Stroke Flashcards
Stroke Causes (2) (2) (4)
Haemorrhagic
Subarachnoid
Intracerebral
Ischaemic (inadequate blood supply) Shock Atherosclerosis Thrombus/embolism Vasculitis
Stroke management (6)
CT/MRI within 1hr to rule out haemorrhage
Diffusion weighted MRI = gold standard
Antiplatelets - once HS excluded, 300mg aspirin for 2 weeks, then clopidogrel
Thrombolysis - as soon as HS ruled out, within 4.5hrs of onset, <90mins = best outcome (alteplase)
24hr CT post lysis
Thrombectomy - additional benefit for large artery occlusion, proximal anterior circulation
Screen swallow - NBM until this is done
Admit to stroke unit - better outcomes with MDT
Stroke MDT
Physios Social workers Nutrition SALT OT
Stroke risk factors
Diabetes CVD HTN Smoking Carotid bruit Increased alcohol use AF
Stroke preventions
Control risk factors
Lower HTN and lipids
Antiplatelets for AF
Post stroke aspirin, clopidogrel
Stroke prevention tests
HTN - retinopathy, neohropathy, cardiomegaly
Emboli - 24hr ECG, CXR (enlarged left atrium), trans oesophageal echo
Carotid artery stenosis - carotid Doppler, CT/MRI angiography, carotid endarterectomy
TIA definition
Transient Ischaemic Attack
Transient neurological dysfunction
Ischaemia without infarction
<24hrs
TIA tests (7)
FBC, ESR, U&Es, lipids
CXR
ECG
Doppler
CT
Diffusion weighted MRI
Echo
TIA treatment (4)
Control CV risk factors
Antiplatelets
Anticoagulants
Carotid endarterectomy
What is the ABCD2 score?
Used following TIA to assess stroke risk
Age >60 years = 1 point
Blood pressure >140/90 = 1 point
Clinical features
- unilateral weakness = 2 points
- speech disturbances w/o weakness =1 point
Duration of symptoms
- >1hr = 2 points
- 10-59 mins = 1 point
Diabetes
>/= 4 = assessed within 24hrs >/= 6 = strongly predicts stroke within 2 days
What is the Bamford Stroke Classification?
Classification of stroke based on presenting symptoms and signs
What is a TACS?
Total Anterior Circulation Stroke
Large cortical stroke affecting areas of brain supplied by BOTH middle and anterior cerebral arteries
All three required:
Unilateral weakness (and/or sensory deficit) of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospacial disorder)
What is a PACS?
Partial Anterior Circulation Stroke
Only part of anterior circulation affected
Two of the following required:
Unilateral weakness (and/or sensory deficit) of face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospacial disorder)
What is a POCS?
Posterior Circulation Stroke
Posterior circulation - cerebellum and brain stem
One of the following required:
Cranial nerve palsy and contra lateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder
Cerebellar dysfunction (vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
What is a LACS?
Lacunar Stroke
Subcritical stroke secondary to small vessel disease
No loss of higher cerebral functions
One of the following required:
Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis
