Cerebrovascular Events Flashcards
What is the medical term for a stroke, and what are the two main types?
The medical term for a stroke is cerebrovascular accident (CVA). The two main types are:
1. Ischaemic stroke: caused by ischaemia or infarction of brain tissue due to disrupted blood supply.
2. Haemorrhagic stroke: caused by intracranial haemorrhage with bleeding in or around the brain.
Define ischaemia and infarction in the context of stroke.
- Ischaemia refers to an inadequate blood supply to tissue.
- Infarction is tissue death resulting from prolonged ischaemia.
What are the common causes of disrupted blood supply leading to ischaemic stroke?
The common causes of disrupted blood supply include:
- A thrombus or embolus
- Atherosclerosis
- Shock
- Vasculitis
What is a transient ischaemic attack (TIA), and how does it differ from a stroke?
A transient ischaemic attack (TIA) involves temporary neurological dysfunction caused by ischaemia, but without infarction. Symptoms last less than 24 hours and resolve fully, unlike a stroke, which causes permanent brain damage.
What are crescendo TIAs, and why are they significant?
Crescendo TIAs refer to two or more transient ischaemic attacks occurring within a week. They indicate a high risk of an impending stroke.
What are common presenting symptoms of a stroke?
Common symptoms of stroke include:
Limb weakness
Facial weakness
Dysphasia (speech disturbance)
Visual field defects
Sensory loss
Ataxia and vertigo (especially in posterior circulation infarction)
Why is the sudden onset of neurological symptoms suggestive of a vascular cause, such as stroke?
Sudden onset of neurological symptoms suggests a vascular cause, as the interruption of blood supply (such as in stroke) occurs abruptly, leading to rapid neurological deficits.
Are stroke symptoms usually symmetrical or asymmetrical, and why?
Stroke symptoms are typically asymmetrical because the disruption of blood flow often affects only one hemisphere of the brain, resulting in unilateral deficits.
List the key risk factors for stroke and TIA.
The key risk factors include:
- Previous stroke or TIA
- Atrial fibrillation
- Carotid artery stenosis
- Hypertension
- Diabetes
- Raised cholesterol
- Family history
- Smoking
- Obesity
- Vasculitis
- Thrombophilia
- Combined contraceptive pill
Why does the combined contraceptive pill increase the risk of stroke, and in which patients is this risk higher?
The combined contraceptive pill carries a small increased risk of stroke, particularly in patients with:
- Migraines with aura
- Smokers over 34 years of age
- A history of stroke or TIA
What does the FAST tool stand for in stroke recognition?
F – Face (facial weakness)
A – Arm (arm weakness)
S – Speech (speech disturbance)
T – Time (act fast and call 999)
What is the ROSIER tool used for, and how does it work?
The ROSIER tool (Recognition Of Stroke In the Emergency Room) helps identify stroke based on clinical features and duration. Stroke is possible in patients scoring one or more points.
What is the initial management of a transient ischaemic attack (TIA)?
Initial management of TIA includes:
- Aspirin 300 mg daily (started immediately)
- Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)
- Diffusion-weighted MRI scan as the imaging of choice
Outline the key steps in the initial management of a stroke, according to the NICE guidelines.
Initial stroke management involves:
- Excluding hypoglycaemia
- Immediate CT brain scan to exclude haemorrhage
- Aspirin 300 mg daily for two weeks (after haemorrhage is excluded)
- Admission to a specialist stroke centre
What is the role of thrombolysis in stroke management, and when is it indicated?
Thrombolysis with alteplase is considered once haemorrhage is excluded via CT scan. It should be given within 4.5 hours of symptom onset, based on local protocols and performed by a trained team.
