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Flashcards in Stroke Presentation and Investigation Deck (47)
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1

What percentage of NHS beds are occupied by stroke patients?

20%

2

What is a stroke?

A neurological deficit of sudden onset, lasting more than 24 hours, of vascular origin

3

What is a transient ischaemic attack?

A neurological deficit of sudden onset and vascular origin but lasting less than 24 hours

4

What causes stroke?

Occlusion of a blood vessel by thrombus or embolus
Haemorrhage from rupture of a blood vessels

5

What percentage of strokes are ischaemic and what percentage are haemorrhage?

85% ischaemic
15% haemorrhagic

6

What are the symptoms of stroke?

Loss of;
Power
Sensation
Speech
Vision
Coordination

7

What areas of the brain are supplied by the carotid system?

Most of the hemispheres and cortical deep white matter

8

What areas of the brain are supplied by the vertebro-basilar system?

Brain stem, cerebellum and occipital lobes

9

What are the potential causes of a stroke?

Vessel occlusion
Disease of vessel wall
Disturbance of normal properties of blood
Rupture of vessel wall

10

What are the main causes of an ischaemic stroke?

Large artery atherosclerosis (35%)
Cardioembolic e.g. atrial fibrillation (25%)
Small artery occlusion (25%)
Undetermined/cryptogenic (10-15%)
Rarer causes e.g. arterial dissection (<5%)

11

What are the main causes of haemorrhagic stroke?

Primary intracerebral haemorrhage (70%)
Secondary haemorrhage e.g. subarachnoid haemorrhage, arteriovenous malformation (30%)

12

What are the stroke subtypes?

TACS - total anterior circulation stroke
PACS - partial anterior circulation stroke
LACS - lacunar stroke
POCS - posterior circulation stroke

13

What are the features of TACS?

20% of strokes
Patient usually has;
weakness,
sensory deficit,
homonymous hemianopia

and higher cerebral dysfunction e.g. dysphasia

14

What are the features of PACS?

35% of strokes
2 of the 3 TACS criteria (weakness, sensory deficit,
homonymous hemianopia)
or
restricted motor/sensory deficit e.g. one limb, face and hand or higher cerebral dysfunction alone

15

What are the features of LACS?

20% of strokes
Can be pure motor, pure sensory, sensorimotor, or ataxic hemiparesis

16

What are the features of POCS?

25% of strokes
Affects brainstem, cerebellar or occipital lobes
Variable and frequently complex presentation

17

What are the risk factors for stroke?

Hypertension
Atrial fibrillation
Age
Race
Family history

18

What is alteplase?

Firbinolytic agent

19

What can alteplase cause in the brain if there is established tissue damage?

Unexpected bleeding
Can also cause bleeding elsewhere e.g. in the gut

20

Patients admitted with a stroke within 4.5 hours of definite onset of symptoms should be treated with what?

0.9mg/kg intravenous rtPA (alteplase)
IF considered suitable
Onset to treatment should be minimised with earliest possible delivery of IV rtPA within time window

21

When should streptokinase not be used?

For treatment of patients in the acute phase of stroke

22

Where should thrombolysis be administered?

Within an acute stroke service

23

According to NICE guidelines, what should patients with a suspected stroke have?

Ambulance priority in appropriate cases
Rapid triage on hospital arrival
Immediate access to specialist stroke services
Rapid brain imaging
Rapid specialist assessment

24

What are the contraindications to thrombolysis?

Age - most RCTs have excluded < 16 and > 80 y/o
Recent bleeding
Severe hypertension

25

What percentage of patients benefit from admission to a stroke unit in acute stroke treatment?

90%

26

What percentage of patients benefit from thrombolysis within 0-3 hours in acute stroke treatment?

10% ischaemic strokes

27

What percentage of patients benefit from aspirin in 0-48 hours in acute stroke treatment?

65% ischaemic

28

What percentage of patients benefit from hemicraniectomy in acute stroke treatment?

0.5%

29

Why are stroke units beneficial?

Well established evidence that patients do better up to 10 years after admission
Mobilise patients ASAP
Concentrate on simple but important things e.g. swallowing, positioning - swallowing problems present in 50% of stroke patients
Early therapy
Concentrated stroke expertise

30

What is the effect of early mobilising in stroke patients on the probability of them returning home?

Probability of returning home decreases by 20% for each day that the patient is not moved