Neurology COPY Flashcards
What is a cerebrovascular accident?
Ischaemia or infarction of brain tissue secondary to inadequate blood supply
OR
Intracranial haemorrhage
What are the different types of cerebrovascular accidents?
Transient Ischaemic Attack(TIA)
Stroke:
Haemorrhagic
Ischaemic
What is a TIA?
Sudden onset focal neurological deficit.
Older definition:
symptoms of a stroke that resolve within 24 hours.
New definition:
transient neurological dysfunction secondary to ischaemia without infarction.
What is a crescendo TIA?
where there are two or more TIAs within a week. This carries a high risk of developing in to a stroke.
What are the risk factors for a TIA?
Increasing age
Hypertension
Smoking
Diabetes
Hypercholesterolaemia
Atrial fibrillation
HTN
VSD
Carotid stenosis
What are the causes of a TIA?
Thrombus formation or embolus (for example in patients with atrial fibrillation)
Atherosclerosis
Shock
Vasculitis
What artery is commonly the route of a TIA?
90% = ICA
10% = Vertebral
What are the symptoms of a TIA?
Depends on the site of the TIA:
ACA - weak/numb contralateral leg
MCA - weak/numb contralateral side of body, face drooping w/forehead spared, dysphasia (temporal)
PCA - Vision loss
Vertebral A - Cerebellar Syndrome
What would be the signs of a TIA in the Anterior Cerebral artery?
Weak/numb contralateral leg
What would be the signs of a TIA in the Middle Cerebral Artery?
weak/Numb contralateral side of body
Face drooping w/ forehead spared
Dysphasia
What would be the signs of a TIA in the Posterior Cerebral Artery?
Vision loss:
Contralateral homonymous hemianopia w/ macula sparing = occipital cortex affected.
What would be the signs of a TIA in the Vertebral Artery?
Cerebellar Syndrome: DANISH w/ +tve romberg test
What is Amaurosis Fugax?
a painless temporary loss of vision, usually in one eye
Due to occlusion/reduced blood flow to the retina through the ophthalmic, retinal or ciliary artery.
This is a bad sign as it often signals stroke is impending
What is the Primary investigation for a TIA?
Clinically made:
Usually TIA/Stroke is obvious
FAST campaign
ABCD^2
What is the FAST acronym?
FACE
ARMS
SPEECH
TIME
What is the ABCD^2 scoring system for TIA/Stroke?
No longer recommended by NICE
Age >60
BP >140/90
Clinical Sx
Duration 1hr +2 / <1hr
DM - Type 2
How can you distinguish between a TIA and a Stroke?
You cant until after recovery
TIA Sx resolve usually within/<24 hours
Stroke Sx last more than 24 hours
What is the management of a TIA?
Aspirin 300mg
Start secondary prevention of CVD:
Clopidogrel 75mg
Atorvastatin 80mg
What are the main complications of a TIA?
Increased risk of stroke
Increased risk of underlying CVD
What are the two types of stroke?
Ischaemic (85% of cases)
Haemorrhagic (15% of cases)
Define a stroke?
Focal neurological deficit that lasts for more than 24 hrs due to infarction
What is an Ischaemic Stroke?
Reduction in cerebral blood flow due to arterial occlusion or stenosis. Typically divided into thrombotic, embolic, and lacunar
What is a Haemorrhagic Stroke?
Ruptured blood vessel leading to reduced blood flow to the brain
What are the subtypes of haemorrhagic stroke?
Intracerebral: bleeding within the brain parenchyma
Subarachnoid: bleeding into the subarachnoid space
Intraventricular: bleeding within the ventricles; prematurity is a very strong risk factor in infants