Stroke Flashcards
What is a stroke? What are the different types?
a sudden loss of oxygen delivery to a brain region due to the interruption of blood flow
ischaemic (most common)
- occlusion due to thrombosis or embolism
haemorrhagic
- rupture of a weakened blood vessel
transient ischaemic stroke (TIA)
- mini stroke where symptoms only last a short amount of time due to a temporary blockage of blood supply to the brain
- lasts less than 24 hours
What are the symptoms of stroke?
paralysis/limb weakness or numbness
impaired speech
sudden loss or blurring of vision
dizziness
confusion
difficulty understanding speech
problems with balance and co-ordination
difficulty swallowing (dysphagia)
sudden and very severe headache
loss of consciousness
vomiting
FAST
- facial drooping, paralysis of the arm/drifting, slurring speech and time
What are the modifiable and non-modifiable risk factors for stroke?
modifiable
- hypertension, atrial fibrillation, diabetes, hyperlipidaemia, smoking, medicines (contraceptive pill, HRT), physical inactivity, obesity, psychologic distress
non-modifiable
- age, gender (male), ethnicity, history of TIA, sickle cell disease
What is a cardioembolic stroke?
embolism/blood clot starts from the heart to the brain
- left side of the brain controls the right and vice versa so symptoms affecting one side means the other has the blockage
How should stroke be diagnosed?
FAST
ROSIER
exclude hypoglycaemia
- mimics stroke symptoms
What is the acute management options for ischaemic stroke? What is the treatment goal?
to restore perfusion
thrombolysis via thrombolytics
- alteplase (tPa) must be given less 4.5 hours after symptom onset (BP must be <185/110 mmHg)
mechanical thrombectomy (for patients unsuitable for thrombolysis)
- procedure used to remove obstructive blood clots from large arteries in the brain
How should suspected transient ischaemic attack be managed?
if it occurred within the last 7 days
- give 300mg aspirin OD (loading dose) and refer to a specialist within 24 hours
if it occurred more than 7 days ago
- give 300mg aspirin OD (loading dose) and refer to a specialist with 7 days
must exclude intracranial haemorrhage before giving aspirin
What is the secondary prevention post ischaemic stroke?
anti-platelet therapy
- long term clopidogrel 75mg OD if contraindicated then MR dipyridamole 200mg BD + aspirin 75mg OD
= started 14 days after attack
high intensity statin
- atorvastatin 80mg OD
= started 48 hours post stroke
When should anticoagulants be used for treating stroke?
patients with atrial fibrillation
patients with a cardiac source of embolism
if intracranial bleeding has been excluded
How should patients surviving a stroke be monitored?
swallowing assessment
fluid replacement
blood glucose
temperature
VTE risk assessment and prevention
How should symptoms post stroke be managed?
swallowing difficulties
- food and drug administration via feeding tubes
excessive saliva production (sialorrhoea)
- antimuscarinics = hyoscine patches, glycopyrronium
dry mouth (xerostomia)
- artificial saliva and good oral hygiene
depression
- screening using validated tools
neuropathic pain
- amitriptyline 10mg OD
- gabapentin 300mg BD
- pregabalin 150mg OD
How should haemorrhage strokes be treated?
craniotomy surgery
- allow repair of blood vessels and removal of haematoma
reversal of coagulopathy
- stop anticoagulant treatment
= vitamin K and fresh frozen plasma reverses warfarin
= idarucizumab reverses dabigatran
anti-hypertensives
anticonvulsants
- to reduce risk of post stroke seizures
What are the types of haemorrhagic bleeds and their causes?
subarachnoid bleed
- rupture of a blood vessel leading to bleeding in the subarachnoid space (between arachnid and pia mater)
= caused by cerebral aneurysm where there’s localised dilatation of blood vessels
intracerebral bleed
- rupture of blood vessels leading to bleeding in the cerebrum
= caused by abnormal tangle of blood vessel connecting arteries and veins
