Stroke Flashcards
(48 cards)
2 main types of stroke
ischaemic 85% (TIA if <24hr, ischaemic stroke if >24hr)
haemorrhagic 15%
subtypes of ischaemic stroke?
thrombotic
embolic (AF big risk factor)
subtypes of haemorrhagic stroke?
intracerebral haemorrhage
SAH
risk factors for
1) ischaemic
2) haemorrhagic
stroke
1) cardiovascular: age, hypertension, smoking, hyperlipidaemia, DM
2) age, hypertension, AVM, anticoagulation therapy
what is stroke (WHO defintion)
rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin
symptoms of a cerebral hemisphere infarct?
contralateral hemiplegia (flaccid then spastic)
contralateral sensory loss
homonymous hemianopia
dysphasia
symptoms of brainstem infarction?
may have more severe symptoms including quadriplegia and lock-in syndrome
what are lacunar infarcts?
small infarcts around the basal ganglia, internal capsule, thalamus and pons
symptoms of lacunar infarcts?
pure motor, pure sensory, mixed motor and sensory signs or ataxia
what 3 criteria is the oxford stroke classification system based on?
1) hemiplegia or hemi-sensory loss in face, arm and leg
2) homonymous hemianopia
3) high cognitive deficit e.g. aphasia
what 3 criteria is the oxford stroke classification system based on?
1) unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2) homonymous hemianopia
3) higher cognitive deficit e.g. dyphasia
Total anterior circulation infacts (TACI)
1) involves which cerebral arteries
2) which oxford stroke classification criteria are present?
1) middle and anterior
2) all 3
Partial anterior circulation infacts (PACI)
1) involves which cerebral arteries
2) which oxford stroke classification criteria are present?
1) small arteries of anterior circulation e.g. upper or lower division of MCA
2) just 2
.
.
Lacunar infarcts (LACI)
1) involves which cerebral arteries
2) presents how?
1) perforating arteries around internal capsule, thalamus and basal ganglia
2) 1 of:
- unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
- pure sensory stroke
- ataxic hemiparesis
Posterior circulation infarcts (POCI)
1) involves which cerebral arteries
2) which oxford stroke classification criteria are present?
1) vertebrobasilar arteries
2) 1 of:
- cerebellar or brainstem syndromes
- LOC
- Isolated homonymous hemianopia
Whilst symptoms alone cannot be used to differentiate haemorrhagic from ischaemic strokes, patients who’ve suffered haemorrhages are more likely to have:
decreased LOC
HA, N&V, seizure
why is neuroimaging urgently indicated in stroke?
to classify as either ischaemic or haemorrhagic and thereby determine whether thrombolysis can be done
what is the criteria for offering thrombolysis in stroke?
must administer within 4.5hrs of onset of symptoms
haemorrhage has been definitively excluded (i.e. imaging)
once haemorrhagic stroke has been excluded patients should be given what medication?
300mg aspirin
immediate management of TIA?
aspirin 300mg (unless contraindicated)
referral pathway
1) if patient has had suspected TIA in last 7 days
2) if patient has had suspected ITA more than 1 week previously
1) urgent assessment within 24hr by stroke specialist
2) urgent specialist assessment within 7 days
T/F: the vast majority of patients with haemorrhagic stroke will undergo surgical intervention
false - most not suitable for surgical intervention
management of haemorrhagic stroke?
supportive
- stop anticoagulants and antithrombotics e.g. clopidogrel
- reverse anticoagulation asap
