22. Transient ischaemic attack and stroke

Question 1

Definition

Answer 1

Characterised by an acute loss of focal brain function lasting more than 24 hours. When the blood supply is suddenly disrupted.

Question 2

What happens

Answer 2

Causes focal neurological deficits that develop rapidly, abrupt onset. When stroke occurs, kills the brain cells in the immediate area. Area of dead cells is called infarct.

Question 3

Cause of a stroke:

Answer 3

Inadequate tissue perfusion (ischaemia, restriction of blood).

Question 4

Explain neuroplasticity:

Answer 4

Changes in brain structure and organisation as we experience, learn and adapt. Remodelling. Learning new things, making new connections so the person can learn how to do something. New pathways being develop.d

Question 5

What are the five types of ischaemic stroke

Answer 5

1. Large artery stroke: Embolus (small blood clot)
2. Cardioembolic stroke: Blockage due to embolus originating from heart. Due to arythmias.
3. Small vessel disease/occlusion: Diabetes and smoking. Coagulating blood inside a cerebral vessel.
4. Other defined cause: Cryptogenic
5. Unknown cause

Question 6

What is a transient ischemic attack?

Answer 6

Brief period of cerebral ischeaia, may cause small neurological deficits that resolve when blood flow is restored. Symptoms resolve within minutes. No permanent damage to brain. Smaller area of damage. 1 minute to 24 hours.

Question 7

Aetiology

Answer 7

Emboli, thrombus (stationary blood clot that forms in vessel), arteriosclerotic occlusion, dissection (damaged vessel), spasm/arteries.

Question 8

Epidemiology

Answer 8

Males, over 65 years old, indigenous pop.

Question 9

Risk factors:

Answer 9

Hypertension (high BP), atrial fibrillation (irregular heart beat), TIA, diabetes.
Lifestyle factors: Smoking, diet, sedentary lifestyle, obesity, alcohol

Question 10

Signs and Symptoms:

Answer 10

Weakness/numbness/paralysis of face arms or legs (generally one side) of body, difficulty speaking, dizziness, loss of balance, loss of vision, headache.
Face: Uneven smile
Arm: Check if one arm is weak
Speech: Listen for slurred speech
Time: Call 000 at first sign

Question 11

Clinical manifestations

Answer 11

Motor: hemiparesis, dysphagia, ataxia.
Communication: Dyslexia, dysgraphia, dysphasia, dysarthria, dyscalculia
Sensory: Altered feeling, hemianopia, quadrantanopia.
Behavioural, cognitive and perceptual: Dyspraxia, difficulty paying attention etc.

Question 12

Medical investigations

Answer 12

Neurological signs and symptoms through physical examination. CT, MRI. Blood tests. Heart tests. (ECG and echocardiogram), Angiogram, urine, chest X-ray. Routine observations.

Question 13

Medical treatment

Answer 13

Hyper acute management: Airway, breathing, circulation. TPA within 4.5 hours blood production
Acute management: Aspirin for stroke, BP management, stroke unit admission, bladder care, pharmacological input.
Neurosurgery

Question 14

Neurosurgery

Answer 14

Complications: Hydrocephalus, brain swelling –> increase in intracranial pressure
Cerebral aneurysm: Clipping (eliminate ballon from blood vessel), coiling (thread tiny coils forming a clot to seal it off), balloon occlusion, stent (up to large aneurysm to seal off and keep key artery open).

Question 15

Comorbidities

Answer 15

Depression, diabetes, hypertension