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elderly yr3 > Stroke medicine > Flashcards

Stroke medicine Flashcards

1
Q

What are TIAs?

A
  • Focal neurological deficits due to blockage of blood supply to part of the brain
  • Lasting less than 24hrs but in practice these are usually much less
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2
Q

Risk assessment for TIA to predict short term risk of stroke?

A

ABCD2 - but NOT a diagnostic tool

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3
Q

How is ABCD2 calculated?

A

Sum of points of 5 different factors inc:
* Age
* BP
* Clinical features
* Duration of symptoms
* Diabetes?

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4
Q

Cut off score for ABCD2

A

Score of 4 or more = higher risk of stroke

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5
Q

Management of high risk patients

A
  • Prioritised to be seen in TIA clinic or by a stroke physician ASAP
  • Aspirin 300mg daily if suspected TIA started immediatly
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6
Q

Investigations for TIA

A
  • Bloods
  • Carotid doppler
  • CT or MRI
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7
Q

Treatment for TIA

A
  • Lifestyle modifcations
  • Treatment of high cholesterol and HTN
  • Surgical intervention for carotid artery disease
  • Antiplatelets if appropriate
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8
Q

What is crescendo TIA?

A

Two or more TIAs in a week - should be treated for high risk stroke

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9
Q

Define stroke

A
  • Sudden onset of focal neurological deficit
  • Lasting more than 24hrs or with imaging evidence of brain damage (eg infarction shown by emboli, thrombosis or low blood flow or haemorrhage)
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10
Q

Initial classification of stroke

A
  • Haemorrhage
  • Infarct (ischaemic)
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11
Q

How do we identify vascular territory involved - classification?

A
  • Bamford classification and then with brain imaging
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12
Q

How to classify underlying cause of infarcts?

A

TOAST classification

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13
Q

Classifying underlying causes of bleeds on brain

A
  • Primary HTN
  • Cerebral amyloid angiopathy
  • Secondary - eg trauma
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14
Q

Emergency treatment of stroke

A
  • Thrombolysis for ischaemic
  • Anticoagulation reversal or neurosurgical intervention for bleeds
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15
Q

Types of strokes

A
  • TACS
  • PACS
  • LAC
  • POCS
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16
Q

What us used to classify the symptoms associated with the types of strokes?

A

Bamford classification

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17
Q

Worse stroke type prognosis

A
  • TACS - often leave pt with significant weakness
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18
Q

Assessment tools used for rapid assessment of stroke

A

FAST:
* Face (facial drooping)
* Arm (weakness)
* Speech (slurred)
* Time (call 999)
ROSIER
* Rosier scale used to distinguish between stroke and stroke mimic. commonly used in A&E

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19
Q

What is NIHSS?

A
  • NIH stroke scale - used as clinical stroke assessment tool to evaluate and document neuroligcal status in acute stroke patients
  • Measure stroke severity
20
Q

15 items on NIHSS

A
  • Level of conc
  • Language
  • Neglect
  • Visual field loss
  • Extraocular movement
  • Motor strength
  • Ataxia
  • Dysarthria
  • Sensory loss
21
Q

Pharmaceutical treatment for identified ischaemic stroke

A

Alteplase - thrombolysis

22
Q

Timeframe to have alteplase

A
  • Within 4.5hrs of onset of stroke
  • Increases likelihood of being functionally independent
  • Does not increase 90 day risk of mortality
23
Q

Where should stroke pts be cared for and why?

A
  • Organised stroke unit
  • Long term reduction in death dependency and need for institutional care
24
Q

What should all people presenting with acute stroke who have had haemorrhage excluded by imaging be given?

A
  • Aspirin 300mg orally if not dysphagic
  • 300mg rectally or by enteral tube if they are
25
Q

How long should aspirin 300mg be continued for?

A
  • 2 weeks after the onset of symptoms
  • Then long term antithrombolytic agent should be commenced
26
Q

Restrictions after stroke and TIA

A
  • Not permitted to drive for 1 month
  • After this time you can again as long as there is no permanent neurolgical problems
  • If recurrent TIAs cannot drive for 3 months - must be assessed by doctor prior to driving
27
Q

How is carotid stenosis quantified?

A
  • NASCET - north american symptomatic carotid endarterectomy trial criteria
  • ECST - european carotdi surgery trialists collaberative group criteria
28
Q

NASCET scoring value to undergo assessment/intervention

A

50-99% carotid stenosis with stable neurologicla symptoms from stroke or TIA

29
Q

ECST value to undergo assessment/surgery

A

70-99% carotid stenosis with stable neurological symptoms from stroke or TIA

30
Q

What should those with 50-99% NASCET and 70-99% ECST have?

A
  • Assessed and referred for carotid endarterectomy within 1 weeek of onset of stroke/TIA symptoms
  • Undergo surgery within a maximum of 2 weeks from onset of stroke/TIA symptoms
  • Fitness for surgery should be assessed and may be small risk of stroke during surgery
31
Q

What are people with severe middle cerebral artery infarction at risk of?

A
  • Malignant MCA syndrome
  • Therefore should be considered for decompressive hemicraniectomy if any deterioration in clinical condition eg decrease in conc
32
Q

Timing for decompressive hemicraniectomy for malignant MCA syndrome risk

A
  • Referred within 24hrs of onset of symptoms
  • Treated within max of 48hrs
33
Q

Criteria for malignant MCA syndrome decompressive hemicraniectomy

A
  • Under 60
  • CT infarct of at least 50% MCA territory
  • NIHSS score above 15
34
Q

Examples of stroke mimics

A
  • Seizures
  • Space occupying lesions
  • Hemiplagic migraine
  • Multiple sclerosis
  • Sepsis in those with pre-existing neurologicla weakness
35
Q

Risk scoring used to assess if suitable for anticoagulation

A

CHADS-VASC 2 score

36
Q

When is CHADS-VASC 2 score used?

A

Determine if someone is suitable for anticoagulants if they are in atrial fibrillation and at risk of stroke

37
Q

What is useful to use alongisde CHADS-VASC 2?

A
  • ORBIT
  • HAS-BLED score
  • Both used to assess bleeding risk
38
Q

Anticoagulation for afib stroke risk

A
  • Warfarin
  • DOAC eg apixaban, rivaroxaban, edoxaban
39
Q

HAS BLED components

A
40
Q

CHAD VASC 2 components

A
41
Q

Complex decisions made in stroke examples

A
  • DNACRPS
  • Commencing enteral feeding eg NG or PEG
42
Q

Indication for enteral feeding

A
  • Poor swallow following large stroke
  • Without if these patients would aspirate
43
Q

Decision for enteral feeding is baseed on…

A
  • Patient and family preference
  • Quality of life expected with treatment
44
Q

Risks of NG/PEG tube

A

Aspiration - still
Some patients will never be able to tolerate oral intake again

45
Q

When are NG tubes often inserted?

A
  • Post stroke when swallowing is affected
  • Decision to proceed with PEG feeding is often complex decision making process involving family and MDT
46
Q
A

elderly yr3 (14 decks)

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