Stroke

Question 1

Stroke definition

Answer 1

Cessation of blood supply to an area of the brain due to blockage or a bleed.
Types: ischaemic or haemorrhagic or TIAs

Question 2

Ischaemic stroke

Answer 2

Make up 85% of strokes.
Embolic or thrombotic

Question 3

Haemorrhagic stroke

Answer 3

15-20% strokes.
Symptoms more likely to be ICH: sudden thunderclap headache, rapid deterioration, N/V, bradycardia and HTN.

Question 4

Stroke mimics

Answer 4

• Hypoglycaemia
• EtOH intoxication
• Bell’s palsy
• Migraine
• Syncope
• Brain tumour
• Sepsis/infection
• Electrolyte disturbance
• SDH
• Seizures
• Inner ear disturbance

Question 5

Stroke sign & symptoms

Answer 5

• Sudden numbness/wekness on unilateral arm. leg or face
• Dysphagia/aphagia
• Vision problem, unequal pupils
• vertigo
• N/V
• Severe headache
• Altered LOC

Question 6

ROSIER Assessment Tool

Answer 6

-1 seizure acitivty
-1 LOC or syncope
1 facial assymetery
1 speech impairment
1 assymetrical arm weakness
1 assymetrical leg weakness
1 visual field defect
Rosier >1 = ACT-Fast assessment and stroke possible

Question 7

Management of stroke

Answer 7

• Full patient assessment including BGL
• FAST assessment/ROSIER assessment
• ACT-FAST
• Large bore IV access
• Head tilt 15-30 degrees
• Prenotification if symptoms <24 hours

Question 8

Eligibility for clot retrieval

Answer 8

• Pt should not be comatosed
• No Hx of seixure activity preceding symptoms
• BGL >2.8mmol/L
• No known malignant brain Ca