Stroke Flashcards

Question

Presentation of stroke

Answer 1

``` Visual loss or visual field deficit - commonly in patients with posterior circulation ischaemia - unilateral - carotid or vertebrobasilar ischaemia - bilateral - vertebrobasilar ischaemia Weakness - complete or partial loss of muscle strength in face/arms/kegs - all three suggests deep hemispheric involvement Aphasia - expressive or receptive Ataxia - cerebellar pathology Sudden onset Diplopia Sensory loss Dysarthria Gaze paresis Neck pain Miosis, ptosis facial anhidrosis Altered level of consciousness Photophobia and headache ```

Answer 2

Presentations which resemble other conditions but are actually stroke Venous infarcts - impaired drainage and gradual onset Small cortical strokes - peripheral nerve lesions Limb shaking TIA Occipital stroke - present with confusion and delirium - visual field defects

Answer 3

``` Non-enhanced CT - within 1 hour - ischaemic - CT normal in first few hours, hyperattenuation of relevant vessel due to clotted blood, loss of grey-white matter differentiation, hypodensity of cortical tissue - haemorrhagic - hyperdense lesion CT with contrast angiography - if thrombectomy indicated CT perfusion imaging or MRI alternative Serum glucose - exclude hypogylcaemia Serum electrolytes Urea + creatinine - renal failure may be contraindication to mx Cardiac enzymes - concomitant MI ECG - exclude arrhythmia or ischaemia FBC Clotting screen Carotid USS - carotid stenosis ```

Answer 4

Total Anterior Circulation Stroke - TACS - usually cardiac emboli - affects area of brain supplied by middle and anterior cerebral arteries Partial Anterior Circulation Stroke - PACS - usually large vessel disease - less severe form or TACS Posterior Circulation Syndrome - POCS - involves damage to area of brain supplied by the posterior circulation - occipital lobe, cerebellum or brainstem Lacunar Syndromes - LACS - usually atheroma in situ - subcortical stroke that occurs secondary to small vessel disease - no loss of higher cerebral functions

Answer 5

All 3 must be present - unilateral weakness of face, arm and leg - homonymous hemianopia - higher cerebral dysfunction - dysphasia, visuospatial disorder

Answer 6

2 of the following present - unilateral weakness of face, arm and leg - homonymous hemianopia - higher cerebral dysfunction - dysphasia, visuospatial disorder

Answer 7

One of the following - cranial nerve palsy and contralateral motor/sensory deficit - bilateral motor/sensory deficit - conjugate eye movement disorder - horizontal gaze palsy - cerebellar dysfunction - vertigo, nystagmus, ataxia - isolated homonymous hemianopia

Answer 8

One of the following present - pure motor stroke - lenticulostriate artery - pure sensory stroke - thalamoperforator artery - sensorimotor stroke - ataxic hemiparesis

Answer 9

``` National Institutes of Health Stroke Scale Level of consciousness o Level of alertness (0-3) o Verbal (0-2) o Visual and motor (0-2) · Best gaze (0-2) · Visual fields (0-3) · Facial Palsy (0-3) · Arm motor (0-4) · Leg motor (0-4) · Limb ataxia (0-2) · Sensory (0-2) · Best language (0-3) · Dysarthria (0-2) · Extinction and inattention (neglect) (0-2) 0 – no stroke symptoms 1-4 – minor stroke 5-15 – moderate stroke 16-20 – moderate to severe stroke 21-42 – severe stroke ```

Answer 10

Used in A+E for stroke diagnosis

Answer 11

Exclude hyperglycaemia first Loss of consciousness or syncope = -1 Seizure activity = -1 New, acute onset of asymmetrical face weakness = +1 New, acute onset of asymmetrical arm weakness = +1 New, acute onset of asymmetrical leg weakness = +1 New, acute onset of speech disturbance = +1 New, acute onset of visual field defect = +1 A stroke is likely if the score is > 0

Answer 12

``` Emergency - IV alteplase - thrombectomy Conservative - admission to stroke unit to optimise physiology and monitor Medical - aspirin 300mg daily for 2 weeks - clopidogrel 75mg TD after aspirin finished Surgical - carotid endarterectomy ```

Answer 13

Activates plasminogen to form plasmin | - degrades fibrin and breaks up thrombi

Answer 14

Clinical diagnosis of ischaemic stroke - NIHSS 4 - aphasia - binocular visual field deficit - swallowing deficit - unable to walk or self-care independtly

Answer 15

``` BP > 185/110 after 2 attempts to reduce Surgery or trauma within last 14 days Active internal bleeding Haematology abnormalities - INR>1.7 or APTT > 40 Arterial puncture at non-compressible site or LP in last 7 days Symptoms of subarachnoid haemorrhage IE, pericarditis Childbirth in last 4 weeks Acute pancreatitis Severe liver disease ```

Answer 16

``` Admission to stroke unit to optimise physiology - Maintain good glycaemic control - Ensure BP doesn't drop - Ensure good sleep - Monitor O2 sats - Nutritional support - Rehabilitation Lifestyle modifications - Smoking - Weight - Alcohol - Diet - Exercise ```

Answer 17

``` Anticoagulation if has AF - balance bleeding and clot risk - CHADVASC - warfarin - HASBLED - DOACs Antihypertensives - target of 130/80 - ACE inhibitors - CCB - Thiazides Statins for hypercholesterolaemia Glycaemic control for diabetes ```

Answer 18

``` Neurosurgical evaluation Airway protection Blood pressure control - labetalol - nicardipine ```

Answer 19

``` Dysphagia may lead to aspiration Prolonged immobility - DVT - Pressure ulcers - Constipation - urinary retention Seizures - abnormal glial activity Recurrent strokes Raised ICP - malignant oedema - hydrocephalus - haemorrhagic transformation Cognitive issues Mood changes Fatigue Pain Alteplase-related orolingual oedema ```

Answer 20

Symptoms lasting less than 24 hours | Refer to TIA clinic within 24 hours

Answer 21

ABCD2 score - A - age > 60 - B - blood pressure > 140/90 - C - clinical features - unilateral weakness = 2, dysphasia without weakness = 1 - D - duration - >60mins = 2, 10-60mins = 1 - D - diabetes

Answer 22

< 3 = specialist assessment within week > 3 = specialist assessment in 24 hours Start aspirin 300mg OD and simvastatin 40 mg OD

Stroke Flashcards

(46 cards)