Cebrovascular disease

Question 1

treatment of TIA

Answer 1

Aspirin 300mg ASAP for 2w + consider for carotid endarterectomy
then clopidogrel should be given longterm

Question 2

treatment of acute ischaemic stroke

Answer 2

CT to confirm
<4.5hrs - thrombylsis with IV altepase

2nd line/then : thrombectomy <6hrs

long term: +clopidogrel (dipyridamole if contraindicated) and aspirin

Question 3

Oxford stroke classification aka Bamford

Answer 3

1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

Total anterior circulation infarcts (TACI, c. 15%)
• involves middle and anterior cerebral arteries
• all 3 of the above criteria are present

Partial anterior circulation infarcts (PACI, c. 25%)
• involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
• 2 of the above criteria are present

Lacunar strokes
	• Motor OR sensory ONLY
	• present with either 
		○ isolated hemiparesis
		○ hemisensory loss 
		○ or hemiparesis with limb ataxia
	• strong association with hypertension
	• common sites include the basal ganglia, thalamus and internal capsule

Posterior circulation infarcts (POCI, c. 25%)
	• involvesvertebrobasilar arteries
	• presents with 1 of the following:
	• 1. cerebellar or brainstem syndromes
	• 2. loss of consciousness
	• 3. isolated homonymous hemianopia

Lateral medullary syndrome (posterior inferior cerebellar artery)
• aka Wallenberg’s syndrome
• ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
• contralateral: limb sensory loss

Weber’s syndrome
• ipsilateral III palsy
• contralateral weakness