Strokes ☺️ Flashcards
Ischemic stroke
- types
- pathophysiology
- prevalence
- risk factors
Most common stroke TIA - U24hrs Ischemic stroke - 24hrs+ -thrombosis from large vessel -embolus often from AF Both block blood flow
Age HTN Smoking High lipids DM AF
Hemorrhagic stroke
- types
- pathophysiology
- risk factors
Intracerebral hemorrhage
Subarachnoid hemorrhage
Both lead to reduction in blood flow to brain
Age
HTN
AVM
AC use
Presentation
-what additional symptoms are more common in haemorrhagic stroke
RAPID FUNCTION LOSS
- unilateral motor/sensory loss with forehead sparing
- homonymous hemianopia
- swallowing problems
- balance problems
Decreased in LOC
Headache
N+V
Admission and key timeframes
ADMIT EVERYONE WITH SUSPECTED STROKE TO STROKE UNIT - within 4hrs of presentation
- determine symptom onset - when patient was last well if unwitnessed
- thrombolysis possible within 4.5hrs
KEY INVESTIGATION - Head CT within 1hr of hospital presentation=> is it ischemic or hemorrhagic?
MRI if still not sure
Possible stroke mimic symptoms
Gradual onset, progressive, migratory Positive symptoms -flashing lights -tingling, jerking, trembling -known history of cognitive impairment -resp, abdo signs
Management of confirmed ischemic stroke
- definitive
- CI to thrombolysis
Thrombolysis + 300mg aspirin (IV alteplase)
-presentation U4.5hrs AND not CI
CI
- past intracranial bleed
- uncontrolled HTN
- pregnant
Management of TIA
- immediate
- multiple TIA/suspected cardioembolic/carotid cause
- TIA in past wk
- TIA in past wk+
Immediate 300mg aspirin
Carotid endarterectomy assessment with duplex US - 50-99%
TIA within 1wk => urgent assessment within 24hrs
TIA within 1wk+ => urgent assessment within wk
Management of hemorrhagic stroke
NEUROSURGERY REFERRAL
Mainly supportive
- Reverse AC
- Lower BP
Secondary management of strokes
- lifestyle
- medication
Increased physical activity Smoking cessation Reduce alcohol Diet optimisation for CVD T2DM, HF
Clopidogrel
Atorvastatin
HTN management
