Stroke - key lecture points

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Therapeutics Fichas sobre Stroke - key lecture points, creado por Hannah Linard el 21/08/2018.
Hannah Linard
Fichas por Hannah Linard, actualizado hace más de 1 año
Hannah Linard
Creado por Hannah Linard hace más de 6 años
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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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