Brain Attack Flashcards
What is important in history of a patient presenting with stroke like symptoms?
Timing
Positive/ negative symptoms
Multiple or single event
Duration of symptoms
Medication
Dysarthria
Problem with articulation of words
Dysphagia
Problems with language
- receptive: can follow commands
- expressive: jargon, stuck on words, single words
Symptoms of balance
Loss of balance
Diplopia
Visual disturbances
Nausea
Brain tumours
History vital
- patient
- friends/ relative etc
Duration of symptoms
Spreading symptoms
Sensory symptoms
Headache
Change in personality
Metabolic/ toxic/ infectious stroke mimics
Intercurrent illness
Hypo-/hyper- gly/Na/Ca
Ophthalmic stroke mimics
Glaucoma
Retinal vein occlusion
Neurological stroke mimics
Epileptic seizure
Tumour
Migraine
Somatisation
Neuropathies
Radiculopathies
Subdural haematoma
Transient global amnesia
Bell’s palsy
Multiple sclerosis
Motor neurone disease
Cataplexy
Other causes of stroke mimics
Syncope
Postural hypotension
Vestibular
Investigations for those with suspected TIA
Bloods
ECG
CXR
Consider 24 hour tape and echo
Carotid dopplers if indicated
Brain imaging
Treatment for ischaemic stroke
Thrombolysis/ thrombectomy
Aspirin 300mg 2/52 then 75mg clopidogrel
PPI while on high dose aspirin
Statin e.g. atorvastatin
BP treatment- thiazide and ACEi
Anticoagulation if AF- warfarin/ DOAC
Imaging of choice
CT- best for haemorrhage
MRI- best of acute ishaemic stroke
Meningioma
Usually quite benign
Carotid duplex
Fit and well normally
Candidate normall
Stroke in anterior circulation
Carotid stenosis surgery
Present with stroke/ TIA and have significant stenosis must be operated on within 2 weeks
