Control CS3 stroke and TIAs Flashcards
What is a stroke?
An abrupt interruption of blood flow to part of the brain depriving the brain tissue of oxygen and nutrients leading to brain cell death
When is a stroke excluded as a diagnosis?
If subarachnoid haemorrhage
Trauma
What are three causes of ischaemia stroke?
Embolism
Thrombosis
Hypoperfusion
What can cause Hypoperfusion?
Low systemic perfusion pressure
Cardiac pump failure
Systemic hypotension
Asymmetric effects in pre existing vascular lesions causing an uneven distribution of underperfusion
What can increase risk of thrombosis?
Haematological diseases
Any systemic hypercoagulable state e.g. cancer
Arteritis
What are causes of a non-traumatic intracerebral haemorrhage?
Hypertension
Vascular malformations e.g. aneurysm
Amyloid angiography
Tumours
Drug abuse e.g. cocaine
Anticoagulants and thrombolytic therapy
Vasculitis
CVT
What test should be done if a stroke is suspected?
FAST test
What are common stroke symptoms?
Slurred/mumbled speech
Facial droop
Acute unilateral loss of strength +/- sensation
Acute vision loss - complete/incomplete, monocular/binocular
Aphasia
Ataxia +/- vertigo
Double vision
Sudden decrease in level of consciousness
What is the first investigation done when a patient presents with a suspected stroke?
CT scan
What is the treatment/management for a intracerebral haemorrhage?
Reverse anticoagulation
Aggressive blood pressure management
Surgical options in some cases e.g. stroke caused by aneurysm or complications like hydrocephalus
What is the name for the area that is at risk of damage after a stroke but it salvageable if perfusion occurs?
The penumbra
What is the process called where the penumbra is saved from infarct?
Recanalisation
What is a medication used for stroke?
Alteplase
How are large vessel occlusion strokes treated?
With mechanical thrombectomy (MT)
What is the difference between a TIA and a stroke?
A TIA is when a neurological deficit, as a result of cerebral or retinal ischaemia, lasts for less than 24 hours
How long do most TIAs last for?
Less than 60 mins
Can TIAs cause brain damage?
Yes
What are common causes of a TIA?
carotid artery/large artery disease
Cerebral small vessel disease
Cardiac embolism
What percentage of strokes are preceded by a TIA?
20%
Can a TIA be caused by a haemorrhage?
No
What diseases/events can have symptoms that mimic a TIA/stroke?
Seizures
Syncope
Hypoglycaemia
Migraine
Acute confusion all states
Which symptoms are specific to issues in the anterior arteries of the neck/brain?
Dysphasia
Amasausis fugax
What symptoms are specific to issues in the posterior circulation of the brain/neck?
Ataxia
Diplopia
Vertigo
Bilateral symptoms
What scoring system can be used when assessing the probability of a patient having a stroke after having a TIA?
ABCD2 score
A = age
B = BP
C = clinical features
D = duration of symptoms
D = diabetes
