Assessment and management of stroke Flashcards
(29 cards)
Define stroke
Acute focal or global impairment of the brain function lasting fro >24 hours and of vascular origin
What are the 2 main categories of stroke
Ischaemic - thromboembolic
Haemorhagic - subarachnoid or intercerebral bleeding
Define a TIA
Sudden focal loss of neurological function that resolves within 24 hours
Describe features of a TACS (total anterior circulation stroke)
= occlusion of a large cerebral artery (internal carotid or middle cerebral)
All 3 of
- contralateral hemiplegia and hemi sensory loss of FAL
- contralateral homonynmous hemianopia
- disturbances including aphasia and visual spatial problems e.g neglect
Describe the features of a LACs (lacunar stroke)
Occlusion of a single lenticulostriate artery supplying the basal ganglia
One of the following
- pure motor
- pure sensory
- sensory motor deficit
- ataxic hemiparaesis
What are the features of a PACs (partial anterior circulation stroke)
= middle cerebral artery occluded
2 of
- motor/sensory deficit
- homonymous hemianopia
- new higher cerebral dysfunction alone e.g aphasia or visuospatial disorder
Describe the features of a POCS (posterior circulation stroke)
= posterior vessel occluded leading to cerebellar, brain stem or occipital infarcts
one of:
- ipsilaterial cranial nerve palsy with contralateral motor or sensory deficit
- disorders of conjugate eye movement
- cerebellar dysfunction (DANISH)
- isolated homonymous hemianopia with macular sparing
- bilateral motor/sensory deficit
What is the immediate stroke management for a patient coming in
- priority 1 ambulance
- focused history and exam and carry out NIHSS and investigations (bloods, ECG)
- CT scan to check for bleeding (in haemoragic stroke)
- proceed with thrombolysis or thrombectomy if appropriate
What types of things does a focused stroke history include
- classifying what type of stroke it is
- check for medication which may contraindicated then from thrombolysis e.g if they take wafarin or other anticoagulants
- find out the time of onset to see if they’re within the window of thrombolysis
- check for bleeding tendency, recent surgery or trauma (may also contraindicate thrombolysis )
- assess the severity of the stroke using NIHSS (0-42 with 42 being the worsed)
Why do we need to do a CT immediately for a stroke patient
Rule out bleeding - this will show up as white on a CT scan
If its ischaemic this means can start reprofusion therapy
Also rules out alternative diagnoses
WHat is the time frame for reprofusion therapy
<4.5 hours for thrombolysis with alteplase
Mechanical thrombectomy can be used up to 24 hours but is best within 6 hours
What are the 2 treatments used in reprofusion therapy
- thrombolysis
Using alteplase to break up the clot, STILL a risk of haemorhage! - Mechanical thrombectomy
Intra arterial clot extraction used in conjunction with thrombolysis or as an alternative treatment in people contraindicated for thrombolysis
Which patients should be considered for mechanical thrombectomy
- stroke onset <6 hours
- NIHSS >4
- large vessel occlusion seen on CT angiogram
How to manage intercerebral haemorhage
- reverse any anticoagulants
- control BP
- consider neurosurgery in selected patients
What happens in a ischaemic stroke is not treated
Brain will infarct and die and appear black on the CT scan
What are some early secondary preventions used for stroke
- aspirin (or clopidogrel)
- statin
- control BP
- anticoagulants in AF (DOAC)
- carotid surgery
What are some common complications of stroke
- pneumonia
- DVT
- poor nutrition
- dehydration
- pressure sores
- spasticity
- seizures
- depression
Which type of stroke causes headaches and why
ICH because blood is an irritant
Also oedema around the haematoma causes raised ICP
OR
POCS because inflam may block 4th ventricle and cause obstructive inflam
Common risk factors for stroke and TIA
Smoking, hypertension, high cholesterol, diabetes, AF and IHD
What % of those with TIA go on to have a stroke
20%
What imaging would you use in TIA
MRI with DWI (something with water)
Excludes alternative diagnoses. In acute ischaemia it will appear bright white
Which sort of symptoms would someone having a haemorhagic stroke have
Headache, vomitting and v high BP
List members of stroke MDT
- doctor
- nurse
- dietitan - management of patients with dysphagia and preventing malnutrition
- physio therapist - restorer movement.
- occupational therapist - help people to participate in activities of everyday life e.g cognition, vision, limb function and ADL
- speech and language therapist - swallowing and communication
- social work
- pharmacy
What are some types of communication disorders in stroke patients
Dysphagia
Dysarthria (slurred speech)
Dyspraxia
Dysphagia (horse voice)
Dysfluency (disrupts ongoing speech)
