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Stroke
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stroke, medicine, pharmacy, bnf
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StrokeStrokes come under several catagories:
1. Ischaemic stroke
2. Transient ischaemic attack
3. Haemorrhagic stroke
Others don’t need to know specifically: Cerebral aneurysm, Subarachnoid haemorrhage,
Carotid artery stenosis
a. Ischaemic stroke: Sudden onset of rapidly developing focal or global neurological
disturbance which lasts more than 24 hours or leads to death. neurological
dysfunction due to ischaemia (due to occlusion of arteries due to thrombus
(atherosclerosis)/ embolus of fatty material from complication of atrial/
atherosclerosis of carotid artery) and death of brain, spinal cord, or retinal tissue
following vascular occlusion or stenosis.
Aetiology:
- People are most likely to have a stroke over the age of 55
- Ischaemic stroke is more common in older people, people with lower levels of
education, and African-American or Hispanic people
Risk factors:
Major factors:
- Older age (non-modifiable risk factor)
- Family history of stroke (more significant if there is a family history at a younger
age than at an older age since old age is already an affecting factor).
- History of previous ischaemic stroke indicates that the patient may sustain more
ischaemic strokes in the future (particularly if risk factors, e.g., hypertension, are
not corrected).
- Hypertension
- Smoking
- Type 2 diabetes
- Comorbid cardiac conditions: MI, cardiomyopathy (potential of causing
cardioembolism)
- Increased serum total cholesterol (>LDL)
- Low levels of education
Weaker risk factors:
- Physical inactivity
- Obesity
- Alcohol abuse
- Poor diet and nutrition
- A small increased risk of ischaemic stroke may be present in users of oral
contraceptive pills; however, studies are conflicting
- Gender — Men are more likely than women to have a stroke at younger age. In
women, an increased risk of stroke has been associated with current use of oral
, contraceptives, migraine with aura, the immediate postpartum period, and pre-
eclampsia.
Complications of stroke that need to be considered:
- A haemorrhagic transformation of ischaemic stroke
- Celebral oedema
- Seizure
- Infection (people with stroke are at an increased risk of infection)
- Mobility problems- weakness on one side of the body, ataxia(lack of coordination
of movement), falls
- Sensory problems
- Continence problems (urinary/ faecal )
- Pain- neuropathic/ musculoskeletal (due to prolonged immobility)
- Problems with swallowing, hydration and nutrition
- Sexual dysfunction
- Anxiety depression
- Communication problems (dysphasia/ dysarthria)
Important point to remember:
stroke in people with atrial fibrillation (AF) is associated with greater mortality and
disability compared to ischaemic stroke in people without a history of AF
Once a person has had a stroke or transient ischaemic attack (TIA) they are at high risk of
a further vascular event, often more severe and disabling than the preceding one.
Disability is very common following stroke:
History/ examination
Loss of sight in one eye may occur and is often transient.
Complete or partial loss of muscle strength in face, arm, and/or leg is a typical
presentation of stroke.
Impaired language function (aphasia)
Impaired coordination (ataxia)
Risk factors:
Consider risk factors that make people more likely to have a stroke:
- Age ≥55 years
- History of transient ischaemic attack (TIA)
- History of ischaemic stroke
- Family history of stroke at a young age
- Hypertension
- Smoking
- Diabetes mellitus
- Atrial fibrillation
- Comorbid cardiac conditions
- Carotid artery stenosis
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