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4th Year CCC > Stroke and TIA > Flashcards

Stroke and TIA Flashcards

1
Q

Define stroke

A

Sudden onset of rapidly developing focal or global neuro disturbance for >24h/until death

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2
Q

What is TIA

A

Episode of transient neuro dysfunction caused by focal brain/SC/retinal ischaemia without evidence of acute infarction.

<24hrs

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3
Q

What proportion of strokes are ischaemic vs haemorrhagic?

A

85% ischaemic

15% haemorrhagic

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4
Q

What is more common stroke or TIA?

A

Stroke

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5
Q

What do you need to cover in history

A

Symptoms- neuro defecit and assoc sx (headache, vomiting, consciousness)

Onset- when, what doing, progression of sx.

Risk factors- cardio disease, diabetes, hyperlipidaemia, smoking, pregnancy, recent trauma, illness/surgery, alcohol/drugs

R/O- migraine, GCA, preceding trauma, seizures

PMH- thrombophilia –> thromboembolic events, miscarrigae

FH- stroke

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6
Q

What if they don’t know the time of onset?

A

When do they last know that they were unaffected?

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7
Q

what examinations do you need to do?

A

ABC and vital signs

Cardio (HF, AF, murmurs, valvular HD, endocarditis)

Neuro including fundoscopy. FAST initial screen.

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8
Q

What do you look for on fundoscopy?

A

Intraocular haemorrhage (aneurysmal SAH)

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9
Q

What investigations?

A

blood glucose to r/o hypo

ECG exclude arryth and look for AF

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10
Q

What is the score for stroke vs stroke mimic?

A

ROSIER

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11
Q

What is ABCD2 score?

A

For TIA patients without neuro signs when seen. To assess risk of another TIA or of stroke.

> 4- assess within 24hr

<4- assess within 1w

Includes- age, BP, clinical features, duration

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12
Q

Very initial management of susp stroke

A

ASAP

Arrange immediate admission to stroke facility and in the mean time monitor and manage ABC- need to determine whether haemorrhagic or ischaemic

Imaging should be within 1hr

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13
Q

Can you start anti-platelet therapy immediately?

A

No wait until haemorrhagic r/o

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14
Q

What is the management if confirmed ischaemic?

A

Aspirin 300mg oral or rectal (NB safe swallow)

Thrombolysis IF within 4.5hrs symptom onset- alteplase

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15
Q

Absolute C/I to thrombolysis

A

Prev IC haemorrhage

Seizure at onset of stroke

Intracranial neoplasm

Susp SAH

Stroke/TBI preceding 3m

LP preceding 7 days

GI haemorrhage preceding 3w

Active bleeding

Pregnancy

Oesoph varices

Uncontrolled HTN (>200/120)

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16
Q

How long is the aspirin continued for

A

2w post stroke then definitive LT antithrombotic

17
Q

Management haemorrhagic stroke

A

Surgical

Stop and reverse any anticoags they are on

18
Q

TIA management

A

Aspirin 300mg

ABCD2 to determine risk

Refer (24h if high risk, 7 days if lower)

19
Q

What investigations will someone who has had a TIA have?

A

Carotid USS

Echo

ECG

?CT

20
Q

Does TIA need to inform DVLA? Can they still drive?

A

Not unless for work

Don’t drive for 1m

21
Q

Secondary prevention drugs stroke and TIA

A

Clopidogrel 75mg OD

Atorvostatin 80mg OD

Antihypertensive IF INDICATED

Anticoag IF AF OR ATRIAL FLUTTER (warfarin or NOAC)

22
Q

What is it called if they have >1 TIA?

A

Crescendo TIA

23
Q

What if they present with TIA >1w after?

A

Specialist assessment ASAP within 7d and don’t drive until seen

24
Q

If someone who presents with TIA already taking anticoag wyd?

A

Don’t give aspirin, they need imaging to exclude haemorrhage.

If already taking low dose aspirin, continue the low dose until reviewed by specialist.

25
Q

what should you include in post-stroke review?

A
  1. Bowel and bladder
  2. Fatigue
  3. Nutrition and hydration
  4. Cognition
  5. Mood and wellbeing
  6. Mouth care
  7. Pain- neuro and MSK
  8. Sexual dysf
  9. Spacicity and contractures
  10. EoL care
26
Q

Can you drive after stroke

A

Wait for at least a month, and get clearance from doctor.

Inform DVLA only if seizure, surgery needed or still complications 1m later

27
Q

Can you drive if multiple TIAs?

A

If you have a number of TIAs over a short period of time, you will need to wait until you have not had any TIAs for three months before returning to driving.

4th Year CCC (19 decks)

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