Cerebrovascular disease

Question 1

What is stroke?

Answer 1

Acute neurological deficit of cerebrovascular origin lasting >24hrs

Question 2

What is TIA?

Answer 2

Acute neurological deficit of cerebrovascular origin lasting <1hr

Question 3

What is amaurosis fugax?

Answer 3

Fleeting loss of vision commonly seen in TIA

Question 4

What are the risk factors for ischaemic stroke?

Answer 4

FH
Age
AF
Hypercoagulable state
Obesity
DM
HTN
Hyperlipidaemia
Sedentary lifestyle 
Smoking
COCP

Question 5

What are the risk factors for haemorrhagic stroke?

Answer 5

FH
Anti coagulant therapy
Uncontrolled HTN
Bleeding disorders

Question 6

What are the symptoms of stroke?

Answer 6

Contralateral muscle weakness
Facial weakness
Loss of sensation
Visual disturbances 
Higher cortical dysfunction
-expressive dysphasia
-receptive dysphasia
-dysphasia
-dysphagia
-ataxia= difficulty doing tasks despite normal motor function
-agnosia= difficulty identifying familiar objects
-asterognosis= difficulty identifying objects by touch despite intact sensation

Question 7

How is TACS and PACS diagnosed?

Answer 7

1) contralateral hemiparesis and/or sensory loss
2) homonymous hemianopia
3) higher cortical dysfunction

TACS= all 3
PACS=2

Question 8

How is lacunar stroke diagnosed?

Answer 8

Any one of the following

• motor weakness in face/arms/legs/all
• pure sensory loss
• ataxic hemiparesis

Question 9

How is posterior stroke diagnosed?

Answer 9

Any one of the following

• isolated homonymous hemianopia
• loss of consciousness
• cerebellar or brainstem dysfunction e.g. broad staggering gait

Question 10

What are symptoms of haemorrhagic stroke?

Answer 10

Severe headache
LOC
Seizures
N&V

Question 11

What investigations are needed?

Answer 11

ECG

Bloods

• glucose
• FBC
• HbA1c
• LFTs
• coag
• lipids
• U&Es

CT head to rule out haemorrhage

Question 12

What is the management once haemorrhage has been ruled out?

Answer 12

Aspirin 300mg stat and continue for 2 wks
If presentation within 4.5hrs
-thrombolysis with altepase

Thrombectomy

• within 6 hrs of symptoms combine with thrombolysis
• can be done between 6-24hrs post symptom onset if confirmation of stroke and will improve outcome

Question 13

What ward management is needed?

Answer 13

SALT assessment
Physio
OT
Skin assessment

Question 14

What is secondary prevention?

Answer 14

Clopidogrel lifelong
Statins 48hrs after symptoms onset
HTN therapy 2wks later
Cannot drive for 4wks

Question 15

What are complications of stroke?

Answer 15

Incontinence
Aspiration Pneumonia
Pressure sores
DVT/PE
Malignant MCA syndrome- neurological deficits

Question 16

What is the management of TIA?

Answer 16

Need to assess risk of further stroke
-have they had recent TIAs or had TIA whilst anticoagulated

Consider if admission to hospital needed

• yes if >1 recent TIA or suspected cardio source
• if not then outpatient TIA clinic within 24hrs

Aspiring 300mg STAT

• once haemorrhage ruled out
• not if contraindicated or if on anti coagulation therapy

Carotid artery doppler in TIA clinic to look for stenosis
-if >50% stenosis on side of symptoms then carotid endartectomy

Clopidogrel lifelong