stroke Flashcards
(58 cards)
Bamford classification of stroke
TACS
PACS
Lacunar (pure sensory or motor, affects face arms and legs usually)
TACS vs PACS
TACS = 3/3:
Homonymous hemianopia
Hemiplegia
HIgher cortical dysfunction e.g. dysphasia, sensory or visual neglect
PACS = 2/3
What additional thing to test if left sided weakness i.e. right sided lesion
Test for neglect
What additional thing to test if right sided weakness ie left sided lesion
Speech/language
Broca’s and wernicke’s relevance
Broca’s (Frontal lobe) = expressive dysphasia
Wernicke’s (temporal lobe) = receptive dysphasia
stroke and TIA definition
rapid onset focal neurological deficit due to vascular lesion lasting > 24h for stroke and < 24h for TIA
Which body part more affected in ACA and MCA stroke
ACA: Legs > arms/face
MCA: Face + arms > legs
POCS features
cerebellar features usually/ pure visual loss/ brain stem
stroke features on inspection
Walking aids
NG tube/ PEG tube
Fixed deformities (flexed upper and extended lower)
Splints (Wrist or ankle)
Features on inspecgion/examination of cranial nerves
UMN sign - often facial weakness, homonymous hemianopia
On inspection of speech
dysarthria (spastic) or dysphasia (Expressive or receptive)
On examination of limbs
ANy UMN signs and reduced sensation
What would you offer to examine at the end of your examination?
Bedside swallow assessment
Fundoscopy (hypertensive and diabetic retinopathy)
HIgher cortical functions e.g. sensory or visual inattention
Cognition (MOCA)
CVS exam - pulse (AF), carotids for bruits, BP, murmurs
Stroke investigations acutely
Bedside:
Urine dip (glucose, protein, blood)
CBG
ECG: AF
Bloods: routine and cardiac risk factors, vasculitis screen if young stroke
CT Head
CTA if eligible for thrombectomy
Carotid dopplers
What would you do in the case of an acute stroke
“I would ensure this patient is medically stable and perform an A-E assessment. I would ascertain the history to see if they are within the window for thrombolysis (4.5 hours) or thrombectomy (24h).
I would then calculate their NIHSS score and arrange an urgent CT head and CT angiogram. I would also contact the thrombolysis/HASU.”
Useful statement when presenting examination findings in suspected stroke
“Asymmetrical pattern of pyramidal weakness”
WHy would you do a cranial nerves exam in a patient with stroke?
Looking for homonymous hemianopia
Stroke investigations (Chronic)
24h/7-day holter
lipids, statins, BP
Carotid dopplers (would not need this if already had a CTA)
Extra investigations in young stroke (< 55)
Clotting screen, vasculitic screen
MRA if ? dissection
Bubble echo
Acute management of stroke
A-E
Check if eligible for thrombolysis/thrombectomy
NIHSS
CTH/CTA
Liaise with thrombolysis team/HASU
Thrombolysis
Following above
Aspirin 300mg for 2 weeks followed by clopi/anticoag if AF
Referral to specialist multidisciplinary stroke unit
DVT prophylaxis
Chronic stroke management
Possible referral for carotid endarterectomy if anterior circulation stroke and stenosis > 70%
MDT (neuro stroke specialist, neruo physio, OT, dietitian, SALT, GP, psychologist)
Management of CVS Risk factors (BP, diabetes, hyperlipidaemia)
Swallow assessment +/- NG/PEG feeding
OT/PT
Dietitian
SALT
No driving for 4 weeks
What DVT prophylaxis should be used in storke patients?
IPC
NOT LMWH OR TEDS
Hemorrhagic stroke management
if < 6 hours, manage bP with systolic target 140-150
Complications of stroke
Malignant MCA syndrome
Haemorrhagic transformation
Re-infarction
Hydrocephalus (in haemorrhagic)
Seizures
Stroke specific:
- Aspiration
- Incontinence
- Hypertonia and pain
- PE/DVT
