Week 6 Clinical Lecture: Stroke and Vascular disorders Flashcards
What is a stroke?
an abrupt interruption of blood flow to part of the brain, depriving brain tissue of oxygen and nutrients.
85% are ischaemic, 15% are haemorrhage
What is the definition of a cerebral ischaemic stroke?
acute focal neurological dysfunction caused by local infarction at single or multiple sites of the brain or retina
What is the definition of a intracerebral haemorrhage (ICH)?
acute neurological dysfunction caused by haemorrhage within the brain parenchyma or in the ventricular system
What are the 3 potential causes of an ischaemic stroke?
- embolism
- hypoperfusion
- thrombosis
What is small vessel disease?
- clots formed in small vessels
- most common mechanisms are hypertension and diabetes
What are the non-traumatic causes of ICH?
- hypertension (most common)
- vascular malformations
- amyloid angiopathy
- tumours
- drug abuse: amphetamine, cocaine
- anticoagulant and thrombolytic therapy
- vasculitis
- CVT
What does F.A.S.T stand for?
- Face – look at the patients face and ask them to smile. Has their face fallen on one side?
- Arms – ask the person to raise both their arms. Can they keep them there?
- Speech – ask the person to say hello and tell you their name. Is their speech slurred?
- Time – call 999
What are the common stroke symptoms?
- slurred speech
- facial droop
- acute unilateral loss of strength and/or sensation
- acute monocular or binocular visual loss (complete or incomplete)
- aphasia
- ataxia and/or vertigo
- double vision
- sudden decrease in level of conciousness
if the right side of the brain is damaged in a stroke, which side is effected?
left side
How do we treat an ICH?
we need to prevent the expansion of the haemorrhage in 6 hours. we can:
- reverse anticoagulation e.g if the patient is taking warfarin
- aggressive BP management
- surgery
- must not treat with blood thinners (unless patients have cerebral venous thrombosis)
Explain the pathophysiology of an ischaemic stroke
- Firstly, the core will be dead no matter what we do – this area will not get function back
- The penumbra is at risk if we don’t do something ASAP
- The benign oligemia, has reduced blood flow, but is not at risk
- If the patient is not treated to help unblock the vessel, the penumbra continues to be at risk and will die in minutes/ hours so the final infarct volume is much larger
- If the patient is successfully recanalized, then we can some some/ if not all of the penumbra and limit the damage to the core
What is recanalization
recanalization is the unblocking of blood vessles
What is alteplase?
- first line of treatment for recanalization
- significantly improves the function of patients with stroke if its within 4 and a half hours
- strong blood thinning medication (so there is an increased bleeding risk)
Whats the difference between a large vessel occlusion stroke compared with a non-LVO stroke?
- larger in infarct size
- more severe presenting deficits
- worse long term outcomes
What is a mechanical thrombectomy (MT)?
Access to the patients arteries from the groin and stick a catheter to the brain and get the clot out physically rather than just giving medication to dissolve the clot
