic brain injury.
People who are pregnant or elderly also have an increased risk of complications.
Outline the three types of thrombolysis?
Systemic thrombolysis: An IV line that delivers medication into your bloodstream. Often used as an emergency procedure for conditions such as heart attack, PE and stroke.
Catheter-directed thrombolysis: A long catheter that brings medication directly to the blood clot. Often used as a scheduled procedure to treat DVT and PAD.
Mechanical thrombectomy: A long catheter with a rotating or ultrasound device, suction cup or fluid jet at the end that breaks up or suctions the clot. Sometimes used along with catheter-directed thrombolysis.
Outline the process of IV guided or systemic thrombolysis.
Your provider will usually deliver systemic thrombolytic therapy through an IV line in an intensive care unit (ICU). Your surgical team:
Gives you a sedative to relax you.
Uses a local anesthetic to numb the area for the IV.
Inserts the IV line into a vein in your arm. The thrombolytic medication travels through your bloodstream until it reaches the blood clot.
Removes the IV after the procedure and the incision is closed with a sterile plug.
The procedure usually takes about one hour.
What is ischaemic penumbra?
Ischaemic penumbra denotes the part of an acute ischaemic stroke that is at risk of progressing to infarction but is still salvageable if reperfused. It is usually located around an infarct core which represents the tissue which has already infarcted or is going to infarct regardless of reperfusion.
The primary aim of current acute stroke intervention is to prevent the penumbra from proceeding to established infarct.
What is the risk stratification score used in assessing for TIAs?
