10.1 Strokes Flashcards
Define a Thrombus
A blood clot formed in situ within the vasculature impeding blood flow
Define an Embolus
Blood clots, fatty deposit or air bubble carried in the blood stream that lodges in a vessel
Define an Infarct
Area of dead tissue resulting from disrupted blood supply
Define a Haemorrhage and state the 3 types
Escape of blood from a ruptured vessel
- Primary – no structural anomaly
- Secondary – aneurysm, vascular malformation or tumour
- Haemorrhagic transformation of an infarction
Define a Transient Ischaemic Attack (TIA)
Focal CNS disturbances caused by vascular events that last <24hrs and with no lasting deficit
Define a stroke
A syndrome of rapidly developing clinical signs of disturbance of brain function, lasting >24hrs and with no apparent cause other than that of vascular origin
What is the key difference between a TIA and stroke
TIA <24hrs
Stroke >24hrs
Where are TIAs most common and give 3 common symptoms
90% in the carotid artery territory
- Motor and/or sensory disturbance
- Visual disturbance
- Amaurosis fugax
List 4 presenations of a TIA in the vertebral arteries
Vertigo, diplopia, dysarthria, limb weakness
Give 2 signs of a stroke on examination (CVS related)
Atrial Fibrillation and carotid bruit
Give 4 Investigations used to diagnose a TIA
Blood tests – FBC, ESR, CRP, BM,
CXR
ECG +/- 24hr tape
Transoesophageal echo
Carotid angiography/USS
CT or MRI brain
What is ABCD2 and how do we calculate this?
Estimates the risk of stroke after a suspected transient ischemic attack
Each + in a catagory = points
Give the catagories ABCD2 and how many points each is
Age >60years = 1 point
BP>140/>90=1point
Clinical features
- any weakness = 2 points
- no weakness but speech disturbance = 1 point
Duration
- 60mins+ = 2 points
- 10-59mins = 1 point
- <10mins = 0 points
Diabetic = 1 point
List the risk for stroke for the following ABCD2 scores:
- 0-3
- 4-5
- 6-7
- 0-3 = 1% LOW risk
- 4-5 = 4%
- 6-7 = 8% HIGH risk
What define LOW vs HIGH risk for a stroke after a TIA
Low risk = score 1-3 (or over a week since symptoms)
High risk = score 4+ (or crescendo = 2 in a week or AF or already on anticoagulation)
List 3 ways we manage a patient who is ‘low risk’ for a stroke
1) Aspirin 300mg daily
2) Specialist assessment within a week
3) Address risk factors immediately
List 2 ways we manage a patient who is ‘high risk’ for a stroke
1) Aspirin 300mg daily
2) Specialist assessment within 24hrs
* neuroimaging, carotid imaging, ECG, ECHO,
What is a non-disabling stroke
MRI evidence of a stroke but no permanent damage
Give 3 types of strokes in order of how common each is
1) Infarct – 85%
- 50% thrombotic
- 35% embolic
2) Haemorrhagic – 10%
3) SAH–5%
Give the MAIN clinical feature of a stroke + 4 others
Main: Sudden onset neurological deficit +
Hemiparesis, homonymous hemianopia, sensory loss, dysphasia, right hemisphere (neglect of contralateral limbs), constructional apraxia, face involvement, clumsiness, confusion, difficulty walking
Give 4 acute managements for a stroke
1) ABCDEFG
2) CT brain (acute infarcts not visible in the acute phase)
3) Thrombolysis within 4.5hours
4) Clot retrieval
5) Swallow protection - NBM
Give 4 ongoing management strategies for a stroke
1) admission to specialist stroke units
2) medication: aspirin 300mg daily for 2 weeks then 75mg daily
3) speech and language assessment (SALT)
4) nutrition
5) blood pressure (only if hypertensive emergency)
6) blood sugar
7) aim for stable BM control
8) oxygen (only if sats <95%)
Give 4 long-term management strategies
1) physiotherapy: early mobilisation reduces depression, muscle wasting and pneumonia
2) occupational therapists: help with mobility and care in the home/community
3) carotid endarterectomy
4) modification of risk factors
Give 4 modifiable risk factors for stroke
HTN, smoking, AF, diet, ETOH, BMI, physical exercise, cholesterol
