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Flashcards

Stroke

Hannah Linard English 26 cards

Stroke

Cards in this deck (26)

  1. 1What is a stroke?Neurologic dysfunction caused by the interruption of the blood supply to the brain, usually because a blood vessel is blocked by a clot or bursts
     ischaemic and haemorrhagic strokes account for about 80% and 20% of cases, respectively
     haemorrhagic strokes have a much higher fatality rate
     also referred to as a cerebrovascular accident (CVA)
     symptoms of stroke persist for longer than 24hrs after onset
     symptoms lasting less than 24hrs are referred to as a Transient Ischaemic Attack (TIA)
  2. 2What is a transient ischaemic attack (TIA)?Temporary neurologic dysfunction caused by a
    5
    vascular occlusion
    traditional definition is symptoms lasting less than 24hrs
     normally last less than 1hr
     patients often present to the doctor hours or days after the symptoms
    have resolved
     less than 1 in 6 patients who have symptoms that have lasted for greater than 1 hour will have their symptoms fully resolve by 24 hours
    new imaging techniques are changing the definition
     a transient episode of neurological dysfunction without acute infarction
    people who have had a TIA are at high risk of further events
  3. 3What is the difference between a ischaemic and haemorrhagic stroke?- ischaemic = blockage in vessel
    - haemorrhagic = bleed in the brain caused by an aneurism or weakened blood vessel
  4. 4What are the signs and symptoms of stroke? Symptoms and signs of stroke include one or more of the following
     motor impairments
     weakness or paralysis of parts of the body including the face
     sensory impairments
     touch, pain, warm/cold
     speech difficulties or slurred speech
     vision difficulties (sudden loss of vision, blurred vision)
     dizziness, loss of balance or unexplained fall
     sudden severe headache
     difficulty swallowing
     The effects of a stroke depend on which part of the brain is injured and how severely it is affected
  5. 5How can we tell if it is a haemorrhagic or ischaemic stroke?It is difficult to differentiate stroke based upon
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    patient presentation Haemorrhagic stroke
    headache, neck stiffness, vomiting, coma Ischaemic stroke
    previous transient ischemic attacks, atrial fibrillation, atherosclerosis risk factors
    Imaging is important for differentiation
     All patients with suspected stroke should have an urgent
    CT or MRI
  6. 6What is the acute treatment of haemorrhagic stroke? If patient being anticoagulated this must be reversed  Warfarin: fresh frozen plasma and vitamin K
     Dabigatran: idarucizumab
     Intra‐cerebral haemorrhage
     neurosurgical intervention may be undertaken to evacuate cerebral hemispheric haematomas, decompress haematomas of the posterior fossa or insert CSF drainage devices
     Sub‐arachnoid haemorrhage
     vasospasm and rebleeding are the main causes of morbidity and mortality
     induce hypertension and hypervolaemia
     nimodipine
     IV infusion then oral
     maybe managed with neurosurgical procedures
     endovascular coiling or craniotomy and clipping
  7. 7What is the acute treatment of ischaemic stroke? Specialist neurointerventional procedures
     intra‐arterial thrombolysis (IAT), endovascular thrombectomy  hemicraniectomy for management of cerebral oedema
     Thrombolysis
     alteplase 0.9 mg/kg up to 90 mg IV over 1 hour, 10% of dose given as an initial bolus
     strict patient selection criteria are required
     results in a significant reduction in the composite end‐point of death or disability
     Aspirin (150‐300mg)
     given as soon as possible after the symptom onset if CT/MRI excludes haemorrhage
     not for 24hrs if patient is thrombolysed  routine use of heparin is not recommended
     may be used for DVT/PE prophylaxis in particularly high risk patients  patients should be mobilised as soon as possible
     Antihypertensives
     If BP > 220/120 start therapy or adjust doses of current medications
     blood pressure should be reduced by no more than 10‐20%  observe patient for signs of neurological deterioration
  8. 8What is the benefit of using a thrombolytic?Significant reduction in
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    death or dependency 51.8% of those allocated to
    thrombolytic therapy compared to 55.8% of those
    allocated to control (OR 0.81, 95% CI 0.73 to 0.90, P < 0.0001)
    equivalent to 50 fewer dead or dependent patients per 1000 treated (95%CI 20 to 70)
  9. 9What are the risks of using a thrombolytic?Significant increase in the rate of fatal intracranial
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    haemorrhage with thrombolysis
     4.45% of patients allocated to thrombolysis compared to 0.74% of those allocated to control OR 4.40, 95%CI 3.21 to 6.03, P < 0.00001
