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Core conditions Olivia MD > Stroke > Flashcards

Flashcards in Stroke Deck (26):
1

what are the risk factors for stroke?

AF, hypertension, hypercholesteraemia, smoking, diabetes CVD,

2

how do we accurately distinguish between ischaemic and hemorrhagic stroke?

imaging- CT and MRI

3

what are the 3 main types of stroke?

ischaemic, haemorrhagic and subarachnoid haemorrhage

4

what are some subtypes of ischaemic stroke? Note there are 5

1. Large artery thromboembolism
2. Cardiogenic embolism (AF!!)
3. Small vessel lacunar infarction
4. Rarer causes (patent foramen ovale)
5. Cryptogenic

5

What are the subtypes of haemorrhagic stroke? there are 2 subtypes

primary intracerebral and deep hypertensive

6

how do we accurately distinguish between ischaemic and hemorrhagic stroke?

CT brain effectively determines whether it is haemorrhagic or ischaemic. MRI (diffusion weighted) gives a better picutre for ischaemic stroke

7

what is the main cause of hemorrhagic stroke?

hypertension

8

what is the time frame for thrombolysis?

Less than 4.5 hrs

9

what thrombolytic agent do we use?

alteplase.

10

Should aspirin be used in acute stroke management?

Yes, Aspirin has a modest benefit when administered within 48 hours of acute ischaemic stroke, and should be used routinely. It should not be given until brain imaging excludes intracranial haemorrhage. If the patient has received alteplase, withhold aspirin for 24 hours and commence after follow-up imaging excludes haemorrhage

11

should anticoagulants be used in acute stroke management?

No, Anticoagulation with warfarin or full therapeutic doses of unfractionated heparin, low molecular weight heparin or danaparoid should be avoided in acute ischaemic stroke. Studies show that the reduction in recurrent stroke is offset by an increased rate of haemorrhage. However, if the patient is immobilised by stroke, then may use LMWH for VTE prophylaxis

12

should anticoagulants be used in acute stroke management?

No, Anticoagulation with warfarin or full therapeutic doses of unfractionated heparin, low molecular weight heparin or danaparoid should be avoided in acute ischaemic stroke. Studies show that the reduction in recurrent stroke is offset by an increased rate of haemorrhage. However, if the patient is immobilised by stroke, then may use LMWH for VTE prophylaxis

13

how might we prevent a stroke from happening again?- medical management

Aspirin or clopidogrel can be prescribed. Warfarin if the patient has AF. Reduce blood pressure with anti-hypertensives, and reduce cholesterol levels with statin

14

how might we prevent a stroke from happening again?- medical management

Aspirin or clopidogrel can be prescribed. Warfarin if the patient has AF. Reduce blood pressure with anti-hypertensives, and reduce cholesterol levels with statin

15

what are some rare causes of stroke?

bacterial endocarditis, cerebral venous thrombosis, arterial dissection and patent foramen ovale and DVT

16

what is the definition of a TIA?

TIA is a transient episode of neurological dysfunction caused by focal brain or retinal ischaemia, without infarction. When there is evidence of brain infarction, the episode is considered to be a mild stroke

17

what is the NISS score? what is the highest score possible?

A score that is done pre and post intervention that gives clinicians a better idea of clinical prognosis
42 is the highest score and indicates severe stroke and poor prognosis

18

what is the time frame for clot retrieval? how is it done?

Ideally around 6 hrs after tPA, although can extend up to 12 hours. The catheter and balloon is inserted through the femoral artery.

19

what are the chances that clot retrieval may cause further damage with micro-clots?

2-5% chance

20

how might we investigate a cerebral aneurysm?

Digital subtraction angiography-
DSA is the most accurate test for visualising aneurysms and should be carried out once the diagnosis of SAH is made based on CT and/or LP results. It also needs to be performed if suspicion is still high despite inconclusive CT and/or LP results or repeated, within the 15 days following SAH, if the suspicion of an aneurysm still remains

21

where do we normally see hemorrhagic lesions due to HT in the brain?

cerebellum
basal ganglia
brainstem

22

what type of stroke can amyloid angiopathy lead to?

hemorrhage

23

where is the lesion that causes visual neglect

left parietal lobe usually

24

what is the blood supply to the midbrain?

PCA (deep branch) + basilar

25

what is the blood supply to the pons

PICA + basilar

26

what is the blood supply to the medulla

vertebral and spinal arteries