Neurology - stroke and haemorrhage Flashcards
(33 cards)
What are the tests for for subarachnoid haemorrhage?
CT - white star
12 hours - 2-4 weeks after do an LP - CSF xanthochromia
How would you treat a subarachnoid haemorrhage?
surgical clipping
endovascular coiling
can help maintain cerebral perfusion with nimodipine
What are the investigations you would do for suspected subarachnoid hameorrhage? What is +?
CT - star shaped white ventricles
LP - oxyhaemoglobin, xaenthechromia
Keep charting BP, pupils and GCS
What is the treatment for ischaemic stroke?
Thrombolysis - 4.5 hours after symptoms appear max
- exclude haemorrhagic by CT/MRI
Thrombectomy - 6 hours after symptoms start max
Name 3 differentials of a stroke
migraine
hypoglycaemia
Bell’s palsy (infection)
Todd’s paraesis (seizure)
What investigations do you do when you suspect a stroke?
CT, MRI
glucose
ECG, echo
How would you treat haemorrhage stroke?
BP < 140/80 GTN labetalol 5mg - 10mg - 20mg - blous check platelets and clotting - can give platelet transfusion if on warfarin give Vit K SURGERY
How would you treat ischaemic stroke?
Thrombosis
Thrombectomy
do not control BP until 24 hours after
What is the most common condition to cause an ischaemic stroke?
Carotid stenosis
What are the two types of haemorrhage?
subarachnoid or intracerebral
How can you cause arterial dissection and what are the two vessels most commonly affected?
neck trauma or hyperextension
dissection of carotid or subarachnoid artery
Which kind of stroke could a cardiac arrest cause?
hypoperfusion could lead to an ischaemic stroke
Name some risk factors for cardioembolic strokes
infective vegatation, AF, rheumatic valves, degenerative or congenital valve disorders
What are 3 modifiable and 3 non-modifiable RF for strokes?
Modifiable: hypertension, smoking, alcohol intake, obesity, cocaine use, high cholesterol
Non-modifiable: older age, male black/African/Asian, cardiac disease, AF, sleep apnoea, hypercoagulability, neurosphyillis
What are some primary and secondary preventions for stroke?
Primary - smoking cessation, weight loss, diet, exercise, alcohol reduction, aspirin
Secondary - anticoagulation, angioplasty/stenting
What happens to vital signs during a stroke?
BP and temp increase
O2 sats fall
What happens to reflexes following a stroke?
Initally a patient will be hyporeflexive due to spinal shock but about 6 weeks later they will be hyperreflexive due to UMN damage
What are some risks of a major bleed?
HAS-BLED hypertension, hepatic or renal failure age stroke previously bleeding labile INR ethanol - alcohol intake drugs - polypharmacy
What are the risk factors for AF causing a stroke?
CHADSVasc Congestive heart failure hypertension age diabetes sex vascular disease
What is the risk score to establish if TIA will lead to stroke?
ABCD2 Age Blood pressure Clinical features - unilateral weakness, speech disturbance Diabetes Duration of symptoms
What are the positives and negatives of thrombolysis?
Positive - improved outcomes, no change in mortality
Negative - 5% risk of haemorrhage
Name 3 contraindications for thrombolysis
Haemorrhagic stroke, head injury, previous haem, aneurysm, hypertension, low platelets, low glucose, pregnancy
What are some effects a stroke has one a person?
Physical - raised ICP, disability, aspiration pneumonia
Mental - depression, cognitive impairment
Social - immobility, financial, isolation
Name 3 blood tests in a stroke workup
FBC, clotting, glucose, CRP, ESR, culture, sphyillis, lipid profile, autoantibodies
