Stroke Flashcards
What does ABCD2 stand for?
Age >60………………………………….1
BP >90 diastole ……………………..1
Clinical features:
Unilateral weakness……………….2
Speech Imped no weakness …1
Duration (mins)
>60…………………………………………..2
0-59…………………………………………1
<10 =0
Diabetes………………………………….1
What are the relevant scores in ABCD2? & what are the indications?
<4 = minimal risk of stroke
<6= high risk of stroke - start aspirin & see specialist in 24 hours. (clopidogrel/dipyridone)
MRI/CT/Doppler
What does ABCD2 score?
Risk of stroke after TIA
What % strokes are preceeeded by TIA?
15
How long off driving after 1 TIA or multiple?
1 month for 1 TIA, 3 months for multiple
In AF following TIA what is given?
300mg Aspirin or Warfarin
When is an endarcectomy indicated?
> 70% stenosis
What are the causes of ischaemic stroke?
Atherothromboembolism Cardioembolism small vessel disease (lacunar) Arterial dissection (in young people) Hypoperfusion of watershed areas due to hypotension.
What differentiates haemorragic and ischaemic strokes symptoms?
Haem- painful, vomit, drowsiness
Isch- painless
How fast do TIAs resolve?
within 24 hours
What aneurysms contribute to intracerebral bleeds & what does it affect?
Charcot Bouchard- Basal Ganglia
What bloods are done in suspected stroke?
FBC ESR Ca++ U&E Cr LFT Glucose Thyroid Cholesterol Clotting Screen Thrombophilias Blood Cultures Lactate Homocysteine Cardiac Enzymes
What investigations in stroke?
CT (T2 weighted) (if doesnt show) MRI ECG Bloods Carotid Doppler Echo TOE
Symptoms of an anterior circulation stroke
Amaurosis fugax (transient monocular vision loss) Hemiparesis Hemisensory loss Hemianopia Aphasia/dysphasia Facial droop Brocca's area (motor defect)
Symptoms of a posterior circulation stroke
Ataxia Cranial Nerves (Diplopia, facial sensory defecit, LMN facial palsy) Dysphasia & Dysarthria Contralateral Hemiparesis Hemisensory loss Vertigo Contralateral homonymous hemianopia Cortical blindness Tertraplegia
Where does the posterior circulation supply & what is the main vessel?
Vertebrobasilar
Supplies brainstem
Symptoms of Lacunar Strokes
Pure motor Pure sensory (thalamus) Ataxic hemiparesis (Pontine)
Holistic management of a stroke includes:
SALT (NG/PEG) BP/O2/glucose Oral candidiasis management Physio & OT Specialist nursing Family support groups SSRI (depression) Compression stockings Keep head at 30 degree tilt
Pontine stroke
Tetraplegia
Small pupils
Coma
Capsular stroke
Hemiplegia & decreased conciousness
Cerebellar Stroke
Ipsilateral ataxia
Acute management of Ischaemic Stroke
- CT to exclude haemorrhage
- If withing 4.5 hour window (90 min particularly) THROMBOLYSE (Alteplase) & delay aspirin 24 horus
- If not thrombolysed 300mg Aspirin (or Clopidogrel if intolerant)
- 75 mg Aspirin daily
- If AF start LMWH.
Contraindications for thrombolysis
On anticoagulants Liver disease Recent arterial puncture Recent LP Clotting disorder Cancer Stroke in last 3 months INR <1.7
Primary prevention of Ischaemic stroke
Risk factors: Cholesterol Smoking Diabetes BP AF
