Flashcards in Stroke Presentation and Investigation Deck (47)
What percentage of NHS beds are occupied by stroke patients?
What is a stroke?
A neurological deficit of sudden onset, lasting more than 24 hours, of vascular origin
What is a transient ischaemic attack?
A neurological deficit of sudden onset and vascular origin but lasting less than 24 hours
What causes stroke?
Occlusion of a blood vessel by thrombus or embolus
Haemorrhage from rupture of a blood vessels
What percentage of strokes are ischaemic and what percentage are haemorrhage?
What are the symptoms of stroke?
What areas of the brain are supplied by the carotid system?
Most of the hemispheres and cortical deep white matter
What areas of the brain are supplied by the vertebro-basilar system?
Brain stem, cerebellum and occipital lobes
What are the potential causes of a stroke?
Disease of vessel wall
Disturbance of normal properties of blood
Rupture of vessel wall
What are the main causes of an ischaemic stroke?
Large artery atherosclerosis (35%)
Cardioembolic e.g. atrial fibrillation (25%)
Small artery occlusion (25%)
Rarer causes e.g. arterial dissection (<5%)
What are the main causes of haemorrhagic stroke?
Primary intracerebral haemorrhage (70%)
Secondary haemorrhage e.g. subarachnoid haemorrhage, arteriovenous malformation (30%)
What are the stroke subtypes?
TACS - total anterior circulation stroke
PACS - partial anterior circulation stroke
LACS - lacunar stroke
POCS - posterior circulation stroke
What are the features of TACS?
20% of strokes
Patient usually has;
and higher cerebral dysfunction e.g. dysphasia
What are the features of PACS?
35% of strokes
2 of the 3 TACS criteria (weakness, sensory deficit,
restricted motor/sensory deficit e.g. one limb, face and hand or higher cerebral dysfunction alone
What are the features of LACS?
20% of strokes
Can be pure motor, pure sensory, sensorimotor, or ataxic hemiparesis
What are the features of POCS?
25% of strokes
Affects brainstem, cerebellar or occipital lobes
Variable and frequently complex presentation
What are the risk factors for stroke?
What is alteplase?
What can alteplase cause in the brain if there is established tissue damage?
Can also cause bleeding elsewhere e.g. in the gut
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
When should streptokinase not be used?
For treatment of patients in the acute phase of stroke
Where should thrombolysis be administered?
Within an acute stroke service
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
What are the contraindications to thrombolysis?
Age - most RCTs have excluded < 16 and > 80 y/o
What percentage of patients benefit from admission to a stroke unit in acute stroke treatment?
What percentage of patients benefit from thrombolysis within 0-3 hours in acute stroke treatment?
10% ischaemic strokes
What percentage of patients benefit from aspirin in 0-48 hours in acute stroke treatment?
What percentage of patients benefit from hemicraniectomy in acute stroke treatment?
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
Concentrated stroke expertise