18 - stroke and TIA

Question 1

5 Sx people should look out for

Answer 1

1. weakness or numbness
2. speech disturbances
3. visual disturbances, esp in one eye
4. severe HA
5. vertigo or loss of balance, especially with the above

Question 2

4 key features to help predict stroke

Answer 2

1. LOC - normal or slightly decreased
2. ONSET - abrupt
3. Focal Sx - fit within a vascular distribution
4. headache - none or mild in ischemic

Question 3

5 signs to think about something else

Answer 3

1. decreased LOC
2. gradual onset
3. fever
4. fluctriating
5. no focal signs

Question 4

some stroke mimics

Answer 4

• seizure
• migraine - more gradual onset
• transient global amesia
• syncope
• hypoglycemia - usually more general
• metabolic encephalopathy - non focal and confused
• encephalitis - confusion and maybe fever
• subdural - less sudden
• bell palsy - peripheral nerve weakness - so frontalis also hit
• peripheral vertigo

Question 5

5 steps in initial eval

Answer 5

1. ABC
2. breif neuro exam
3. Hx - time of onset!
4. PhX
   - vitals
   - head and neck for bruits
   - CV
   - resp and abdo
   - skin and extremity
5. neuro exam

Question 6

4 intial investigations

Answer 6

1. basic bloods
2. ECG
3. head CT
4. vascular imaging of carotid and vert. arts in 24hours

Question 7

why vascular imaging

Answer 7

need to get endartectomy of >70% stenosis

Question 8

early mgmt

Answer 8

ABCs
Postition lying down
NPO until swallow assessed
fluids- NS
cardiac monitors
o2>94%
antiplatelet
hypertension: no aggressive Tx
hypotension: look for underlying causes
hyperthermia - cool and antipyretics
anticoagulation - DVT prophylaxis with LMWH
hypoglycemia - target 5-10

Question 9

3 antiplatelet therapies

Answer 9

1. ASA
   - laoding of 325
   - follow with 81mg
2. plavix
   - loading of 300mg
   - use if failed ASA
3. aggrenox and ASA
   - for ASA failures

Question 10

how long for TPA

Answer 10

4.5 hours, but best in 90minutes

Question 11

conta to TPA

Answer 11

• hemmorage
• spine/head trauma in 3 months
• major surg in past 2 weeks
• art puncture in past 7 days
• PTT and INR
• other bleeding conditions
• low or high glucose

Question 12

how to determine admission for TIA

Answer 12

ABCD2 score

Question 13

how to determine need for antiocoag in afib

Answer 13

CHA2Ds2 score