Stroke: Physiology and Early Management

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Stroke Physiology and Early Management

• Chris Patterson
• June 14 2006

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Why is stroke important?

• 150 000 strokes per year in UK
• 1 every 3 minutes
• 1000 people under 30
• 3rd commonest cause of death
• Commonest cause of disability
• 250 000 living with disability

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What is a stroke?

• A sudden onset of focal neurological deficit with
  signs and symptoms lasting greater than 24 hours
  (or resulting in death) where the cause is
  thought to be vascular
• (WHO)

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What is a stroke?
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Types of stroke
Ischaemic (blockage)
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Types of stroke
Haemorrhagic (bleed)
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Symptoms of stroke

• Numbness, weakness, paralysis
• Slurred speech, word-finding problems
• Loss of vision
• Confusion
• Inco-ordination
• Severe headache

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History

• Previous stroke/TIA
• Hypertension
• IHD
• Diabetes
• Atrial fibrillation
• Smoking
• Raised cholesterol
• Carotid stenosis

• Family history
• Peripheral vascular disease
• Lifestyle
• Age
• Sex

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Examination

• To confirm diagnosis
• List impairments
• Classify stroke (TACI, PACI, POCI, LACI)
• Identify co-existing conditions
• Swallow status
• CPR status

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Examination
GCS BP / Pulse / Cardiac Hemiparesis Speech Hemian
opia Neglect Brainstem / cerebellar
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Swallow

• Over 30 of stroke patients have initial
  swallowing problems
• All should have swallow test

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Investigations

• FBC
• Urea Electrolytes
• Glucose
• Cholesterol
• ECG
• CT head
• (Carotid duplex, ECHO, thrombotic screen)

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CT scan within 24 hours
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Temperature

• Fever worse prognosis
• Search for infection
• Give paracetamol

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Hypoxia

• Exacerbated by seizure, arrhythmia and pneumonia
• Worsens cognitive outcome
• Correct if present

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Blood pressure

• BP falls spontaneously in first 10 days
• Lowering of BP can be harmful
• Record at least twice daily
• Correct low BP
• Delay treatment for
• 10 days

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Glucose

• Measure on admission
• High glucose predicts poor outcome
• Monitor 6 hourly first few days

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Prevention of DVT

• Over 50 of stroke patients develop below-knee DVT

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Other considerations

• Pressure sore
• prevention
• Warfarin for AF
• Stroke Unit

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Aspirin

• If no bleed give 300mg immediately and continue
  for 2 weeks

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And maybe one day..
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Any questions?