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3703 > CNS- Stroke > Flashcards

CNS- Stroke Flashcards

1
Q

What is a stroke

A

Blood supply to part of the brain is cut off

Focal disturbance to cerebral function lasting more than 24 hours

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2
Q

What are the main types of stroke

A

Acute ischaemic stroke

Haemorrhagic (ICH/ SAH)

Transient ischaemic attack (TIA)

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3
Q

What does F stand for as a stroke symptom

A

Face- dropped on one side,
Not able to smile
Mouth or eye has dropped

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4
Q

What does A stand for as a stroke symptom

A

Arms- unable to lift both arms and keep them there

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5
Q

What does S stand for as a stroke symptom

A

Speech- slurred or garbled
Not able to speak at all
Problems understanding what others say to them

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6
Q

What does T stand for as a stroke symptom

A

Time- time to dial 999

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7
Q

How is severity of stroke assessed

A

The NIHSS
Minor, moderate, moderate to severe and severe stroke

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8
Q

What tests are needed to identify a TIA

A

MRI - shows where the damage occurred and if there is a haemorrhage

Carotid imaging - candidates of a carotid endarterectomy

Post TIA assessment by a specialist

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9
Q

What tests are done for a acute ischemic and haemorrhagic strokes

A

CT - rules out haemorrhagic stroke and identifies intracranial bleeds

CTA - detects occlusions

MRI - detects the site/extent of infarction or bleeding

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10
Q

Why are strokes damaging?

A

Starve the brain of oxygen and glucose, depletion of nutrients leads to cell death

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11
Q

When should a CT scan be done for acute strokes?

A

The patient takes anticoagulants

Indication of thrombolysis

Unconsciousness

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12
Q

What is the management for TIA

A

Aspirin 300mg

Secondary prevention 2 weeks after on discharge via:
Clopidogrel 75 mg daily

Atorvastatin 20–80 mg daily

Anti-hypertensive drugs

Anticoagulants - once intracranial bleeding excluded

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13
Q

Management of acute ischaemic stroke

A

In acute ischaemic strokes

Alteplase - within 4.5 hours of onset of stroke symptoms

No sign of haemorrhaging

Aspirin - 300mg started within 24 hours

PPI with aspirin if previous dyspepsia

2 weeks after symptoms or on discharge:
Start long-term anticoagulants

Full-dose heparin then warfarin in patients with venous stroke or DVT

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14
Q

What additional tests need to be done for stroke?

A

Blood sugar - exclude hypoglycemia or diagnose diabetes mellitus

FBC - if patient is anaemic or bleeding can help to choose treatment

ECG - arrhythmias (AF) and myocardial infarction

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15
Q

What is the penumbra in ischaemic strokes

A

The zone of reversible ischaemia that surrounds the core of irreversible infarction

Can be salvaged after the first few hours

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16
Q

How is the penumbra damaged?

A

Hypoperfusion
Hyperglycaemia
Fever
Seizure

17
Q

What lifestyle advice should be given?

A

Reduce alcohol to 14 units per week

5 portions of fruit and veg daily

Oily fish twice a week

Reduce fats and salts

Stop smoking

Exercise regularly

Minimise sitting

18
Q

What surgical interventions are made with stroke?

A

Ischemic stroke:

Angioplasty and stenting
Thrombectomy
Carotid endarterectomy

ICH:

Evacuation of haematoma

SAH:

Clipping and coiling of aneurysm

19
Q

What are the causes of an embolus in ischaemic strokes?

A

Carotid artery plaque

Atrial fibrillation

Heart aneurysm

Myocardial infarction

20
Q

What are the causes of an ICH stroke?

A

High blood pressure

Amyloid build up in brain

Anticoagulants

Liver injury

Physical trauma

21
Q

What are the causes of an SAH stroke?

A

Brain aneurysm

Trauma

Malformations in children

22
Q

Symptoms of stroke

A

Weakness, paralysis or numbness of the face, arm and the leg

Loss of Speech, or difficulty speaking or understanding speech

Dimness or loss of vision in only one eye

Unexplained dizziness, unsteadiness or sudden falls

Sudden severe headache and/or loss of consciousness

22
Q

Why is ABCD2 not used for TIA?

A

Not accurate for predicting future strokes in TIA

23
Q

What is the management for DVT in haemorrhagic strokes?

A

Intermittent pneumatic compression (IPC) started within 3 days

Treatment for 30 days or until patient is mobile or discharged

24
Q

How are clotting levels stabilised after drug-induced or PIH haemorrhagic strokes?

A

Combination of Vitamin K and prothombin complex concentrate (PCC) to reverse DOACs and warfarin

25
Q

When should blood pressure be maintained for an acute ICH and how?

A

Patient presents within 6 hours of symptoms with a BP >150 mmHg

BP target: 130-140 within 1 hour of starting treatment

Maintain BP for 7 days

Treatment:
Nicardipine - long acting CCB

Labetalol - alpha 1 blocker

3703 (13 decks)

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