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Summary

This comprehensive on-demand teaching session explores the crucial facets of ischemic stroke, including its presentations, diagnostics, and management. The talk will particularly benefit medical professionals studying for MLA revision or looking to refresh their understanding of this common condition. Participants will engage with a case study of a 70-year-old male presenting with common stroke symptoms. The session touches on the various attributes of ischemic stroke, from detailed presentations, overlapping symptoms across various affected regions, to primary causes and risk factors. Attendees will also delve into diagnostic strategies like the use of fast, score and the non-contrast CT. In terms of management, the session explores initial management with aspirin and referral to stroke team, intravenous or intraarterial thrombolysis and mechanical thrombectomy. Furthermore, it covers the importance of post-stroke support, its legal implications, and the minimisation of future stroke risk. Tune in to enhance your knowledge about ischemic stroke and prepare better for acute cases in an emergency setting.
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Description

Hi Everyone

Welcome to the final episode of our first MLA Revision Series!

We hope you enjoy this episode on Ischaemic Stroke and look back on the rest of our episodes :)

Unfortunately we are unable to provide a summary poster for this video but remember to take a look at the supporting materials for our other episodes!

Please consider giving us feedback as it allows us to continually update our approach in order to make content more useful

All the best,

IR Juniors Education Team

Learning objectives

1. Understand the clinical presentation of ischemic stroke, including the range of symptoms relating to different affected brain regions. 2. Identify and differentiate the potential causes of ischemic stroke, including embolism and thrombosis. 3. Recognize the common risk factors associated with ischemic stroke, such as old age, hypertension, hypercholesterinemia, smoking, and a previous cardiovascular history. 4. Comprehend the diagnostic methods used in the detection of ischemic stroke, ranging from initial assessments like the FAST (Face, Arms, Speech, Time) test to more specialized procedures like a non-contrast CT scan. 5. Clearly understand the management strategies for ischemic stroke, such as intravenous thrombolysis, mechanical thrombectomy, and supportive treatments.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone. Welcome to this talk on ischemic stroke. As a part of a series of lectures for MLA revision, we will be covering the presentations, diagnostics and management of ischemic stroke. Starting with the case presentation, we have a 70 year old male presenting to A&E with sudden onset left sided body weakness for sudden onset limb weaknesses. The first thing to think about is stroke. Other causes can be hypoglycemia which can cause neurological symptoms, hemiplegic migraine which can present with upper motor weakness as an aura or to paralysis, which is neurological condition experienced by people with epilepsy leading to weakness in or part of the body. Ischemic stroke occurs in around 85% of all stroke cases and present acutely with rapid onset neurological defect depending on the affected regions. However, symptoms do overlay across regions. Strokes of the anterior circulation include the anterior cerebral artery, middle cerebral artery lacuna or small deep infarcts and striatal capsule infarcts which are infarcts of the called the nucleus putamen and anterior limb of the internal capsule. These present with mostly higher cerebral dysfunction such as dysphasia, difficulty swallowing, sensory with or without unilateral motor defects and homonymous visual field defect, posterior circulation includes posterior cerebral artery cerebellar and brainstem. In vals strokes in these areas present with similar symptoms from anterior circulation. In facts with the additions of dizziness slash vertigo dysarthria, which is difficulty speaking due to weak muscles, unilateral limb weaknesses, ataxia, ga's palsy, which means cannot move both eyes in the same direction and visual problems. Vinosum means impairment of recognizing visually presented objects. Ischemic stroke is mostly due to disrupted blood flow to intracranial artery leading to deprivation of oxygen and nutrients to the vascular territory. This leads to possible cellular death if circulation is not reestablished in time. Main causes of ischemic stroke include embolism via atrial fibrillation which causes stasis of blood and increasing chance of clotting fat emboli air emboli and endocarditis which forms vegetation. Other causes include thrombosis by atherosclerosis and arterial dissection. Risk factors include old age, male hypercholesterinemia, hypertension, smoking, poor diet, diabetes, atrial fibrillation and previous history. Some of which are also cardiovascular risk factors. Initial diagnosis of stroke, ischemic stroke include fast, it stands for face, arms, speech and time often used in the community. Uh We then exclude hypoglycemia which which can cause neurological problems. And rosia is a scoring system used in the emergency room. Non contrast. CT is used to confirm the diagnosis of stroke and determine its nature of ischemic or hemorrhagic. A thrombectomy which means the removal clot is indicated an enhanced CT scan will be performed. A CT perfusion scan can also be offered to show the area which are worth salvaging such as the uh see the penumbra in the middle picture. Ischemic stroke management has three major parts. Firstly, initial management is done with hemorrhage, hemorrhagic stroke excluded. And then we give aspirin 300 mgs, then control BP, control glucose and refer to the stroke team who will perform A N I HSS score uh to assess neurological impact. Secondly, intravenous or intraarterial thrombolysis is done. Uh This is done within 4.5 hours after onset. Given that a possible hemorrhagic stroke is ruled out. Thirdly. Mechanical thrombectomy may also be done depending on the time the patient presents if presentation is within six hours after onset, thrombectomy is given with IV thrombolysis for acute ischemic stroke, meaning no hemorrhagic potential with occlusion of proximal anterior circulation, which is determined via CTA or MRA imaging. If patient presents within 6 to 24 hours after onset, thrombectomy is given for ischemic stroke. Given ruling out hemorrhagic stroke with occlusion of proximal anterior circulation with potential salvaging of the brain determined by aceto perfusion or diffusion weighted MRI scans. If patient presents 24 hours within onset thrombectomy is given with IV thrombolysis for ischemic stroke with occlusion of proximal posterior circulation and potential of salvaging of the brain. After stroke has been treated, supportive management is given to minimize the risk of future strokes clip which is antiplatelet statin with dyslipidemia and uh antihypertensives and lifestyle management. It is legal to drive within one month of getting a stroke and you need to inform the DL after one month to report any persisting problems on the left. We can see a picture of mechanical thrombectomy on the right. It is a decompressive craniectomy procedure which is only used in certain cases such as a large middle cerebral artery. In fact, going back to the case, the patient has a past history of hypertension and previous tia, you examine him and he has weakness in his left arm and visual disturbances with sensations intact. Do they investigate using a non contrast CT scan to summarize ischemic stroke is is more common than hemorrhagic stroke with risk factors including old age, male hypertension smoking, previous cardiovascular history, hypercholesterinemia presentations usually depend on the areas affected and neurological symptoms are likely diagnosis is fast fras noncontrast management. Uh is IV thrombolysis mechanical thrombectomy and supportive treatment. Along with the initial management we've discussed um to make this powerpoint use the nice guidelines and also radio um P. Thank you for listening.