  10. 10What should be done if the patient's BP rises after giving a thrombolytic?What should be done if the patient's BP rises after giving a thrombolytic?
  11. 11What is stroke rehabilitation?Rehabilitation is a proactive, person‐centred and goal‐oriented process that begins the first day after stroke.
    Aims to
     improve function and/or prevent deterioration of function  bring about the highest possible level of independence
    physically, psychologically, socially and financially
     maximise self‐determination and optimise choices for those
    with stroke
     aid reintegration of the person into the community
  12. 12What health professionals are involved with rehabilitation of a stroke patient?A coordinated program by a specialised team of health
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    professionals
     Physiotherapists
     recovery of sensorimotor function in the upper and lower limb, and functional mobility
     Occupational therapists
     optimise participation and independence for all daily occupations
     Speech pathologists
     difficulties with communication and swallowing
     Dieticians
     modified diets or alternative feeding for those with swallowing
    problems
     Social workers
  13. 13What is an issue stroke patients may encounter?- swallowing difficulties
    - patient may find it hard to swallow tablets
  14. 14When do people need primary and secondary prevention? A person with stroke has an accumulated risk of subsequent
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    stroke of ~40% over 10 years with an annual rate of ~4%
     Up to 20% of patients with a TIA will have a stroke during the next 3 months
    Primary prevention
     treatment to prevent a person
    suffering their first stroke/TIA
    Secondary prevention
     treatment to prevent person from
    having another stroke/TIA
  15. 15Do people experiencing TIAs have a high risk of stroke?yes
    People who have had a TIA are at high risk of further
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    events
     one in three will have an ischaemic stroke
     30% of people with a major stroke have had an earlier TIA  9% of people with TIAs have a stroke within one week
     one in three will have repeated TIAs
     risk of stroke can be assessed using the ABCD2 tool    Do people experiencing TIAs have a high risk of stroke?
  16. 16What are the stroke risk factors?Risk factors for stroke include
    transient ischaemic attack
    carotid artery stenosis
    high blood pressure
    high blood cholesterol
    tobacco smoking
     the risk from smoking decreases after quitting with the risk disappearing altogether after 5 years
     diabetes
    high alcohol consumption
    atrial fibrillation other heart disease
  17. 17What is an important tool when assessing someone who may be at high risk of stroke?- CHADS2
    - CHA2DS2-VASc
  18. 18When treating AF, is it important to anticoagulate someone who has a high CHADS2 or CHA2DS2-VASc score?yesWhen treating AF, is it important to anticoagulate someone who has a high CHADS2 or CHA2DS2-VASc score?
  19. 19DOACs vs. warfarin, which has the better outcome/lower risk of bleeding?DOACs vs. warfarin, which has the better outcome/lower risk of bleeding?
  20. 20What are the doses for each of the DOACs, and what are they decreased to if bleeding is increased?Stroke prevention in AF
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     Dabigatran 150mg BD
     reduce to 110mg if  CrCl 30‐50mL/min  bleeding risk
     Age >75
     Apixaban 5mg BD
     reduce to 2.5mg if two of  weight <60 kg
     age >80 years
     SeCreat >133 mol/L
     Rivaroxaban 20mg D  reduce to 15mg if
     CrCl 30‐49mL/min
  21. 21If someone experiences an intracranial haemorrhage on an anticoagulant, should the anticoagulant be restarted it has been resolved?Decision based on the balance of anticoagulant benefit and the risk of further ICH
     limited evidence on which to make a decision    If someone experiences an intracranial haemorrhage on an anticoagulant, should the anticoagulant be restarted it has been resolved?
  22. 22Are there any pharmacological options for primary prevention of stroke?yes
    - NOT antiplatelets
    - anyihypertensives
    - statins
  23. 23Are there pharmacological options for secondary prevention of stroke?yes
    - antiplatelets
    - antihypertensives
    - statins
  24. 24What are the risks of aspirin and dipyridamole?- headache
    - nausea
    - vomiting
    - dizziness
    - AF
    - diarrhoea
    - hypotension
  25. 25How do we manage these risks of dipyridamole?Give 1 capsule at night plus aspirin (75-150mg) each morning for up to 1 week then stop separate aspirin, and start doing BD
  26. 26Does rivaroxaban or aspirin have a higher risk of bleeding?rivaroxaban

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Description
Flashcards on Stroke, created by Hannah Linard on 10/11/2018.
Created by
Hannah Linard · Nov 2018
Updated
Nov 12, 2018
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