Cerebrovascular accidents

Question 1

What is a transient ischaemic attack (TIA)?

Answer 1

• Sudden transient episode of neurological dysfunction → caused by focal brain, spinal cord or retinal ischaemia → without infarction
• Focal neurological deficit = completely resolved within 24 hours

Question 2

What are some causes of a TIA?

Answer 2

• CAROTID THROMBOEMBOLISM (90%)
• Emboli (e.g. AF) - remember CHA2DS2VASc

Question 3

Rx for TIA

Answer 3

• Atrial fibrillation
• Valvular disease
• Carotid stenosis
• Congestive heart failure
• Hypertension
• Diabetes mellitus
• Cigarette smoking
• Alcohol-use disorder
• Advanced age

Question 4

A lesion in the anterior cerebral artery would cause which symptoms?

Answer 4

• Weak numb contralateral leg

Question 5

A lesion in the middle cerebral artery would cause which symptoms?

Answer 5

• Weak numb contralateral side of body
• Face drooping w/ forehead spared
• Dysphasia (temporal)

Question 6

What is amaurosis fugax?

Answer 6

• Occlusion in the opthalamic artery
• Transient loss in vision (‘darkening’)
• Occurs in TIA - bad sign → often stroke is impending

Question 7

A lesion in the posterior cerebral artery would cause which symptoms?

Answer 7

• Vision loss
• Contralateral homonymous hemianopia with macular sparing

Question 8

Difference between a stroke and TIA

Answer 8

TIA:
* Sx resolve within usually, always within 24 hours
* No infarct

Stroke:
* Sx last 24 hours
* infarct

Question 9

What is ABCD2 and what score warrants a referral to neurology straight away?

Answer 9

A - Age >60 (1)
B - Blood pressure >140/90 mmHg (1)
C - Clinical Sx: Unilateral weakness (2); Slurred speech no weakness (1)
D - Duration: 1hr+ (2); Less than an hour (1)
D - DMT2 (1)

Score above 6 = refer to neurology

Question 10

Treatment of TIA

Answer 10

• Aspirin 300 mg
• Prophylaxis long term Clopidogrel 75mg + Atorvastatin 80mg