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Flashcards in Stroke Deck (23)
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1
Q

What is a stroke?

A

Rapidly developing clinical symptoms and/or signs of focal and at time global loss of brain function with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin

2
Q

What are important facts to elicit in clinical assessment of a stroke?

A

Time of onset
What were/are symptoms
How did they progress

3
Q

What are some common stroke mimics?

A
Seizure
Sepsis 
Toxic/metabolic
Space occupying lesion
Pre syncope
Acute confusion/ delirium
Vestibular dysfunction 
Functional 
Dementia
4
Q

What is the rosier score?

A

If there has been a loss of consciousness or seizure activity you lose a point
Add a point for asymmetric facial, arm and leg weakness, speech disturbance and visual field defect

5
Q

What are the 3 branches of stroke?

A

Haemorrhage
Subarachnoid haemorrhage
Infarct

6
Q

What are the different types of haemorrhagic stroke?

A

Structural abnormality such as arteriovenous malformation
Hypertensive
Amyloid angiopathy

7
Q

What are the different types of infarct stroke?

A

Cardioembolic - AF
Small vessel
Atheroembolic
Other

8
Q

What is the 1st line investigation for a stroke?

A

CT head

9
Q

What should be done if there is nothing on CT but clinically a stroke is still suspected?

A

MRI - infarct which is more common than haemorrhagic takes a while to show on CT as it shows as oedema etc whereas MRI is much more sensitive

10
Q

When will a CT become insensitive to blood on the brain?

A

After 1 week - late presentation

11
Q

What is the management of a stroke?

A
Thrombolysis 
Thrombectomy
Imaging
Swallow assessment
Nutrition and hydration 
Antiplatelets
Stroke unit care
DVT prevention
12
Q

What are things to thing about before thrombolysis?

A
Age
Time since onset
Previous intracerebral haemorrhage or infarct
Atrophic changes
BP
Diabetes
Potential benefit
13
Q

What are commonly used thrombolysis drugs?

A

tPA

Alteplase

14
Q

Why MUST you do a CT head before thrombolysis?

A

If haemorrhagic - DO NOT thrombolyse. Will make it MUCH worse

15
Q

What time frame impacts the administration of IV tPA?

A

Limited to <4.5 hours from onset of symptoms

16
Q

What is the recommended antiplatelet therapy post stroke?

A

Aspirin 300mg ASAP after stroke

Wait 24 hours if been thrombolysed

17
Q

What is the recommended DVT prophylaxis post stroke?

A

Intermittent pneumatic compression

LMWH has showed little benefit that is outweighed by bleeding risk

18
Q

How is dysphagia managed?

A

Initial swallow screen
If abnormal then assessment by a speech and language therapist
May require NG tube placement ot textured diet

19
Q

What is the commonest complication post stroke?

A

Aspiration pneumonia from dysphagia

20
Q

What is a TIA?

A

A brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia with clinical symptoms typically lasting less than one hour and without evidence of infarction

21
Q

What is done at the rapid access TIA clinic?

A
History
Carotid imaging
ECG
Blood test
Aspirin +/- clopidogrel
Statin
22
Q

How is a haemorrhagic stroke treated?

A

If presentation within 6 hours and there is a systolic BP above 150 mmHg then it should be treated with either IV GTN or IV labetolol

23
Q

How are anticoags reversed?

A

Vit K/ prothrombin for warfarin
Specific antidotes for DOACs
Tranexamic acid