Stroke Flashcards

(21 cards)

1
Q

How classify stroke?

A

Oxford classification system

TACS - total anterior

PACS - partial

POCS - posterior

LACS - lacunar

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2
Q

What is more clinically relevant? - i.e. how differentiate artery affected

MCA

ACA

Posterior cerebral artery

What does PCA stand for?

A

MCA - face and arms more than legs, hemiparesis

ACA - legs > face, arms

PostCA - isolated homonymous hemianopia

Posterior communicating artery

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3
Q

Define stroke

A

Sudden neurological event of vascular origin, that does not include subarachnoid haemorrhage.

Deficit lasts >24h…

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4
Q

What proportion are haemorrhages?

How rule this out with imaging?

When is imaging essential?

A

1 in 6

CT head

Before thrombolytic or anticoagulant therapy

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5
Q

First step in management?

Wht Ix?

Look at hand out from study group!!!

A

ABCDE

Investigations -

B - urine dip (? glucose, infx), BM, ECG

B - CRP (vasc), FBC (hyperviscosity/plt), U+E, LFT, CSc (esp if on warfarin), Glucose, Lipids,

I - CT-head is key, + carotid doppler, echo,

O - EEG if epilepsy suspected

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6
Q

How do you manage stroke acutely?

Look at hand out from study group!!!

A

ABCDE

Investigations -

CT head to rule out haemorrhage (infarct only visible at 24h)

Stabilise glucose, don’t reduce BP

NBM until swallow assessed

Keep hydrated ? catheter

explain fully what has happened

Refer to Neuro Reg

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7
Q

What is the overall risk within a year of:

Recurrent stroke

Death

Dependency

Independent living

A

1 in 6

1 in 4

2 in 4

1 in 4

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8
Q

What are features of TACI?

At one year Mortality?

Chance of good recovery to indp living?

A
  1. Hemiparesis - contralateral, severe
  2. Homonymous hemianopia
  3. Higher cortical function defect e.g. Dysphasia, inattention, dyspraxia

60% mortality and 5% independent recovery

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9
Q

Features of PACI?

What is the significant risk?

A

2 out of 3 TACI

Usually: Higher cortical dysfunction + contralateral weakness or sensory loss

Incomplete deficit and risk of recurrence

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10
Q

3 main possibilities that would suggest POCI?

Risk of late recurrence?

What cranial nerve and weakness sign might be seen?

A
  1. Contralateral homonymous hemianopia OR
  2. Cerebellar signs OR
  3. Brainstem signs - Horner’s, conjugate gaze palsy, ipsilateral cranial nerve lesion with contralateral hemiparesis
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11
Q

What features are absent in a LACI?

A
  • No higher cortical dysfunction
  • No homonymous hemianopia
  • No drowsiness
  • No brainstorm signs
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12
Q

What lacunar syndromes are there? 4

A
  1. Pure motor (posterior limb internal capsule)
  2. Pure sensory (posterior thalamus)
  3. Sensorimotor (internal capsule)
  4. Dysarthria-clumsy hand
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13
Q

What are some medical complications of a stroke?

A

Pressure sores

Amongst others…

Aspiration pneumonia

VTE

recurrent ischaemic stroke

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14
Q

When assessing patient disability, what elements form part of the screen? (Think about stroke caused deficits)

A
  • GCS
  • swallow
  • Speech and language
  • Visual fields
  • Gait
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15
Q

Post acute management? (4)

A

Reduce risk factors - e.g.

  • Carotid artery disease >> stent or endarterectomy
  • Drug prophylaxis - daily anti platelets e.g clopidogrel, aspirin, statin and ACEI +- thiazides (aim <130/80)
  • If in AF – warfarin to INR 2-3, depending on chads score…

DC with community care - intermediate care team

GP follow-up

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16
Q

What are the indications for thrombolysis?

A

Acute ischaemic stroke. Benefit if given within 4.5 h (?3)

Main risk is haemorrhage

17
Q

What are the major contraindications to thrombolysis ?

A

Haemorrhagic diathesis

Overt bleeding or haemorrhage on CT

Neoplasm with increased bleeding risk

Pregnancy

Oral anticoagulation (INR > 1.4)

Seizure at stroke onset

Systolic BP > 185 or Diastolic > 110 pre-treatment

18
Q

how manage if present beyond 4.5 hours?

What else to manage?

A

Aspirin 300mg for 2 weeks, then clopidogrel 75mg thereafter

Hyperglycaemia - insulin may be required

Don’t manage BP unless symptomatic

Treat raised temp with paracetamol

19
Q

Risk factors for stroke?

A

Non-modifiable - male, age, FH

CVD risk factor s- BP, Cholesterol, DM, previous MI

Embolus risk - AF, Valvular heart disease, Carotid stenosis

Clot risk - HRT, OCP

20
Q

What scoring system used to assess risk of stroke following TIA?

A

ABCD2 - high risk if >6, ≥5 seen in TIA clinic; >1 episode in last week needs admission

  • Age >60
  • BP > 140/90
  • Clinical features - 2 points for unilateral weakness, 1 point if just speech, 0 if other
  • Duration >60 min is 2, 10-60 is 1
  • Diabetes
21
Q

What factors increase the risk of stroke in AF? (scoring system)

A

CHADS2 VASC

  • > 2 needs oral anticoagulant*
  • > 1 aspirin or oral anticoagulant*

Congestive heart failure

Hypertension

Age > 75 (2 points)

Diabetes

Stroke - Previous Stroke (2 points)

Vascular disease

Age 65-74

Sex (female)