stroke Flashcards
(28 cards)
what is a sign of a MCA stroke?
Hyperdense MCA sign- early sign of an ischaemic stroke
what are the complications of stroke?
cerebral oedema and haemorrhage -will show htn, new signs, GCS Aspiration Depression Reduced cognition
what are the investigations for stroke?
Ct first to distinguish is ischaemic or haemorrahgic
MRI to find exact location –DWA (diffuse weighted) is very accurate
Carotid doppler US if carotid suspected
CT angio if coronary artery suspected- if thrombectomy indicated
If unprovoked look for connective tissue disorder
Blds, chol, sugars
how do you classify between total and partial anterior stroke (using bamford criteria)?
for total all 3, for partial 2 of:
unilateral weakness
homonmous heminopia
higher cerebral dysfunction- dyshasia, visuospatial problems
What is the different type of lacunar stroke according to bamford criteria for a lacunar syndrome?
one of: Lacunar infarcts (LACI, c. 25%) involves deep perforating arteries around the internal capsule, thalamus and basal ganglia presents with 1 of the following: 1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three. 2. pure sensory stroke. 3. ataxic hemiparesis 4. sensory-motor stroke
What is the criteria for a posterior circulation stroke?
one of: cranial nerve palsy with contralateral motor or sensory deficit bilateral motor or sensory deficit eye movement disorder isolated homonymous heminopia cerebellar dysfunction- DANISH brainstem dysfucntion
What is the management for stroke
Thrombolysis for ischaemic stroke
- in 4.5 hrs
- use rTPA- recombinant tissue plasminogen activator eg alteplase- improves independence rates. Haemorrhage occurs in 1 in 20
carotid stenosis (buildup of fatty plaques in carotid arteries)- endectomy recommended in two weeks by NICE
thrombectomy is gold standard treatment
Stop driving for four weeks
Give aspirin 300mg then switch to clopidogrel after two weeks. If they have AF give warfarin/ apixaban
preventions ie statin and BP control and DM control
How does carotic dissection normally present?
Usually young, can be unprovoked, due to trauma/ vessel weakness, can be due to sympathetic NS eg Horner’s
Classically if when head is pulled back eg at barbers, have headache, neck pain, ptosis, constricted pupil
Describe haemorrhagic stroke
Management is to aim for 140 systolic
Roughly 15% of strokes
Usually due to htn but can be due to amyloidosis
Describe bells palsy
If patient only has unilateral facial weakness it is likely. NOT FOREHEAD SPARING –UPPER SPARES UPPER and is lmn
Occurs post infection
What is features the ABCD2 score?
Age 60+
BP 140/90+
Clinical features: unilateral weakness, speech disturbance
Diabetes
Duration symptoms
(over 60 = 2 points, 10-59 mins - 1 point)
What is ABCD2 for?
Assessment probability of stroke in next 24 hours post TIA
What is the criteria for CHA2DS2Vasc?
CHF Htn Age 75+ Diabetes Stroke/TIA/thromboembolism Vascular diease Age 65-74 Sex - Female
What is CHADSVasc for?
risk of stroke if have AF and whether should give warfarin.
What is a CT angio good for?
Angio good for vessel blockage/stenosis/dissection- the infarct will be distal to this point. Small strokes may be normal
What is a posterior circulation stroke?
occipital/ brainstem/cerebellum stroke usually emboli from heart/vertebral/basilar arteries- dissection can be cause especially if young and have intense job
What cardiac infection is linked to strokes?
Infective endocarditis
How do we investigate IE?
Remember to check blood cultures and use Duke’s criteria
What might be the cause of unilateral visual loss in sroke?
amaurosis fugax- due to retinal artery/ophthalmic artery atherosclerosis or embolism from the heart.
How do we treat amaurosis fugax?
Treat with carotid enterectomy or stent ASAP
What is Todd’s paresis?
It is associated with epileptic seizure, that causes temporary neurological deficit of weakness
What is the process for a nasogastric tube?
When put in a NG tube first test pH of aspirate in tube before every use of the tube and after insertion. If there is no aspirate or pH is more than 5.5 (not acidic enough to be sure is in stomach) then you need to do CXR.
MCA vs ACA
leg involved in ACA MCA doesnt involve leg
mx of TIA?
ABCD2
Immediate antithrombotic therapy: give aspirin 300 mg unless pt has bleeding disorder/ on anti-coag or other CI
FOLLOW UP:
1st line: clopidogrel
2nd line: Modified-release dipyridamole in combination with aspirin
Everyone with TIA who after specialist assessment is considered as a candidate for carotid endarterectomy should have urgent carotid imaging.
carotid stenosis of 50% to 99% according to the NASCET criteria: are assessed and referred urgently for carotid endarterectomy to a service following current national standards
