What is stroke?
Infarctions or bleeding into the brain manifests c sudden onset focal CS sign
What is TIA
- Sx in TIA resolve in 24hrs (old definition)
- transient neurological dysfunction secondary to ischaemia without infarction
What is Cresendo TIA?
- multiple recurrent episodes of TIA occuring over hours to days
What are the two types of stroke?
- Ischaemic stroke (majority)
- thrombotic
- embolic
- hypoxic
- Haemorrhagic stroke
What are the causes of stroke?
Ischaemic
- atherosclerosis
- fibromuscular dysplasia
- vasculitis
- AF
- paradoxical embolus
- septic shock
- drowning
Haemorrhagic
- intracerebral
- subarachnoid
What are the RF for stroke?
- HTN
- smoking
- DM
- PVD
- Heart Disease
- Hypercholesterolaemia
- alcohol
- syphilis
What are the general sx for stroke?
* they all occur sudden onset
- Facial drooping
- limb weakness
- Speech difficulties
*
What tool can be used for rapid recognition of stroke?
FAST tool
- F: facial drooping
- A: arm weakness
- S: speech difficulties
- T: time - call 999
What tool can be used to rapidly diagnose stroke in the emergency department?
Recognition of stroke in emergency room (ROSIER)
- anything
Using the Oxford classification of stroke, how would you diagnose Total Anterior Circulation Stroke TACS?
All three
- Unilateral weakness and/or sensory deficit of face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Using the Oxford classification of stroke, how would you diagnose Partial Anterior Circulation Stroke PACS?
2 of
- Unilateral weakness and/or sensory deficit of face, arm and leg
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphasia, visuospatial disorder)
Using the Oxford classification of stroke, how would you diagnose Posterior Circulation Syndrome POCS?
1 of
- Cerebellar/brainstem syndrome
- Loss of consciousness
- Isolated homonymous hemianopia
Using the Oxford classification of stroke, how would you diagnose Lacunar Syndrome LACS?
1 of
- unilateral weakness and/or sensory deficit of face, arm, leg
- pure sensory stroke
- ataxic hemiparesis
What are the sx for cerebellar occlusion?
*remember DANISH
- Dysdiadochokinesia
- Ataxia
- Nystagmus
- Intention tremor
- Slurred speech
- Hypotonia
Why do you get macula sparing in POCS?
- macula area supplied by MCA
How would you mx TIA?
Initial
- 300mg aspirin daily
- secondary prevention for heart disease
- refer to stroke specialist within 24 hrs of sx
Imaging
- MRI - determine teritory of sichaemia or detect haemorrhage
*
What medications are used for the secondary prevention of stroke?
- clopidogrel 75mg OD
- Artovastatin 80mg OD
*
How would you initially mx stroke?
Initial
- admit to specialist stroke centre
- exclude hypoglycaemia
- immediate non enhanced CT brain - exclude haemmorhage
- aspirin 300mg - continued for 2 weeks
How would you pharmacologically and surgically mx stroke?
- Alteplase
- start within 4.5 hours onset pf sx
- intracranial haemorrhage has been excluded
- Thrombectomy
- offered within 6hrs of sx onset
- occlusion confirmed on imaging
What is the imaging sequence for pt c stroke?
- non-enhanced CT
- CT contrast Angiography - if thrombectomy needed
- CT perfusion/MRI if thrombectomy needed beyond 6hrs
What is the NIH Stroke Scale?
- Diagnostic method of providing quantitative measure of stroke-related neurologic deficit
What to be aware when administering Alteplase with ACEi?
- risk of Angiodemea
What medication is used to control BP in stroke pt?
- Labetelol
