10.1 Strokes Flashcards
Define a Thrombus
A blood clot formed in situ within the vasculature impeding blood flow
Define an Embolus
Blood clots, fatty deposit or air bubble carried in the blood stream that lodges in a vessel
Define an Infarct
Area of dead tissue resulting from disrupted blood supply
Define a Haemorrhage and state the 3 types
Escape of blood from a ruptured vessel
- Primary – no structural anomaly
- Secondary – aneurysm, vascular malformation or tumour
- Haemorrhagic transformation of an infarction
Define a Transient Ischaemic Attack (TIA)
Focal CNS disturbances caused by vascular events that last <24hrs and with no lasting deficit
Define a stroke
A syndrome of rapidly developing clinical signs of disturbance of brain function, lasting >24hrs and with no apparent cause other than that of vascular origin
What is the key difference between a TIA and stroke
TIA <24hrs
Stroke >24hrs
Where are TIAs most common and give 3 common symptoms
90% in the carotid artery territory
- Motor and/or sensory disturbance
- Visual disturbance
- Amaurosis fugax
List 4 presenations of a TIA in the vertebral arteries
Vertigo, diplopia, dysarthria, limb weakness
Give 2 signs of a stroke on examination (CVS related)
Atrial Fibrillation and carotid bruit
Give 4 Investigations used to diagnose a TIA
Blood tests – FBC, ESR, CRP, BM,
CXR
ECG +/- 24hr tape
Transoesophageal echo
Carotid angiography/USS
CT or MRI brain
What is ABCD2 and how do we calculate this?
Estimates the risk of stroke after a suspected transient ischemic attack
Each + in a catagory = points
Give the catagories ABCD2 and how many points each is
Age >60years = 1 point
BP>140/>90=1point
Clinical features
- any weakness = 2 points
- no weakness but speech disturbance = 1 point
Duration
- 60mins+ = 2 points
- 10-59mins = 1 point
- <10mins = 0 points
Diabetic = 1 point
List the risk for stroke for the following ABCD2 scores:
- 0-3
- 4-5
- 6-7
- 0-3 = 1% LOW risk
- 4-5 = 4%
- 6-7 = 8% HIGH risk
What define LOW vs HIGH risk for a stroke after a TIA
Low risk = score 1-3 (or over a week since symptoms)
High risk = score 4+ (or crescendo = 2 in a week or AF or already on anticoagulation)