Stroke

• What are some risk factors for a stroke?

  Male

  Diabetes

  Hypertension

  Over 55

  FHx
• How is a stroke managed surgically?

  Carotid artery endarterectomy

  Thromectomy (ischaemic stroke)
• How is a haemorrhagic stroke managed pharmacologically?


  Statins if cholesterol >3.5 mmol/L
• How is an ischaemic stoke managed pharmacologically?

  Thrombolysis with alteplase if present within 4.5 hours of stroke

  300mg aspirin and antiplatelet therapy

  Clopidogrel or aspirin and dipyridamole for secondary prevention
• How is a stroke managed conservatively?

  Maintain: Blood glucose, O2 stats, hydration, temp

  Only lower BP in acute phase (unless complications)
• How is a haemorrhagic stroke managed conservatively?


  Lower BP

  Stop anti coags and antithrombotics

  Reverse any anti coags given
• What are some scans done for a stroke?

  MRI

  CT (rule our haemorrhage before thrombolysis)
• Which bedside investigations can be done for a stroke?

  FAST (Face Arms Speech Time)

  ROSIER assessment

  (exclude hypoglycaemia 1st)
• What does the ROSIER criteria for strokes stand for?


  Recognition of Stroke in the Emergency Room
• What is the ROSIER criteria for stroke?

  Fill in the gaps

  A) LoC

  B) Seizure

  C) Asymmetrical facial weakness

  D) Asymmetric arm weakness

  E) Asymmetric leg weakness

  F) Speech disturbance

  G) Visual field defect

  
• What are some risk factors for a stroke?

  Age

  Hypertension
• What are some risk factors for haemorrhagic stroke?


  Arteriovenous malformation

  Anti coag therapy
• What are some risk factors for ischaemic stroke?


  Smoking

  Diabetes

  Afib

  Hyperlipidaemia
• Why does an ischaemic stroke accur?


  Reduced blood supply to brain tissue
• What are some causes of an ischaemic stroke?


  Thrombosis

  Embolism

  Systemic hypoperfusion and cerebral venous sinus thrombosis
• What are some causes of a haemorrhagic stroke?

  Intracerebral haemorrhage

  Subarachnoid haemorrhage
• Why does a haemorrhagic stroke occur?


  Rupture of blood vessel

  Abnormal vascular structure
• What are the 4 Bamford stroke classification of stroke?


  TACS (total anterior)

  PACS (Partial anterior)

  POCS (posterior)

  LACS (lacunar)
• What 3 criteria must be present to diagnose a TACS stroke?


  Homonymous hemianopia

  Higher cerebral dysfunction

  Hemiparesis and/or sensory deficit
• What criteria must be present to diagnose a PACS stroke?


  2 TACS criteria or higher cerebral dysfunction alone
• Where is affected in a PACS stroke?


  Part of the anterior circulation
• Where is affected in a TACS stroke?


  Areas of brain supplied by anterior and middle cerebral arteries
• Where is affected in a POCS stroke?


  Posterior circulation
• What criteria are needed to diagnose a POCS stroke?


  One of:

  • Bilateral sensory/motor deficit
  • Isolated homonymous hemianopia
  • Cerebellar dysfunction
  • Conjugate eye movement disorder
  • Cranial nerve palsy and contralateral motor/sensory deficit
• What criteria need to be met for a LACS stroke?


  No higher loss of cerebral functions and one of:

  • Pure motor
  • Pure sensory
  • Sensorimotor
  • Ataxic hemiparesis
• Where is affected in a LACS stroke?


  Subcortical stroke

  Secondary to small vessel disease
• What signs and symptoms are seen in a brainstem infarct stroke?


  More severe symptoms (quadriplegia, lock in syndrome etc.)
• What are signs and symtpms of a lacunar infarct stroke?


  Pure motor/sensory

  Sensosorimotor

  Ataxia
• What are some signs and symptoms of a haemorrhagic stroke?


  Headaches

  Seizures

  Nausea and vomiting

  Decreased level of consciousness
• What are some signs and symptoms of a stroke?

  Motor weakness

  Speech problems

  Swalling problems

  VIsual field defects

  Balance problems
• How do you now distinguish TIA and stroke within the first hour?


  Presence of an acute infarction on imaging
• What scoring system is used to quantify disability in stroke?

  Barthel index