Stroke & TIA Flashcards
What are the 4 main causes of Stroke?
Cerebral microangiopathy/small blood vessel occlusion
Cardiac Emboli (from AF, endocarditis, MI)
Atherosclerotic thrombotic emboli (from carotid artery)
Haemorrhage (Inc BP, aneurysm, trauma, anticoagulation)
Modifiable Risk Factors for stroke
BP control, Smoking, Diabetes, Cholesterol, Heart Disease (valvular, ischaemic and AF), PVD, Carotid bruit, Inc PCV, The pill.
What are the pointers to haemorrhage
Meningism, Severe Headache, Coma within hours.
CT scan showing for haemorrhage:
Initially dark grey on CT overtime becomes black.
What are the pointers to Infarct.
Carotid bruit, AF, Past TIA IHD.
3 types of infarcts and %?
Cerebrum infarcts (50%) Brainstem infarcts (25%) Lacunar infarcts (25%)
What % of strokes are infarcts and haemorrhage?
15% - Haemorrhage
85% - Ischaemic
What % of Ischaemic strokes become Haemorrhagic?
33% 1/3 of ischaemic strokes.
- ) Most common brain stem stroke?
2. ) How do you interpret brain stem strokes?
- )Lateral medullary syndrome]
2. ) Rule of 4.
- ) What are Lacunar Infarcts?
2. ) What structures do they effect?
1.) Small occlusions of distal arteries.
Usually clinically silent, however over time repeated offences can cause vascular dementia.
Brain Stroke Syndromes
- ) Middle Cerebral Artery
- ) Posterior Cerebral Artery
- ) Anterior Inferior Cerebellar Artery
- ) Posterior Inferior Cerebellar Artery
- ) Basilar Artery
- ) Vertebral Artery
1.)
Ataxic Hemiparesis
Gerstmann Syndrome (Gerstmann Syndrome)
Middle Cerebral Artery - Inferior Division
Middle Cerebral Artery - Superior Division
2.)
Posterior Cerebral Artery - Unilateral Occipital
Thalamic Pain Syndrome
Weber Syndrome
3.)
Lateral Pontine Syndrome
4.)
Lateral Medullary Syndrome
5.) Ataxic Hemiparesis Cortical Blindness Inferior Medial Pontine Syndrome Lateral Pontine Syndrome Locked-in Syndrome Medial Medullary Syndrome Ventral Pontine Syndrome Ventral Pontine Syndrome
6.)
Lateral Medullary Syndrome
Medial Medullary Syndrome
Management: Acute
Protect airway
Pulse, BP and ECG - Is it an embolus from AF?
Blood glucose - 4-11mmol/l
Urgent CT/MRI - IF:
Thrombolysis considered
Cerebellar stroke
Unusual presentation OR HIGH risk of Haemorrhage (from Hx):
Meningism, severe headache, Dec GCS, Inc ICP, anti-coagulated, PMH of bleeding.
Otherwise imaging can wait.
Thrombolysis:
if <4.5 hours and no Contraindications exist.
IV tpa - tissue plasminogen factor. 0.9mg/kg over 1hr.
Always do CT 24 hours post tpa treatment.
C/I: Recent birth, surgery, trauma. Major infarct or Haemorrhage on CT INR > 1.7 or on Anticoagulants. Aneurysm Past CNS bleeds Platelets <100 Severe liver disease, varices, portal hypertension
Primary prevention of Stroke
Secondary prevention of stroke
PRIMARY No Smoking. Lipids - Statins. Folic acid (reduces Homocysteine), Exercise (Glucose tolerance and HDL inc) DM - control of glucose - medication. AF or Prosthetic heart valve on left --> Anticoagulants.
SECONDARY
Control RiskF’s as above.
Medications, assuming no haemorrhage: Clopidogrel.
- ) Tests for cause of stroke
- ) Prognosis
- ) complications
Hypertension (don’t treat in acute setting)
ECG - look for AF
CXR - Large left atrium.
Echo - Post MI or Valvular disease, mural thrombus from AF.
Carotid doppler - artery stenosis >70% is significant.
2.) 60,000/year die. Mortality 20% at one month <10%/year. Full recovery - <40% Drowsiness - poor prognosis.
3.) aspiration pneumonia - Keep nil by mouth.
pressure sores
constipation
After Stroke Care
Enablement Approach
6 points of early management
Swallowing, falls risk, bladder and bowel, minimise spasticity, time taken to sit up, emotional liability.
Tests Perceptual function - name body part Spatial ability - matching matchsticks Apraxia - copying a clock. Agnosia - picking objects. Depression - screen for it.
Physio
End of life decisions
