Neurology COPY 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 with complete clinical recovery secondary to ischaemia without infarction.
Sx Last <24 hrs
Caused by Reduced blood flow, ischaemia, embolism or disease of blood vessels or blood.
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 is the epidemiology of a TIA?
15% of first strokes are preceded by TIA
M > F
Black ethnicity is at greater risk due to their hypertension and atherosclerosis predisposition
20, 000 people have a TIA
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 + embolism from carotid
Shock
Vasculitis
Hyper viscosity - polycythaemia, sickle cell, myeloma
What artery is commonly the route of a TIA?
90% = ICA
10% = Vertebral
What are the Clinical features of a TIA?
Depends on the site of the TIA:
- Sudden Loss of function with complete recovery
- Stroke Sx - Slurred Speech Facial Droop
- 90% of TIAs affect anterior circulation (ICA)
- 10% affect Posterior Circulation (vertebral Arteries)
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
Dysdiadokinesia
Ataxia
Nystagmus
Intention tremor
Slurred staccato speech
Hypotonia
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. (often due to emboli)
This is a bad sign as it often signals stroke is impending
What is the Primary investigation for a TIA?
Diagnosis is Clinically made: Usually TIA/Stroke is obvious
ABCD^2 assessment
FAST test
MRI - First line for confirmation
Carotid Doppler - Look for Stenosis
CT angiography - Look for Stenosis
ECG
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 - Unilateral Weakness (+2). Speech Disturbance w/o weakness (+1)
Duration >1hr (+2) / <1hr (+1)
DM - Type 2
What would be a high or low risk score following ACBD^2 assessment for TIA/stroke?
High risk:
ABCD2 score of 4 or more
AF
More than TIA in one week
TIA whilst on anti-coagulation
Low risk:
None of the above
Present more than a week after their last symptoms have resolved
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 High and low Risk TIA?
Lower RFs - stop smoking, reduce alcohol, exercise and diet
Immediate Aspirin 300mg
Start secondary prevention of CVD:
Clopidogrel 75mg
Atorvastatin 80mg
Treat BP - Ramipril
High Risk - Refer for specialist assessment within 24 hours of onset of symptoms
Low Risk - Refer for specialist assessment within 7 days of onset of symptoms
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?
Rapid onset neurological deficits caused by focal, cerebral, spinal or retinal infarction lasting more than 24 hrs
What is the epidemiology of a stroke?
1.2 million people living with stroke in the UK
110, 000 people have a first or recurrent stroke per year
Uncommon in those under 40
More common in males than females
Incidence is falling due to more vigorous approach to risk factors in primary care e.g. statin use and BP control