Neurological and spinal emergencies Flashcards
(48 cards)
what percentage of UK deaths do strokes account for?
11%
How many people in England and Wales are admitted to hospital with acute stroke each year?
80,000
What lifestyle factors increase risk of a stroke?
- smoking
- alcohol misuse and drug abuse
- physical inactivity
- poor diet
What established cardiovascular diseases increase a person’s chance of having a stroke?
- Hypertension
- AF
- Valvular disease
- Carotid artery disease
- Congestive heart failure
- congenital or structural heart disease
What non-lifestyle, non-cardiovascular factors might increase a person’s chance of having a stroke?
- Age (chance of stroke doubles every decade after the age of 55)
- Gender
- Hyperlipidaemia
- DM
- Sickle cell disease
- Antiphospholipid syndrome and other hypercoagulable disorders
- Chronic kidney disease
What are the gender related risk factors for stroke?
Men are more likely than women to have a stroke at younger age, in women, an increased risk of stroke has been associated with current use of oral contraceptives, migraine with aura, the immediate postpartum period, and pre-eclampsia
What is the pathophysiology of a stroke?
It is a clinical syndrome characterised by sudden onset of rapidly developing focal or global neurological disturbance which lasts more than 24 hours or leads to death, disruption of blood flow to brain tissue causes ischaemia/infarction of brain tissue, the location of this damaged tissue will dictate the presenting symptoms
What are the two types of stroke?
- Ischaemic
- Haemorrhagic
What percentage of strokes are ischaemic verses haemorrhagic?
- 85% ischaemic
- 15% haemorrhagic
What does focal changes refer to in neurology?
Signs/symptoms are a caused by a lesion to a specific area of the brain, specific nerve or part of the spinal cord
In neurology what does the term global refer to?
Affecting the whole brain
What are common signs + symptoms of a stroke?
- Confusion, altered level of consciousness and coma
- Headache – sudden, severe and unusual headache which may be associated with neck stiffness
- Sentinel headache(s) may occur in the preceding weeks
- Weakness − sudden loss of strength in the face or limbs
- Sensory loss – paraesthesia or numbness
- Speech problems such as dysarthria or dysphasia Visual problems – visual loss or diplopia
- Dizziness, vertigo or loss of balance — isolated dizziness is not usually a symptom of TIA
- Nausea and/or vomiting
- Specific cranial nerve deficits such as unilateral tongue weakness or Horner’s syndrome (miosis, ptosis, and facial anhidrosis)
- Difficulty with fine motor co-ordination and gait
Define hemiplegia
Paralysis of one side of the body
Define hemiparesis
Muscle weakness on one side of the body
What do you check for in a FAST test?
- Facial weakness
- Arm weakness
- Speech problems
- Time to call 999
What is the BEFAST test?
- Balance
- Eyes (vision)
- Face
- Arms
- Speech
- Time
What are the 12 steps to treating / managing a stroke pre-hospitaly?
- Manage ABCD
- Supplemental O2 id SPO2 is <92% or <88% for COPD
- Nil by mouth
- Reassure and explanation
- guard against secondary injury (hypoxia / dehydration / hemiparesis)
- Assess CBG and correct if hypoglycaemic
- 12 lead ECG
- IV access
- under 3 hours since onset of symptoms?
- note anticoagulation status
- Pre-alert and convey under emergency conditions to nearest ED
- Note and report onset time during pre-alert
How is a stroke managed / treated in hospital?
- Straight to CT Scan
- Scan of head, +/- contrasting agent
- Bleed or Thombo-embolic?
- Thrombolysis / Surgery
- Admitted
What conditions are frequently misdiagnosed as stroke?
- Hypoglycaemia
- Sepsis
- Hyperglycaemia
- Conditions causing dizziness, faintness or balance disturbance
- Migraine
- Neurological Abnormalities
- Functional Neurology
- Physiological disorders including anxiety
- Mass lesions such as subdural haematoma or tumours
- Seizures
- Physical Trauma (Including Concussion)
What is a TIA?
Transient Ischaemic Attack, is a temporary disruption in the blood supply to part of the brain that causes symptoms similar to a stroke but resolves without medical intervention, it can be a warning sign that a person will have a stroke
How long does a TIA last?
Typically less than an hour, usually only a few minutes
What is the MEND exam?
Miami Emergency Neurological Deficit exam:
- check mental status (AVPU, check their speech, ask questions, give commands)
- effects on cranial nerves (check for facial droop, visual fields, horizontal gaze)
- Limbs (motor-arm drift, leg drift, sensory, co-ordination)
What is the ABCD2 score?
Measures likelihood of TIA:
- Age >60: +1
- Blood pressure >140systolic, >90 diastolic: +1
- Clinical features
^ Unilateral weakness: +2
^ Speech disturbance without weakness: +1
- Duration of symptoms
^ >60minutes: +2
^ 10 - 59mins: +1
- DM: +1
- 0-3 points = low
- 4-5 points = moderate
- 6-7 points = high
Thinking specifically about risk factors, when must a person having a TIA be conveyed to hospital?
- Crescendo TIA’s (more than one suspected TIA occurred in 7 days)
- Prescribed anticoagulants
- Diagnosed clotting disorders
- Diagnosis of AF, or AF on ECG
- ABCD2 of > 4, where hospital still uses ABCD2
