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Description
Flashcards by Hannah Linard, updated more than 1 year ago
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Created by Hannah Linard
over 5 years ago
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| Question | Answer |
| What are the differences between ischaemic and haemorrhagic stroke? | - ischaemic = blockage of blood flow - haemorrhagic = bleeding into the brain from a burst vessel |
| What are the signs and symptoms of stroke | - Motor impairments - Sensory impairments - Speech difficulties/slurred speech - Vision difficulties - Dizziness, loss of balance/unexplained fall - Sudden severe headache - Difficulty swallowing |
| Why is time since onset of symptoms important for determining stroke treatment | - knowing the time from symptom onset makes it easier to determine the amount of damage that has occurred - may also be reversed if within a specific timeframe - may also be able to be thrombolysed (ischaemic) within specific timeframe |
| What is the NIHSS scoring system | - an 11-item clinical evaluation instrument to assess neurologic outcome and degree of recovery: 0-51, where 51 is maximum disability - has different exercises to do and you have to give a score |
| What is the management of haemorrhagic stroke | - If being anticoagulated, patient must be coagulated o Warfarin: fresh frozen plasma and vitamin K o Dabigatran: idarucizumab - Intra-cerebral haemorrhage o Neurosurgical intervention may be undertaken to evacuate cerebral hemispheric haematomas, decompress haematomas of the posterior fossa or insert CSF drainage devices - Sub-arachnoid haemorrhage o Vasospasm and rebleeding are the main causes of morbidity and mortality Induce hypertension and hypervolaemia o Nimodipine IV infusion then oral o Maybe managed with neurosurgical procedures Endovascular coiling or craniotomy and clipping |
| What is endovascular thrombectomy? | - can be used for people who have a blood clot - longer timeframe than thrombolytics |
| What is the timeframe that an endovascular thrombectomy be performed? | - within six hours after symtom onset |
| What is the use of thrombolytics in ischaemic stroke? | - neurons die quickly under ischaemic conditions - thrombolytics will only be of benefit if given relatively soon after symptom onsen - treatment is limited to less than 4.5 hours since onset |
| what are the important disciplinary teams in stroke rehabilitation? | - Physiotherapists - Occupational therapists - Speech pathologists - Dieticians - Social workers |
| Risk factors for stroke and how they are modified | - Risk factors o TIA o Carotid artery stenosis o High blood pressure o High blood cholesterol o Tobacco smoking o Diabetes o High alcohol consumption o Atrial fibrillation o Other heart disease - Primary prevention o Someone who is high risk is avoiding having a stroke - Secondary prevention o Someone who has had a stroke is avoiding having another |
| What is the difference between aspirin, aspirin plus dipyridamole and clopidogrel in stroke prevention? | Aspirin < Aspirin + dipyridamole < clopidogrel - Aspirin does not show sufficient evidence of affecting all-cause or CVD-related mortality, but does have a small benefit for the reduction of non-fatal vascular events - Dipyridamole and aspirin together have a greater reduction in those who die of stroke compared with aspirin - Clopidogrel is just as effective as dipyridamole and aspirin but has a much lower incidence of adverse effects occurring - clopidogrel plus aspirin increases the risk of intracranial haemorrhage and therefore is not recommended for long term use |
| What is the importance of statins in the prevention of ischaemic stroke? | - evidence shows it decreases risk of ischaemic stroke - All patients with ischaemic stroke or TIA with possible atherosclerotic contribution and reasonable life expectancy should be prescribed a high-potency statin - high dose (80mg d atorvastatin) is often prescribed after stroke |
| BP lowering is important in both types of stroke. What are the determinants of antihypertensive selection? | comorbidities NOTE: all patients should have their blood pressure reduced even if below 130/80mmHg |
| Stroke prevention in AF | - anticoagulation o Warfarin o NOAC/DOAC o NOT aspirin |
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